Delayed conversion from central venous catheter to non‐catheter hemodialysis access associates with an increased risk of death: A retrospective cohort study based on data from a large dialysis provider
Bibliographic record
Abstract
BACKGROUND: Hemodialysis initiation using a central venous catheter (CVC) poses an increased risk of death. Conversion to an arterio-venous graft or fistula (AVF, AVG) improves outcomes. The relationship of primary dialysis access and timing of conversion from CVC to either AVF or AVG to all-cause mortality was investigated. METHODS: Two retrospective analyses in incident hemodialysis patients commencing treatment from January 2010 to December 2014 in dialysis clinics in the United States were conducted. Analysis 1 stratified as per access at initiation and those commencing with CVC were further stratified into (a) those that had a CVC, AVF, or AVG the entire year; (b) those that were converted to either AVF or AVG within either (i) the first or (ii) the second 6 months. Kaplan Meier analysis and Cox regression analysis were employed. Analysis 2 included all CVC patients investigating the relationship between access conversion time and mortality risk using a Cox proportional hazards model depicting the hazard ratio (HR) as a spline function over time. RESULTS: Two subsets from initial 78,871 patients were studied. In Analysis 1 both AVF (referent) and AVG [HR 1.12 (0.97 to 1.30)] associated with a better outcome than CVC [HR 1.55 (1.38 to 1.74)] during follow-up. Lower mortality risk was seen for early switch from a CVC to AV access within the first 6 months [HR = 1.04 (0.97-1.13)] compared to a later switch [HR = 1.23 (1.10-1.38)]. Analysis 2 indicated that a CVC to AVF switch resulted in improved survival. Analysis 2 indicated early conversion to confer a survival benefit for CVC to AVG switch. DISCUSSION AND CONCLUSION: AVF and AVG show a survival benefit over CVC. Early conversion from CVC to either access improves survival. This emphasizes the importance of early preparation for dialysis by creation of an AVF or AVG and to convert CVCs early.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".