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Record W3123392619 · doi:10.34067/kid.0006262020

The Arteriovenous Fistula and Progression of Kidney Disease

2021· letter· en· W3123392619 on OpenAlexaboutno aff
Thomas A. Golper

Bibliographic record

VenueKidney360 · 2021
Typeletter
Languageen
FieldHealth Professions
TopicCentral Venous Catheters and Hemodialysis
Canadian institutionsnot available
Fundersnot available
KeywordsArteriovenous fistulaMedicineKidney diseaseDiseaseRadiologyInternal medicine

Abstract

fetched live from OpenAlex

In 1978, Bill Bennett hired me to “do academic dialysis.” As part of the first National Kidney Foundation Dialysis Outcome Quality Initiative  Clinical Practice Guideline leadership team, I became more interested in hemodialysis vascular access. I designed and placed “save the vessels” bracelets for our patients to wear protecting vessels. When I considered hemodialysis to be likely within 12 months, I strongly encouraged creation of arteriovenous fistulae (AVFs). I delayed arteriovenous graft (AVG) placement until much closer to the expected hemodialysis initiation date. Over 35 years I noticed that a significant fraction of patients with functioning AVFs seemed to slow the decline in their rate of eGFR. In a simple proof-of-concept retrospective observational study, it appeared that eGFR decline did display a slowing after AVF creation (1). Subsequent better-designed studies corroborated our findings (2⇓⇓–5). Although fraught with methodological problems, one study suggested that even placing a peritoneal dialysis catheter slowed progression (4). This did not make physiologic sense to me. In this issue of Kidney360 , another study from Montreal dispels the notion that placing of a peritoneal dialysis catheter affects eGFR decline (5). Sumida et al. utilized a Veterans Administration database, which included AVGs and AVFs with over 3000 patients, not limited by AVF maturation, and used central venous catheter recipients as propensity-matched controls (2). AVF and AVG recipients showed eGFR deceleration after surgical creation, independent of maturation, whereas our study only evaluated maturing AVFs. The first Montreal paper precisely defined the cohort, its clinical characteristics, tried to adjust for known confounders, and used maturation for inclusion (3). Attenuation of eGFR decline over time was again noted after AVF creation. At about the same time, Lundstrom et al. (4) were utilizing a Swedish national database and used patients with peritoneal dialysis catheters as comparators …

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not 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.

metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.001
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: Not applicable
GenreCandidate signal: Commentary · Consensus signal: Commentary
Teacher disagreement score0.024
Threshold uncertainty score0.902

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0000.001
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.000
Bibliometrics0.0000.000
Science and technology studies0.0010.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0010.002
Insufficient payload (model declined to judge)0.0000.000

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.

Opus teacher head0.028
GPT teacher head0.335
Teacher spread0.307 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designNot applicable
Domainnot available
GenreCommentary

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".

Quick stats

Citations2
Published2021
Admission routes1
Has abstractyes

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