Flow reduction in high‐flow arteriovenous fistulas improve cardiovascular parameters and decreases need for hospitalization
Bibliographic record
Abstract
High output heart failure (HF) and pulmonary hypertension have been demonstrated in patients with prevalent arteriovenous (AV) fistulas. Fistulas with flow >2000 mL/minutes are more likely to induce changes in cardiac geometry and pulmonary artery pressure. The effects of reducing flow in AV access and its implications on HF decompensation and hospitalizations have not been studied. Retrospective analysis of 12 patients who needed hospitalization for acute Congestive Heart Failure (CHF) decompensation with AV access flow of 2 L/minutes (as defined by Kidney Disease Outcomes Quality Initiative (KDOQI)) or more were included in the study. All the patients underwent banding of their inflow at the anastomosis with perioperative access flow measurement. Follow-up period was 6 months. 2D echo was done at 6 months postbanding in addition to access flow and clinical evaluation. Complete data was available for all the 12 patients. Study data was collected on all the 12 patients. Mean age was 64.7 years. The mean access flow pre and postbanding were 3784 mL/minutes and 1178 mL/minutes, respectively (P < 0.001). Eighty percent of the patients had diabetes and 41% had coronary artery disease. There was a statistically significant decrease in cardiac output (pre = 7.06 L/minutes, post = 6.47 L/minutes P = 0.03), pulmonary systolic pressure (pre = 54 mmHg, post = 44 mmHg P = 0.02), left ventricular mass index (LVMI) (pre = 130 g/m(2) , post = 125 g/m(2) P = 0.006) and need for rehospitalization for CHF decompensation. The New York Heart Association (NYHA) staging improved by 1 stage postbanding (P = 0.002). The hospitalization rate was 3.75 ± 1.2 in the 6 months before banding and was decreased to 1.08 ± 1.2 (P = 0.002) postbanding. The hemoglobin level, predialysis systolic blood pressure, calcium phosphorous product and the use of Renin Angiotensin Aldosterone System (RAAS) blockade agents and calcium channel blockers were comparable before and after inflow banding. Flow reduction in high flow fistulas are associated with decreased LVMI and pulmonary artery pressures. There is also a significant reduction in the risk for hospitalization due to acute HF and an improvement in NYHA heart failure stage.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".