Abnormal digital brachial index prior to hemodialysis access construction and cardiovascular mortality
Bibliographic record
Abstract
INTRODUCTION: An abnormal ankle-brachial index indicating presence of peripheral arterial disease (PAD) is known to predict mortality in end-stage renal disease (ESRD). Hand ischemia, reflected by low finger pressures, is also a factor associated with increased mortality in patients undergoing hemodialysis (HD). The Aim of the present study is to determine whether an abnormal digital brachial index in ESRD patients prior to HD access surgery is related to lower survival rates. METHODS: A digital brachial index (DBI, systolic finger pressure/systolic brachial arterial pressure) was obtained using digital plethysmography in ESRD patients before construction of a primary HD access between January 2009 and December 2018 in a single center. Patients were grouped based on categories of DBI (low <80%, normal 80-99%, high ≥100%). Overall and cardiovascular mortality were assessed with the ERA-EDTA classification system (ERA-EDTA codes 11, 14-16, 18, and 22-26, 29). Factors potentially influencing survival rates were analyzed using standard statistics. FINDINGS: Follow-up was available in 199 patients (female n = 80; age 70 years ±12; follow-up index 99% ±1). Overall, 2 and 4 years survival were similar among DBI groups Moreover, 2 and 4 years freedom from cardiovascular death were also not different (low DBI 80% ±8 and 58% ±11; normal DBI 86% ±4 and 75% ±6; high DBI 74% ±6 and 61% ±7). Following correction for age, diabetes mellitus, cardiovascular disease and smoking, a high DBI conferred a significantly increased risk of cardiovascular mortality (HR 2.09 [1.06-4.13], P = 0.03) and a trend toward higher overall mortality (HR 1.69 [0.98-2.93], P = 0.06). DISCUSSION: ESRD patients with an abnormally elevated DBI before HD access creation have an increased risk of cardiovascular mortality in the first four postoperative years.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| 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 | 0.001 |
| 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 teacher head, 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".