Effect of Cinacalcet Combined With Sevelamer Hydrochloride on the Incidence of Urolithiasis in Maintenance Hemodialysis Patients With Diabetic Kidney Disease.

目的探究司维拉姆（sevelamer, SL）与醋酸钙（calcium acetate, CA）治疗终末期肾病（end-stage renal disease, ESRD）维持性血液透析（maintenance hemodialysis, MHD）患者高磷血症的治疗效果及对钙磷代谢、外周血胎球蛋白A（fetuin A）、成纤维细胞生长因子-23（fibroblast growth factor-23, FGF-23）水平的影响。方法选取2022年1月–2023年12月于淄博市第一医院收治的92例ESRD患者，依据随机数字表法分为CA组和SL组，每组各46例，两组均实施维持性血液透析治疗及常规治疗，CA组在此基础上加以醋酸钙治疗，SL组在常规治疗基础上加以司维拉姆治疗，持续治疗3个月。比较两组患者主要结局指标：临床疗效；次要结局指标：钙磷代谢指标〔血钙、血磷、钙磷乘积、甲状旁腺激素（intact parathyroid hormone，iPTH）〕及冠状动脉钙化积分（coronary artery calcification score, CACs）水平、血清生化指标〔fetuin A、FGF-23、C-反应蛋白（C-reactive protein, CRP）〕及治疗期间不良反应情况、心血管事件发生率。结果两组基线资料比较差异均无统计学意义（P>0.05）；SL组、CA组临床疗效比较差异具有统计学意义（P<0.05）；两组治疗前后血钙、血磷、钙磷乘积、iPTH、CACs差值比较，差异具有统计学意义（P<0.05）；两组治疗前后fetuin A、FGF-23、CRP差值比较，差异具有统计学意义（P<0.05）；治疗期间，组间不良反应发生率、心血管事件发生率比较无差异（P>0.05）。结论司维拉姆在治疗MHD患者高磷血症的疗效优于CA，可有效调节机体钙磷代谢、降低CACs、调节外周血fetuin A、FGF-23水平，不良反应少，值得临床应用。

Increased inflammation and oxidative stress may be caused by proteins and lipids modified by cytotoxic advanced glycation end products (AGEs) in food. Restricting food containing elevated AGEs improves these risk factors in diabetic CKD. Because diet adherence can be problematic, this study aimed to remove cytotoxic AGEs from food already ingested and to determine whether sevelamer carbonate sequesters cytotoxic AGEs in the gut, preventing their uptake and thereby reducing AGE-induced abnormalities. This single-center, randomized, 2-month, open-label, intention-to-treat, crossover study compared sevelamer carbonate with calcium carbonate treatment in stage 2-4 diabetic CKD. Participants received 2 months of treatment with one drug, had a 1-week washout, and then received the opposite drug for 2 months. Sevelamer carbonate reduced HbA1c, serum methylglyoxal, serum (ε)N-carboxymethyl-lysine, triglycerides, and 8-isoprostanes. Total cholesterol and fibroblast growth factor 23 were reduced by sevelamer carbonate, relative to calcium carbonate. AGE receptor 1 and sirtuin 1 mRNA were increased and PMNC TNFα levels were decreased by sevelamer carbonate, but not calcium carbonate. Medications and caloric and AGE intake remained unchanged. Sevelamer carbonate reversibly bound AGE-BSA at intestinal, but not stomach, pH. Sevelamer carbonate significantly reduces HbA1c, fibroblast growth factor 23, lipids, and markers of inflammation and oxidative stress, and markedly increases antioxidant markers, independently of phosphorus in patients with diabetes and early kidney disease. These novel actions of sevelamer carbonate on metabolic and inflammatory abnormalities in type 2 diabetes mellitus may affect progression of early diabetic CKD.

Introduction: Regular dialysis, is not able to maintain phosphorus in the normal range. Therefore, using phosphate chelators to keep serum level of phosphorus in the normal range is essential. Sevelamer is a chelator for phosphate. Objectives: The purpose of this investigation was to compare the therapeutic impact of sevelamer carbonate versus sevelamer hydrochloride on electrolytes and metabolic acidosis and gastrointestinal symptoms in a group of hemodialysis patients. Patients and Methods: In this randomized clinical trial, patients were divided into two treatment groups; sevelamer carbonate and sevelamer hydrochloride. Sevelamer carbonate and sevelamer hydrochloride were prescribed as daily 800 mg tablets three times daily with their meals. Patients were evaluated for serum calcium, phosphorus, plasma bicarbonate and pH levels after one month. Results: Around 44 patients were enrolled, of which 22 patients were treated with sevelamer hydrochloride and 22 patients in the intervention group with sevelamer carbonate. There was no significant difference between the effects of sevelamer carbonate and sevelamer hydrochloride on serum calcium and phosphorus levels at the end of the study (P&gt;0.05). There was a significant difference between the effects of sevelamer carbonate versus sevelamer hydrochloride on plasma bicarbonate and pH levels (P=0.036 and P=0.012 respectively). In terms of gastrointestinal complications, two drugs did not differ significantly. Conclusion: To prevent acidosis, along with increasing plasma bicarbonate and blood pH in patients undergoing hemodialysis, sevelamer carbonate is better than sevelamer hydrochloride. Therefore, the administration of sevelamer hydrochloride is preferable. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT20141016019554N13, https:// en.irct.ir/trial/28916, ethical code#IR.ZUMS.REC.1397.352).

The primary goals were to re-examine whether sevelamer carbonate (SC) reduces advanced glycation end products (AGEs) (methylglyoxal and carboxymethyllysine [CML]), increases antioxidant defenses, reduces pro-oxidants, and improves hemoglobin A1c (HbA1c) in patients with type 2 diabetes mellitus (T2DM) and diabetic kidney disease (DKD). Secondary goals examined albuminuria, age, race, sex, and metformin prescription. This two-center, randomized, intention-to-treat, open-label study evaluated 117 patients with T2DM (HbA1c >6.5%) and stages 2-4 DKD (urinary albumin/creatinine ratio ≥200 mg/g) treated with SC (1600 mg) or calcium carbonate (1200 mg), three times a day, without changing medications or diet. Statistical analyses used linear mixed models adjusted for randomization levels. Preselected subgroup analyses of sex, race, age, and metformin were conducted. SC lowered serum methylglyoxal (95% confidence interval [CI], -0.72 to -0.29; P<0.001), serum CML (95% CI, -5.08 to -1.35; P≤0.001), and intracellular CML (95% CI, -1.63 to -0.28; P=0.01). SC increased anti-inflammatory defenses, including nuclear factor like-2 (95% CI, 0.58 to 1.29; P=0.001), AGE receptor 1 (95% CI, 0.23 to 0.96; P=0.001), NAD-dependent deacetylase sirtuin-1 (95% CI, 0.20 to 0.86; P=0.002), and estrogen receptor α (95% CI, 1.38 to 2.73; P ≤0.001). SC also decreased proinflammatory factors such as TNF receptor 1 (95% CI, -1.56 to -0.72; P≤0.001) and the receptor for AGEs (95% CI, -0.58 to 1.53; P≤0.001). There were no differences in HbA1c, GFR, or albuminuria in the overall group. Subanalyses showed that SC lowered HbA1c in women (95% CI, -1.71 to -0.27; P=0.01, interaction P=0.002), and reduced albuminuria in those aged <65 years (95% CI, -1.15 to -0.07; P=0.03, interaction P=0.02) and non-Caucasians (95% CI, -1.11 to -0.22; P=0.003, interaction P≤0.001), whereas albuminuria increased after SC and calcium carbonate in Caucasians. SC reduced circulating and cellular AGEs, increased antioxidants, and decreased pro-oxidants, but did not change HbA1c or the albumin/creatinine ratio overall in patients with T2DM and DKD. Because subanalyses revealed that SC may reduce HbA1c and albuminuria in some patients with T2DM with DKD, further studies may be warranted.

Background and Aims Hyperphosphatemia is common in advanced CKD and is associated with increased cardiovascular morbidity, bone mineral abnormalities and mortality. Most patients on MHD require phosphate binders to control hyperphosphatemia. Traditional phosphate binders, such as sevelamer carbonate, are often associated with high pill burdens and limited efficacy in achieving optimal serum phosphorus levels. SFO is a newer calcium-free, polynuclear iron (III) based oral phosphate binder which may offer higher potency with lower pill burden. Our study evaluated the efficacy of SFO in MHD patients who failed to achieve optimum phosphorus control despite maximum tolerated doses of Sevelamer along with usual standard of care (SOC). Method This prospective study was conducted in hyperphosphatemic MHD patients. Those patients (n = 32) who failed to achieve optimum Phosphorus control despite maximum tolerated doses of sevelamer carbonate (800 mg, 4–6 tablets daily) for three months were switched to SFO (500 mg chewable tablets). They received either once-daily (n = 12), twice-daily (n = 19), or thrice-daily (n = 1) doses for three months as per phosphorus control. Serum phosphorus levels were measured at initiation and after 3 months of Sevelamer and monthly thereafter for 3 months on SFO. Serum Phosphorus levels at initiation and at 3 months of SFO therapy were analysed for current study. Statistical analysis was performed using a paired t-test. Results Thirty-two patients (males = 17 &amp; females = 15) were analysed with a mean age of 61.5 years and a median dialysis vintage of 23 months. The mean serum Phosphorus level significantly reduced from 6.37 mg/dL to 5.07 mg/dL after 3 months of SFO therapy, with a mean change of 1.3 mg/dL (p = 0.03) (Fig. 1). There was no statistically significant difference in phosphorus level changes between males and females (p = 0.228). Importantly, the pill burden reduced from average of 3.8 to 2.2 tablets per day (p = 0.02). Sucroferric oxyhydroxide was well-tolerated, with no significant adverse events reported during the study period. Conclusion SFO demonstrated superior efficacy in reducing serum phosphorus levels in MHD patients who previously failed to achieve phosphorus control with sevelamer carbonate in tolerated doses. SFO offered a better phosphorus control (p = 0.03), numerically lower mean daily pill burden (p = 0.02), lower treatment cost and a better treatment adherence than sevelamer carbonate. These findings strongly support the use of SFO as first line hyperphosphatemic patients with advanced CKD to improve phosphorus control, patient longevity and Quality of life.

Sevelamer hydrochloride, as a phosphate binder that contains neither aluminum nor calcium, is expected to improve the prognosis of dialysis patients. However, sevelamer hydrochloride has been reported to lower the serum bicarbonate level. In the present study, we performed a retrospective study on the potential influences of sevelamer hydrochloride on metabolic acidosis in hemodialysis patients. The subjects were 72 patients who underwent hemodialysis at our hospital. Thirty-six patients taking sevelamer hydrochloride and 36 patients matched for sex, diabetes mellitus, age and duration of dialysis who were not taking sevelamer hydrochloride were studied. We assigned the 36 patients who had been taking sevelamer hydrochloride to the 'sevelamer group', and the 36 patients not taking sevelamer hydrochloride were the control group. Statistical significance was evaluated by a t-test and Pearson's correlation coefficient. In the sevelamer group, the mean levels of bicarbonate, base excess and pH decreased significantly after administration, compared with the values before administration, but in the control group, aggravation of acidosis was not seen. The levels of bicarbonate, base excess and pH after the medication of sevelamer hydrochloride were found to be significantly and negatively correlated with the daily dose of sevelamer hydrochloride. The levels were also found to be significantly and negatively correlated with the cumulative dose of sevelamer hydrochloride; however, the value of the mean levels of chlorine and the anion gap did not increase with sevelamer hydrochloride. Sevelamer hydrochloride caused metabolic acidosis in a dose-dependent manner in hemodialysis patients without hyperchloremia.

Influential Nutrient in Urolithiasis Incidence: Protein or Meat?

To clarify the association between regional variations in urolithiasis incidence and nutrition intake, we evaluated associated data from Japanese national surveys. The incidence of urolithiasis in 12 regions of Japan was calculated from 2005 patient data obtained from 430 hospitals (n=92,797). Nutrition intake data were obtained from the National Health and Nutrition Survey. We examined the association between urolithiasis incidence and average intake of various types of food or nutrients by region. Continuing surveys in Japan reveal fixed variations in urolithiasis incidence among geographic regions. The national average of patients with urolithiasis was estimated as 203.1 per 100,000 citizens. Regarding food, intake of fruit correlated negatively with the incidence of urolithiasis (r=-0.721, p=0.008), while intake of eggs (r=0.537, p=0.072) and sugar (r=0.475, p=0.119) tended to positively correlate with incidence. Regarding nutrients, intake of potassium (r=-0.500, p=0.098), vitamin K (r=-0.562, p=0.057), and pantothenic acid (r=-0.560, p=0.058) tended to negatively correlate with incidence. The incidence of urolithiasis is higher in geographic areas with populations having low fruit and high sugar intake.

Background It has been suggested that glycated hemoglobin (HbA1c) underestimate the actual glycemic control levels in maintenance hemodialysis (MHD) patients, because of anemia and the using of erythropoietin (EPO); it was recommended that glycated albumin (GA) should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbA1c in this research by referring to mean plasma glucose (MPG) in diabetes mellitus (DM) patients undergoing MHD or not. Methods MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbA1c, albumin (ALB), GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbA1c was done among the groups of MHD patients with DM (n=88) and without DM (NDM; n=90), and non-MHD ones with DM (n=102) using MPG for an actual glycemic control standard. Results In these 3 groups, only for DM patients' (whether undergoing MHD or not), GA and HbA1c correlated with MPG significantly (P &lt;0.01). Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts (2.418 vs. 2.329) and slopes (0.053 vs. 0.057) were very close to each other. On the contrary, regression curves of HbA1c did not coincide in the two groups, because variance of the slopes (0.036 vs. 0.052) were relatively large. Through comparing receiver operating characteristic (ROC) areas under the curve (AUC), it could be understood that the assessment performances of GA and HbA1c in MHD patients were lower than those in non-MHD ones, and assessment performance of HbA1c in MHD patients was better than GA (P &lt;0.05). In addition, the effects of Hb and EPO dose on HbA1c, or that of ALB on GA were unobvious in our study. Conclusions Actual glycemic control level in MHD patients with DM may be underestimated by HbA1c, and it could be avoided by GA; however, glycemic evaluating performance of HbA1c may be still better than that of GA. Therefore, HbA1c should not be replaced completely although GA can be used as a choice to monitor glycemic level.

The aim of the present study was to investigate the effects of the iron chelator deferiprone in diabetic nephropathy (DN) rats and the mechanisms involved. Thirty-two male Wistar rats (180-220 g, 6 weeks old) were randomly divided into a control group, a DN group and two DN groups treated with either 50 or 100 mg/kg per day deferiprone. The DN group was established by feeding of a high-carbohydrate-fat diet and injection of 35 mg/kg streptozotocin into the vena caudalis. The duration of deferiprone treatment was 20 weeks. Histopathological changes were detected by hematoxylin-eosin and Masson staining, as well as transmission electron microscopy. Levels of nuclear factor (NF)-κB, monocyte chemotactic protein (MCP)-1, matrix metalloproteinase (MMP)-9, tissue-specific inhibitor of metalloproteinase (TIMP)-1, cyclo-oxygenase (COX)-2, and nitrotyrosine were determined in kidney tissues using reverse transcription-polymerase chain reaction (RT-PCR), western blotting, and immunohistochemistry. Histopathological observations showed that deferiprone treatment alleviated inflammation infiltrates and collagenous fibrosis in DN rats. Results from RT-PCR and western blotting indicated that deferiprone inhibited the expression of NF-κB, MCP-1, COX-2, and nitrotyrosine, which were overexpressed in DN rats. Immunohistochemistry showed that the mechanism of deferiprone action may involve regulation of MMP-9 and TIMP-1. Decreased MMP-9 expression and increased TIMP-1 expression in DN rats were significantly promoted and inhibited by deferiprone, respectively. Iron chelation by oral deferiprone has a renoprotective effect in DN rats by relieving oxidative stress, inflammation, and fibrosis, which is related to the cytokines NF-κB, MCP-1, MMP-9, TIMP-1, COX-2, and nitrotyrosine.

The aim of this study was to examine the therapeutic effect of hypocalcemic stimulation caused by sevelamer hydrochloride (SH) administration on adynamic bone disease (ABD). The subjects were 28 maintenance hemodialysis (HD) patients who had remained in ABD state in spite of no administration of vitamin D(3) since HD induction (15 males and 13 females;12 diabetic patients and 16 non-diabetic patients). The mean age was 61.8+/-9.5 years and the mean HD duration was 5.5+/-3.9 years. The calcium concentration in the dialysate was 3.0 mEq/L. We made the final daily dose of SH after two months the same as the first daily dose of calcium carbonate (CC) in the following manner. At first we administered only CC at breakfast and lunch and SH at supper. And for the next two weeks we administered CC at breakfast and SH at lunch and supper. And for the final two weeks we administered only SH. After that we increased the dose of SH as much as possible. We evaluated the therapeutic effect of the above treatment on ABD using intact-osteocalcin (iOC) [Teijin. Tokyo] as a marker before and 6, 12 months after the beginning of the replacement. If iOC Ievel of 30 to 70 ng/mL showed normal tumover bone (NTB), 5 cases (17.9%) changed into NTB in 6 months. 9 cases (32.1%) changed into NTB in 12 months and one case (3.6%) changed into ostitis fibrosa in 12 months. It is thought that SH is effective for the treatment of ABD but we have to be careful for ostitis fibrosa.

Editorial

This study aims to explore the mechanism through which Yishen Jiangtang Decoction(YSJTD) regulates endoplasmic reticulum stress(ERS)-mediated NOD-like receptor thermal protein domain associated protein 3(NLRP3) inflammasome to improve diabetic nephropathy(DN) in db/db mice. Thirty db/db mice were randomly divided into the model group, YSJTD group, ERS inhibitor 4-phenylbutyric acid(4-PBA) group, with 10 mice in each group. Additionally, 10 db/m mice were selected as the control group. The YSJTD group was orally administered YSJTD at a dose of 0.01 mL·g~(-1), the 4-PBA group was orally administered 4-PBA at a dose of 0.5 mg·g~(-1), and the control and model groups were given an equal volume of carboxylmethyl cellulose sodium. The treatments were administered once daily for 8 weeks. Food intake, water consumption, and body weight were recorded every 2 weeks. After the intervention, fasting blood glucose(FBG), glycosylated hemoglobin(HbA1c), urine microalbumin(U-mALB), 24-hour urine volume, serum creatinine(Scr), and blood urea nitrogen(BUN) were measured. Inflammatory markers interleukin-1β(IL-1β) and interleukin-18(IL-18) were detected using the enzyme-linked immunosorbent assay(ELISA). Renal pathology was assessed through hematoxylin-eosin(HE), periodic acid-Schiff(PAS), and Masson staining, and transmission electron microscopy(TEM). Western blot was used to detect the expression levels of glucose-regulated protein 78(GRP78), C/EBP homologous protein(CHOP), NLRP3, apoptosis-associated speck-like protein containing CARD(ASC), cysteinyl aspartate-specific proteinase(caspase-1), and gasdermin D(GSDMD) in kidney tissues. The results showed that compared to the control group, the model group exhibited poor general condition, increased weight and food and water intake, and significantly higher levels of FBG, HbA1c, U-mALB, kidney index, 24-hour urine volume, IL-1β, and IL-18. Compared to the model group, the YSJTD and 4-PBA groups showed improved general condition, increased body weight, decreased food intake, and lower levels of FBG, U-mALB, kidney index, 24-hour urine volume, and IL-1β. Specifically, the YSJTD group showed a significant reduction in IL-18 levels compared to the model group, while the 4-PBA group exhibited decreased water intake and HbA1c levels compared to the model group. Although there was a decreasing trend in water intake and HbA1c in the YSJTD group, the differences were not statistically significant. No significant differences were observed in BUN, Scr, and kidney weight among the groups. Renal pathology revealed that the model group exhibited more severe renal damage compared to the control group. Kidney sections from the model group showed diffuse mesangial proliferation in the glomeruli, tubular edema, tubular dilation, significant inflammatory cell infiltration in the interstitium, and increased glycogen staining and blue collagen deposition in the basement membrane. In contrast, the YSJTD and 4-PBA groups showed varying degrees of improvement in renal damage, glycogen staining, and collagen deposition, with the YSJTD group showing more significant improvements. TEM analysis indicated that the model group had extensive cytoplasmic edema, homogeneous thickening of the basement membrane, fewer foot processes, and widening of fused foot processes. In the YSJTD and 4-PBA groups, cytoplasmic swelling of renal tissues was reduced, the basement membrane remained intact and uniform, and foot process fusion improved.Western blot results indicated that compared to the control group, the model group showed upregulation of GRP78, CHOP, GSDMD, NLRP3, ASC, and caspase-1 expression. In contrast, both the YSJTD and 4-PBA groups showed downregulation of these markers compared to the model group. These findings suggest that YSJTD exerts a protective effect against DN by alleviating NLRP3 inflammasome activation through the inhibition of ERS, thereby improving the inflammatory response in db/db DN mice.

ObjectiveTo investigate the value of neutrophil-to-lymphocyte ratio (NLR) for diagnosing sarcopenia in patients undergoing maintenance hemodialysis (MHD) and efficacy of Baduanjin exercise combined with nutritional support on MHD patients with sarcopenia.MethodsA total of 220 patients undergoing MHD in MHD centers were selected, among which 84 had occurred with sarcopenia confirmed by measurements from the Asian Working Group for Sarcopenia. Data were collected for analyzing the influencing factors that lead to the onset of sarcopenia in MHD patients with the use of one-way analysis of variance and multivariate logistic regression. The role of NLR in the diagnosis of sarcopenia was explored, and its correlation with relevant diagnostic measurement performance such as grip strength, gait speed and skeletal muscle mass index was analyzed. In the end, some 74 patients with sarcopenia that qualify for further intervention and observation standards were divided into observation group (Baduanjin exercise plus nutritional support) and control group (nutritional support only), which were both intervened for 12 weeks. A total of 68 patients finished all interventions, with 33 patients in the observation group and 35 in the control group. The grip strength, gait speed, skeletal muscle mass index as well as the NLR were compared between the two groups.ResultsWith the employment of multivariate logistic regression analysis, it was found that age, hemodialysis duration and NLR were risk factors for the onset of sarcopenia in MHD patients (P < 0.05). The area under ROC curve for NLR of MHD patients with sarcopenia was 0.695, and NLR was negatively correlated with a biochemical indicator—human blood albumin (P < 0.05). NLR was also negatively correlated with patient's grip strength, gait speed and skeletal muscle mass index, with the same correlation found in sarcopenia patients (all P < 0.05). After intervention, patient's grip strength and gait speed were both higher, and the NLR lower in the observation group than those in the control group (P < 0.05).ConclusionThe occurrence of sarcopenia in MHD patients is associated with patient's age, hemodialysis duration and NLR. Therefore, it has been concluded that NLR has certain values in the diagnosis of sarcopenia in patients undergoing MHD. Moreover, the muscular strength can be enhanced and inflammation decreased in sarcopenia patients through nutritional support and physical exercise, i.e., Bajinduan exercise.

Objective To analyze the present situation of maintenance hemodialysis (MHD) patients with pruritus, and to explore the effect of nursing intervention based on quantitative evaluation on maintenance hemodialysis patients with pruritus. Methods A total of 158 patients with MHD who underwent examination in our hospital from June 2014 to November 2016 were enrolled in this study. All of them were complicated with pruritus and were randomly divided into two groups with 79 patients in each group. The observation group was treated by nursing intervention based on quantitative evaluation, and the control group was treated by conventional nursing intervention. Nursing effects of the two groups were compared. Results There was no statistically significant difference in the general data between the two groups (P>0.05). The blood calcium levels in the two groups were similar (P>0.05). The levels of blood phosphorus, SCr, hs-CRP, and BUN in the observation group were significantly higher than those in the control group, the levels of iPTH and ALB were significantly lower than those in the control group (P<0.05). The treatment effect of the observation group was better than that of the control group (P<0.05). The total effective rate of the observation group (96.20%) was significantly higher than that of the control group (62.03%) (P<0.05). The quality of life of the observation group was significantly higher than that of the control group (P<0.05). The satisfaction degree of the observation group (94.94%) was significantly higher than that of the control group (39.24%) (P<0.05). Conclusions Renal failure of the selected patients were caused by diabetic nephropathy, chronic glomerulonephritis, systemic lupus erythematosus, hypertensive nephropathy, polycystic kidney disease, and other causes. Nursing intervention based on quantitative evaluation can improve the symptoms of skin pruritus, and the effect is approved by patients. Key words: Maintenance hemodialysis; Pruritus; Quantitative evaluation