Informing Choices about Arteriovenous Fistula Creation: Insights from a Prospective Cohort Study
Bibliographic record
Abstract
Background: Selection of a dialysis access type should incorporate patients’ circumstances and preferences, termed the “Kidney Failure Life Plan”. Data on long-term outcomes for arteriovenous fistulas (AVF) can guide decisions surrounding the Plan. We did this study to inform patients’ choices about AVF creation, accounting for the risk of primary non-function and the presence of competing risks. Methods: Prospective observational study of 257 adults with newly created AVF in Alberta, Canada. Participants were followed for 15 years or until the first outcome of death, outmigration, modality switch, or AVF failure/abandonment/ligation/removal. The primary outcome was primary function. Secondary outcomes included loss of primary patency and loss of secondary patency, assessed using Fine-Grey subdistribution hazard models to account for competing risks. Results: Of 257 participants, 63.0% were male with mean age 62.3y, 54.9% had a radiocephalic AVF, and median follow up was 18.5 months. 50 AVF could not be assessed for primary function, with death being the most common reason. Of the remaining 207 AVF, 105 had primary function, and function was eventually established in 37/102 with primary non-function. In the 142 AVF with established function, loss of primary patency at 1, 3, and 5 years was 36.6%, 65.5% and 66.2% respectively. Similar values for loss of secondary patency were 0.7%, 11.3% and 16.2%. Overall, of 257 participants undergoing AVF creation, only 55% ultimately used that AVF for hemodialysis. These data were used to create the icon array (Figure) which is the basis for a decision aid. Conclusion: This study highlights patient-important outcomes that may inform patients’ Kidney Failure Life Plans and choices about AVF creation. Future studies will validate and refine decision aids with input from patients.
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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 | 0.007 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| 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".