MP704REGIONAL DIFFERENCES IN THE ASSOCIATIONS BETWEEN PRESCRIBED DIALYSATE SODIUM CONCENTRATION AND INTERDIALYTIC WEIGHT GAIN IN THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY: A CALL FOR QUALITY ASSURANCE?
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Several research groups have shown that higher dialysate sodium (DNa) prescription levels, translating into higher dialysate-to-serum sodium gradients, are associated with thirst and interdialytic weight gain (IDWG). A recent analysis of four dialysis centers in the United States (US), however, found that the measured DNa might be considerably higher than the prescribed DNa, contrasting the results of another study from Austria/Europe. We hypothesized that the well-established association between DNa and IDWG might differ by region, in part as a consequence of having outlier facilities with large differences between prescribed and measured DNa. METHODS: The international Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective cohort study, enrolling national samples of dialysis facilities and randomly selected hemodialysis (HD) patients >18 years of age, here limited to vintage ≥1 year from each participating facility. The present analysis employed data from DOPPS phases 2 (2002-2004), 3 (2005-2008), 4 (2009-2011), and 5 (2012-2014). Multivariable linear mixed-model regression was used to assess the association between baseline relative IDWG as a continuous variable and DNa for each region. Model adjustments included age, sex, race, vintage, postdialysis weight (BW), 14 comorbid conditions, labs, pre-dialysis systolic blood pressure, residual renal function, treatment time. RESULTS: Results on the association between relative IDWG and DNa are shown by region in the Table. IDWG was positively associated with DNa in all countries that were analyzed. However, the strength of association differed markedly by country, being strongest in Europe. In Canada and Japan, the association between relative increase in IDWG and DNa was weaker than in Europe. In the US, this association was weakest and of limited clinical relevance (by effect size). Results by DOPPS phase are shown in the Figure and demonstrated consistent regional differences across study phase. MP704 Table MP704 Figure
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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 | 0.020 | 0.037 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".