Current Issue http://www.cjn.org.cn EN-US http://www.cjn.org.cn/EN/current.shtml http://www.cjn.org.cn 5 Objective To analyze the status of anemia at the beginning of dialysis in maintenance hemodialysis (MHD) adult patients, and to explore the relationship between early dialysis anemia and early survival and long-term survival. Methods It was a retrospective cohort study. The baseline demographic and clinical data of newly admitted MHD patients from January 1, 2013 to December 31, 2020 were retrospectively analyzed. According to the hemoglobin (Hb) level at the beginning of dialysis, the patients were divided into high Hb group (Hb鈮�110 g/L), middle Hb group (80 g/L鈮b<110 g/L) and low Hb group (Hb<80 g/L). The baseline data among the three groups were compared, and the changing trend of Hb level in MHD patients during the 8 years was analyzed. The follow-up ended at peritoneal dialysis, kidney transplantation, death or on December 31, 2021. All-cause death event within 6 months after the initiation of dialysis was defined as early death, while all-cause death event more than 6 months after the initiation of dialysis was defined as long-term death. Kaplan-Meier survival curve was used to analyze the survival rate, and log-rank test was used to compare the survival rates among the three groups. Multivariate Cox regression analysis model was used to analyze the association between anemia (Hb<110 g/L) at the beginning of dialysis and both early and long-term mortality. Results A total of 36 216 MHD patients were included in this study, with age of (61.3卤15.5) years old and 22 163 males (61.20%). The Hb at the beginning of dialysis was (89.33卤20.89) g/L. The compliance rate of Hb (鈮�110 g/L) was 16.43% (5 952/36 216). There were 12 232 patients (33.78%), 18 032 patients (49.79%), and 5 952 patients (16.43%) in low Hb group, middle Hb group, and high Hb group, respectively. There were statistically significant differences in gender distribution, age, serum creatinine, blood phosphorus, blood calcium, C-reactive protein, intact parathyroid hormone, blood leukocytes, platelets, serum albumin, triglyceride, total cholesterol, and proportions of chronic glomerulonephritis, diabetic nephropathy, diabetes mellitus, cardiovascular and cerebrovascular diseases, tumors, emporary catheter, long-term catheter and autologous arteriovenous fistula among the three groups (all P<0.05). During the 8-year period, the Hb level had an increased trend steadily each year, and Hb was (88.48卤22.07) g/L, (88.52卤21.43) g/L, (87.86卤21.29) g/L, (88.93卤20.69) g/L, (88.87卤20.69) g/L, (90.03卤20.47) g/L, (90.74卤20.31) g/L and (90.31卤20.54) g/L year by year. There were 2 176 early deaths (6.01%), and 6 557 long-term deaths (18.10%) by the end of follow-up. Kaplan-Meier survival curve showed that early survival rate of low Hb group was significantly lower than those of high Hb group (log-rank test, 蠂²=57.115, P<0.001) and middle Hb group (log-rank test, 蠂²=49.918, P<0.001), and long-term survival rates of low Hb group (log-rank test, 蠂²=107.097, P<0.001) and middle Hb group (log-rank test, 蠂²=47.430, P<0.001) were significantly lower than that of high Hb group. Multivariate Cox regression analysis showed that Hb<80 g/L at the beginning of dialysis was an independent influencing factor of early death (Hb 鈮�110 g/L as a reference, HR=1.307, 95% CI 1.096-1.559), and 80 g/L鈮b<110 g/L and Hb<80 g/L at the beginning of dialysis were the independent influencing factors of long-term death (Hb鈮�110 g/L as a reference, HR=1.108, 95% CI 1.021-1.203; HR=1.228, 95% CI 1.127-1.339, respectively) in MHD patients. Conclusions The compliance rate of Hb at the beginning of dialysis in MHD patients is low. Hb <80 g/L at the beginning of dialysis is an independent risk factor of early death, and Hb <110 g/L at the beginning of dialysis is an independent risk factor of long-term death in MHD patients.

]]> Objective To investigate the influencing factors of cardiac autonomic dysfunction in maintenance hemodialysis (MHD) patients by recording 48 h heart rate variability. Methods It was a single-center cross-sectional study. MHD patients at the Hemodialysis Center of Peking University People's Hospital between October 1, 2021 and December 31, 2022 were enrolled in the study. These patients initiated hemodialysis for more than three months and were older than 18 years old, and patients with tachyarrhythmia, implanted cardiac pacemaker and the recording time less than 48 h were excluded. Demographic data, comorbidity, laboratory data, hemodialysis session data and heart rate variability were collected. Multivariate linear regression model was used to analyze the influencing factors for cardiac autonomic dysfunction in MHD patients. Results A total of 110 patients were enrolled in the study, including 37 females (33.6%) and 36 diabetic patients (32.7%). The age of the patients was (57.8卤14.8) years old, and the median dialysis vintage was 73.00(27.75卤130.25) months. At baseline, the serum phosphate level was (1.6卤0.4) mmol/L, and the N-terminal pro B-type natriuretic peptide (NT-proBNP) after ln transformed {ln[NT?proBNP(ng/L)]} was 8.4卤1.2. The standard deviation of all normal R-R interval (SDNN) was (90.6卤27.9) ms, ln[root mean square of successive differences in R-R interval (RMSSD, ms)] 3.2卤0.8, ln[low frequency (ms²)] 3.4卤1.3, ln[high frequency (ms²)] 3.1卤1.4, and ln[low frequency/high frequency ratio] 0.28卤0.64. After adjusting the age, coronary heart disease, diabetes, hemoglobin, serum phosphate and 25-hydroxy-vitamin D, serum natrium (尾=2.042, 95% CI 0.021鈥�4.064, P=0.048) and ln[NT-proBNP (ng/L)] (尾=-7.027, 95% CI -12.247鈥�-1.808, P=0.009) were independently correlated with SDNN (adjusted R²=0.218). Univariate linear regression model showed that diabetes was correlated with ln[low frequency(ms²)] of MHD patients (尾=-0.659, 95% CI -1.171鈥�-0.146, P=0.012), but in the multivariate linear regression model, significant correlation between diabetes and low frequency was not found. After adjusting the diabetes, coronary heart disease, dialysis vintage, hemoglobin, serum phosphate, serum albumin, pre-dialysis systolic blood pressure, post-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, increasing age (尾=-0.011, 95% CI -0.019鈥�-0.003, P=0.007) and ln[NT-proBNP(ng/L)] (尾=-0.151, 95% CI -0.253鈥�-0.048, P=0.004) were independently correlated with a decrease in the ln[low frequency/high frequency ratio]. In the multivariate linear regression model with ln[high frequency(ms²)] or ln[RMSSD(ms)] as dependent variable, after adjusting the relevant factors, serum phosphate level was independently correlated with ln[RMSSD(ms)] (尾=-0.421, 95% CI -0.777鈥�-0.065, P=0.021) or ln[high frequency(ms²)] (尾=-0.752, 95% CI -1.325鈥�-0.180, P=0.010). Conclusions Hyperphosphatemia is an independent influencing factor of parasympathetic nervous system in MHD patients. Higher NT-proBNP is associated with lower SDNN and lower ratio of low frequency/high frequency, so serum phosphate control and volume control should be highlighted. Age is associated with autonomic dysfunction in MHD patients, so more attention should be paid to elder patients.

]]> Objective To investigate the relationship between intramuscular adipose tissue index (IATI) calculated from computed tomography images at transverse process of the first lumbar and all-cause mortality in maintenance dialysis patients, and to provide a reference for improving the prognosis in these patients. Methods It was a multicenter retrospective cohort study. The clinical data of patients who received maintenance hemodialysis or peritoneal dialysis treatment from January 1, 2017 to December 31, 2019 in 4 grade 鈪� hospitals including Zhongda Hospital Affiliated to Southeast University, Taizhou People's Hospital Affiliated to Nanjing Medical University, Affiliated Hospital of Yangzhou University, and the Third Affiliated Hospital of Soochow University were retrospectively collected. IATI was calculated by low attenuation muscle (LAM) density/skeletal muscle density. The receiver-operating characteristic curve was used to determine the optimal cut-off value of IATI, and the patients were divided into high IATI group and low IATI group according to the optimal cut-off value. The differences of baseline clinical data and measurement parameters of the first lumbar level between the two groups were compared. The follow-up ended on December 23, 2022. The endpoint event was defined as all-cause mortality within 3 years. Kaplan-Meier survival curve and log-rank test were used to analyze the survival rates and the differences between the two groups. Multivariate Cox regression analysis models were used to analyze the association between IATI and the risk of all-cause mortality in maintenance dialysis patients. Multivariate logistic regression analysis model was used to analyze the influencing factors of high IATI. Results A total of 478 patients were eligibly recruited in this study, with age of (53.55卤13.19) years old and 319 (66.7%) males, including 365 (76.4%) hemodialysis patients and 113 (23.6%) peritoneal dialysis patients. There were 376 (78.7%) patients in low IATI (<0.42) group and 102 (21.3%) patients in high IATI (鈮�0.42) group. The proportion of age 鈮� 60 years old (蠂²=24.746, P<0.001), proportion of diabetes mellitus (蠂²=5.570, P=0.018), fasting blood glucose (t=-2.145, P=0.032), LAM density (t=-3.735, P<0.001), LAM index (t=-7.072, P<0.001), and LAM area/skeletal muscle area ratio (Z=-9.630, P<0.001) in high IATI group were all higher than those in low IATI group, while proportion of males (蠂²=11.116, P<0.001), serum albumin (Z=2.708, P=0.007) and skeletal muscle density (t=12.380, P<0.001) were lower than those in low IATI group. Kaplan-Meier survival analysis showed that the 3-years overall survival rate of low IATI group was significantly higher than that in high IATI group (Log-rank 蠂²=19.188, P<0.001). Multivariate Cox regression analysis showed that IATI<0.42 [<0.42/鈮�0.42, HR(95% CI): 0.50 (0.31-0.83), P=0.007] was an independent protective factor of all-cause mortality, and age 鈮�60 years old [HR (95% CI): 2.61 (1.60-4.23), P<0.001], diabetes mellitus [HR (95% CI): 1.71 (1.06-2.78), P=0.029] and high blood neutrophil/lymphocyte ratio [HR (95% CI): 1.04 (1.00-1.07), P=0.049] were the independent risk factors of all-cause mortality in maintenance dialysis patients. Stepwise Cox regression analysis showed that IATI<0.42 was still an independent protective factor of all-cause mortality in maintenance dialysis patients [<0.42/鈮�0.42, HR (95% CI): 0.45 (0.27-0.76), P=0.003]. Multivariate logistic regression analysis showed that low skeletal muscle density [OR (95% CI): 0.84 (0.81-0.88), P<0.001] and high serum triglyceride [OR (95% CI): 1.39 (1.07-1.82), P=0.015] were the independent influencing factors of IATI鈮�0.42. Conclusion IATI<0.42 of the first lumbar level is an independent protective factor of all-cause mortality in maintenance dialysis patients. Localized myosteatosis within high-quality skeletal muscle may reduce the risk of all-cause mortality in these patients.

]]> Objective To explore the influencing factors of hemodialysis (HD) initiation in non-diabetic kidney disease (NDKD) patients with predialysis arteriovenous fistula (AVF) creation. Methods This was a single-center prospective cohort study. The NDKD patients undergoing predialysis AVF creation were enrolled at the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2018. According to the estimated glomerular filtration rate (eGFR, the Chronic Kidney Disease Epidemiology Collaboration equation) and age, patients were divided into different subgroups, eGFR: group 1 [eGFR<10 ml路min^-1路(1.73 m²)^-1], group 2 [ eGFR between 10 to 15 ml路min^-1路(1.73 m²)^-1], and group 3 [eGFR > 15 ml路min^-1路(1.73 m²)^-1]; age: age 鈮�65 years group and age <65 years group. The primary outcome was defined as the initiation of HD within 1 year after AVF surgery. The second outcome was the use of AVF access at the time of HD initiation. Cox proportional hazard regression was performed to identify which demographic and clinical factors were associated with the initiation of HD after AVF surgery. Logistic regression analysis was performed to investigate factors associated with AVF use at the initiation of HD. Results A total of 220 patients were enrolled, with age of (48.1卤16.2) years, of which 143(65.0%) were males. Overall, the clinical parameters of eGFR, cystatin C, serum albumin, 24h-Urine protein, serum phosphorus were as follows respectively, 7.7 (6.6,9.2) ml路min^-1路(1.73 m²)^-1, (3.93卤1.12) mg/L, (36.0卤4.0) g/L, (2.22卤1.36) g, (1.71卤0.53) mmol/L. The proportion of patients initiating HD within 6 months (Fisher=6.832, P=0.020) and the level of hemoglobin (F=3.112, P=0.047) were higher in group 3 compared to the other two eGFR groups. While the median time interval between AVF creation and HD initiation (H=6.295, P=0.043) was shorter in group 1. In age <65 years group, the level of serum albumin (t=2.076, P=0.039), triglyceride (t=1.995, P=0.048) were higher compared with age 鈮�65 years group; interestingly, the proportion of patients initiated HD within 3 months (蠂2=4.033, P=0.045) and 6 months (蠂2=5.012, P=0.025) were lower in age <65 years group. The median time interval between AVF creation and HD initiation among these patients was 84 (49,174) days. The patients initiating HD within 3 months, 6 months, and 1 year after AVF creation were 112 (50.9%), 152 (69.1%), and 202 (91.8%), respectively. Multivariate Cox regression analysis indicated that higher cystatin C level (HR=1.283, 95% CI 1.121-1.469, P<0.001) was associated with earlier HD initiation within 1 year of AVF surgery in NDKD patients. AVF usage was accomplished in 64.3% of patients who initiated HD within 90 days, the ratio was 100.0% in those initiated HD between 91 to 180 days, and 88.0% in those 鈮�181 days after AVF surgery. No factor was independently associated with AVF use at HD initiation identified by multivariate logistic regression analyses in patients with NDKD. Conclusion Serum cystatin C level is associated with HD initiation within 1 year of the predialysis AVF creation in NDKD patients.

]]> Objective To investigate the effectiveness and safety of ultrasound-guided endovascular therapy for autogenous arteriovenous fistula (AVF) thrombosis. Methods It was a single-center retrospective cohort study. Data of patients undergoing ultrasound-guided intravascular therapy due to AVF thrombosis in the First Hospital of Hebei Medical University from August 2018 to June 2021 were analyzed. According to different surgical procedures, the patients were divided into two groups. Patients treated with percutaneous transluminal angioplasty (PTA) + drilling thrombectomy were in group A, and patients treated with PTA only were in group B. After 1 year of follow-up, the surgical technique success rate, primary patency rate, secondary patency rate and complications were compared between the two groups. Results A total of 152 patients were enrolled, including 74 in group A and 78 in group B. There were no significant differences in gender, age, proportion of patients with diabetes and hypertension, and thrombosis time of AVF between the two groups (all P>0.05). Compared with group B, the diameter and length of thrombus in group A were larger [13.0(9.0, 16.0) mm vs. 6.0(5.0, 6.5) mm, Z=-9.362, P<0.001; 12(8, 15) cm vs. 3(3, 4) cm, Z=-10.061, P<0.001], and the establishment time of AVF was longer [5(2, 7) years vs. 2(1, 5) years, Z=-2.698, P=0.007]. Among the overall patients, the success rate of surgery was 96.7% (147/152), and the success rate of surgery was 95.9% (71/74) in group A and 97.4% (76/78) in group B respectively, with no statistical difference (蠂²=0.004, P=0.952). Kaplan?Meier survival analysis showed that, overall, the primary patency rate at 3rd, 6th and 12th month after operation was 87.1%, 71.4% and 56.6%, and the secondary patency rate was 97.1%, 96.4% and 94.1%, respectively. The primary patency rate of group A at 3rd, 6th and 12th month was 82.4%, 66.7% and 53.6%, and the secondary patency rate was 95.7%, 94.2% and 89.7%, respectively. The primary patency rate of group B at 3rd, 6th and 12th month was 91.5%, 73.2% and 59.7%, and the secondary patency rate was 98.6%, 98.6% and 98.5%, respectively. There was no significant difference in the primary and secondary patency rate between group A and group B at 3rd, 6th and 12th month (all P>0.05). The duration of operation in group A was longer than that in group B [2.0(1.9, 2.0) h vs. 2.0(1.0, 2.0) h, Z=-5.181, P<0.001], but no serious complications occurred in both groups. Conclusion The two surgical methods are effective, safe and reliable in the treatment of AVF thrombosis, and have high clinical application value.

]]> Objective To investigate the clinical features of patients with maintenance hemodialysis (MHD) infected with SARS-CoV-2 and analyze the risk factors of death after SARS-CoV-2 infection, and to provide clinical data for early detection of critically ill patients and timely intervention. Methods It was a cross-sectional investigation study. MHD patients in the hemodialysis centers of four tertiary hospitals with geographical representation in Shanxi province from December 1, 2022 to January 31, 2023 were enrolled, and the demographic data, dialysis-related indicators, laboratory test results and clinical features of SARS-CoV-2 infection were collected by distributing the questionnaires on SARS-CoV-2 infection, and consulting the hospital medical record system and the outpatient hemodialysis information system. SARS-CoV-2-infected patients were divided into survival group and death group according to whether all-cause death occurred and the differences of baseline data between the two groups were compared. Multivariate logistic regression analysis method was used to analyze the risk factors of mortality in MHD patients infected with SARS-CoV-2. Results A total of 519 MHD patients were included in this study, with 508 patients (97.88%) infected with SARS-CoV-2, 474 patients in the survival group and 34 patients in the death group. The clinical symptoms of MHD patients infected with SARS-CoV-2 were diverse, and the most common initial symptom was fever (314/508, 61.81%). Other initial symptoms included cough and phlegm in 66 patients (12.99%), fatigue in 66 patients (12.99%), poor appetite in 20 patients (3.94%), dyspnea in 20 patients (3.94%), muscle pain in 14 patients (2.76%) and diarrhea in 8 patients (1.57%). Compared with the survival group, the death group had older age (t=5.229, P<0.001), high proportions of males (蠂²=12.319, P<0.001) and diabetic nephropathy (蠂²=49.423, P<0.001), and lower levels of red blood cells (t=-5.060, P<0.001), lymphocyte (t=-2.614, P=0.011), neutrophil (t=-5.117, P<0.001), serum albumin (t=-2.940, P=0.012), serum prealbumin (t=-3.519, P=0.001), blood phosphorus (t=-3.309, P=0.002), serum creatinine (Z=-3.607, P<0.001), total triglyceride (Z=-2.486, P=0.013), total cholesterol (Z=-3.291, P=0.001) and low-density lipoprotein cholesterol (Z=-3.292, P=0.001). Among 508 SARS-CoV-2-infected patients, 194 patients (38.19%) were treated with nonsteroidal anti-inflammatory agents, 154 patients (30.31%) were treated with antibiotics, and 98 patients (19.29%) were treated with antiviral drugs. There were 225 (43.29%) vaccinated patients against SARS-CoV-2. Multivariate logistic regression analysis showed that low red blood cells (OR=0.256, 95% CI 0.014-0.429), low lymphocytes (OR=0.487, 95% CI 0.193-0.826), low serum albumin (OR=0.613, 95% CI 0.329-0.917), older age (OR=1.227, 95% CI 1.066-1.412) and diabetes mellitus (OR=1.126, 95% CI 1.025-1.235) were the independent influencing factors of all-cause mortality in MHD patients infected with SARS-CoV-2. Conclusions The clinical manifestations of SARS-CoV-2 infection in MHD patients are varied. Low red blood cells, low lymphocytes, low serum albumin, elder age and diabetes mellitus are the independent risk factors of death after SARS-CoV-2 infection in MHD patients. Strengthening management of MHD patients especially in the elderly, and improving and correcting anemia and malnutrition in time, may reduce the death risk of SARS-CoV-2 infection in MHD patients.

]]> Objective To explore the construction of abdominal aortocaval fistula (ACF) model in adenine-induced renal failure rats, and to provide a suitable animal model for subsequent mechanism and intervention researches. Methods Adult female Sprague-Dawley rats (250-300 g) were fed with 0.75% adenine diet (renal failure group, n=60) and the same diet without adenine (control group, n=10) for 4 weeks, and the rats were randomly grouped by block randomization method with a ratio of 6鈭�1. Thirty rats in the renal failure group were randomly selected by block randomization method at a ratio of 1鈭�1 to undergo laparotomies to establish ACF models (renal failure+ACF group). The serum creatinine, blood urea nitrogen detection and Masson staining were used to evaluate the establishment of renal failure model. Small animal ultrasound imaging system was applied to verify the successful construction of the ACF model. After 6 weeks of ACF observation, blood samples were collected from the heart of rats, and ACF-vascular tissues were collected for pathological study (HE staining). Results At 4 weeks of feeding, compared with the control group, serum creatinine [(63.8卤23.5) 渭mol/L vs. (33.0卤3.8) 渭mol/L, Z=3.651, P<0.001] and blood urea nitrogen [(13.1卤6.9) mmol/L vs. (5.3卤0.6) mmol/L, Z=3.254, P=0.001] in the renal failure group were both higher. Masson staining showed renal tubulointerstitial inflammatory cell infiltration, renal tubular epithelial cell atrophy, interstitial fibrosis and vascular injury. Five rats sacrificed after ACF surgeries, and the survival rate was 83.3%. Doppler ultrasound showed turbulent blood flow of arterial to venous shunt at the anastomosis of open ACF (23/25) in the renal failure+ACF group. HE staining showed typical eccentric neointimal hyperplasia in the outflow tract of ACF vein in the renal failure+ACF group. Conclusions The adenine-induced ACF rat model is successfully constructed, and ACF shows typical eccentric neointimal hyperplasia. The ACF construction would provide a reliable animal model to study the mechanism and intervention of neointimal hyperplasia for autologous arteriovenous fistula.

]]> Chronic active Epstein-Barr virus (CAEBV) infection with renal involvement is not common. The paper reported a child of multisystem-compromised CAEBV infection with the onset of IgA nephropathy (IgAN). The child presented with intermittent gross hematuria, and renal biopsy showed focal proliferative IgAN, administered methylprednisolone pulse followed by oral prednisolone treatment. Intermittent increase of blood Epstein-Barr virus (EBV) load and abnormal EBV antibody, pneumonia caused by EBV and Staphylococcus aureus-mixed infection, periappendiceal abscess, and pancytopenia occurred during treatment follow-up. The CAEBV infection was considered. Echocardiography suggested pulmonary hypertension. Head CT presented multiple calcifications in the bilateral basal ganglia. Bone marrow biopsy showed bone marrow EBV-DNA 6.5脳10³ copies per liter. Immunohistochemistry of renal biopsy showed about 50 CD8⁺ (scattered +) cells per high power field (HPF), about 40 CD4⁺ (focal +) cells per HPF (local), CD68⁺ (-), latent membrane protein 1 (-), EBV-encoded small RNA (scattered +) approximately 25 cells per HPF. The lymphocyte subsets infected with EBV showed CD4⁺ T cells EBV-DNA 3.4脳10⁴ copies per 1 million cells, CD8⁺ T cells EBV-DNA 3.3脳10⁵ copies per 1 million cells, B cells EBV-DNA 1.25脳10⁴ copies per 1 million cells, NK cells/NK T cells EBV-DNA 2.3脳10⁴ copies per 1 million cells. The clinical diagnosis was CAEBV infection and EBV-associated IgAN. The patient currently receives oral prednisone treatment, and it is recommended to undergo hematopoietic stem cell transplantation and treatment is under follow up.

]]> D-dimer is a fibrin degradation product. The increased D-dimer indicates hypercoagulability and secondary hyperfibrinolysis, which can be used as a biomarker for activation of coagulation and fibrinolysis system. D-dimer is routinely used in the diagnosis of thrombotic diseases. D-dimer level is affected by age, pregnancy, blood glucose, infection, liver failure, cancer and stroke. The increased D-dimer is closely related to kidney diseases. The paper reviews the formation mechanism and influencing factors of D-dimer, the relationship between D-dimer and kidney diseases, and the prognostic value of D-dimer in kidney diseases, to provide references for clinical diagnosis and treatment.

]]> Erythropoiesis-stimulating agents (ESAs) are commonly used drugs in the treatment of renal anemia. There are currently two types of ESAs available to clinicians, including short-acting ESAs and long-acting ESAs. Short-acting ESAs have been used for decades in China, which are being widely accepted nowadays. Several professional societies have published consensus guidelines for the use and interpretation of short-acting ESAs worldwide in recent years. The advantages of long-acting ESAs include long half-life, low infusion frequency, good patient compliance, etc. There is still a lack of guidance on the clinical use of long-acting ESAs although important progress of long-acting ESAs has been made in clinical trials in recent years. Thus, the Society of Nephrology & Dialysis of China Non-Government Medical Institutions Association organized relevant experts to jointly formulate the "Chinese Expert Consensus on Long-acting ESAs in the Treatment of Renal Anemia". This consensus mainly introduces the classification, mechanism of action and pharmacological characteristics of long-acting ESAs, their indications, timing, administration protocols, application in special populations, adverse reactions and management in renal anemia. It is the hope of this concensus will guide the clinical use of long-acting ESAs in the treatment of renal anemia.

]]> Continuous renal replacement therapy (CRRT) is an important treatment for critically ill patients. Critically ill patients often need to receive antimicrobials and CRRT treatments at the same time. CRRT affects the pharmacokinetics and pharmacodynamics of antimicrobials, and there is a lack of recommendations and suggestions for the antimicrobial dosing during CRRT. The clinical medicine, pharmacy, intensive care and infectious diseases specialists in China set up an expert group on antimicrobial dosing optimization during CRRT, conducted evidence search around CRRT factors, drug characteristics, patient factors and antimicrobial dosing optimization during CRRT, and fully discussed and formulated the consensus, to provide guiding advices on the rational use of antimicrobials during CRRT.

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