Why Do So Many Patients Have a Dialysis Catheter and Not Arteriovenous Fistulae or Grafts?
Bibliographic record
Abstract
The Dialysis Outcome and Quality Initiative has guidelines for vascular access and states that the dialysis catheter (DC) should be limited to less than 20% of the end‐stage renal disease (ESRD) patients. Our center has found this target difficult to achieve. Objective: We wondered what the reasons for use of a DC might be. Methods: We noted the number of patients with a DC in place and assessed the reasons why the DC was being used on 8/1/03. Results: 73 of the 170 (42.9%) patients had a DC on 8/1/03. 24 (32.9%) of the patients refused to have initial arteriovenous fistulae or grafts (AVF/G) or a secondary AVF/G revision or replacement procedure performed after initial AVF/G failure. 15 (20.5%) patients had a maturing AVF/G, 12 (16.4%) had significant medical and/or surgical contraindications for AVF/G placement, 9 (12.3%) patients were awaiting surgical thrombectomy, revision or placement of AVF/G, 6 patients (8.2%) were awaiting transfer to CPD therapy, 4 (5.5%) patients were undecided about having an AVF/G placed, and 1 (1.4%) had acute renal failure and early ESRD recovery was expected. Only 2 (2.7%) patients had no access plan by the nephrology team. Conclusions: Patients' refusal for an AVF/G placement and patients with a maturing AVF/G or awaiting surgical revision or placement were the most common reasons for the use of a DC in our center. To significantly impact on the high use of the DC, it would be crucial to better understand the reasons for patients’ refusals.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".