Residual renal function (RRF) characteristically declines after patients with end-stage renal disease (ESRD) initiate dialysis. Although RRF preservation correlates with improved patient's quality of life and survival prospects, poor understanding of the pathophysiology underlying RRF decline limits protection strategies.

Hemodialysis (HD) is the primary renal replacement therapy for patients with end-stage renal disease. However, residual renal function (RRF) characteristically declines after these individuals start dialysis. This loss of RRF not only impacts the adequacy of dialysis and control of complications but also affects the patient's quality of life and survival prospects. Due to a lack of clear understanding regarding the pathophysiology underlying this decline in RRF, no effective strategies exist for its preservation at present. The objective of this study is to explore the changes in renal perfusion during hemodialysis in patients with end-stage renal disease, and provide a new idea for protection of RRF. This study was an observational study, and no interventions were performed.

Inclusion Criteria:

• Age ≥ 18 years;
• Clinical diagnosis of end-stage renal disease requiring long-term hemodialysis treatment, with dialysis duration ≤ 3 months;
• Urine output > 500ml/day or GFR > 3ml/min/1.72m2;
• Signed and dated informed consented is obtained.

Exclusion Criteria:

• Presence of vascular access dysfunction (blood flow rate < 180ml/min);
• Severe heart failure;
• Active infection;
• Infectious disease;
• Patients with severe anemia;
• Patients with polycystic kidney disease;
• Expected dialysis duration < 6 months;
• Pregnancy or lactation women;
• Patients who are participating in other clinical studies, or who have participated in other clinical studies within 3 months prior to enrollment;
• Unwillingness to be followed up or poor adherence to treatment;
• Other circumstances that the investigator considers unsuitable for enrolment.

First Medical Center of Chinese PLA General Hospital