A meta-analysis of the impact of initial hemodialysis access type on mortality in elderly incident hemodialysis population
Bibliographic record
Abstract
BACKGROUND: Selecting the appropriate vascular access type for elderly patients before initiating hemodialysis presents a challenge, given their limited life expectancy and multiple comorbidities. This systematic review aims to evaluate whether initial arteriovenous access (AVa), including arteriovenous fistulas (AVF) and/or arteriovenous grafts (AVG), offers a benefit in reducing the risk of all-cause mortality compared to central venous catheters (CVC) for patients aged ≥ 65 years. METHODS: We conducted searches in PubMed (from 1946 to March 20, 2023), Embase (from 1947 to 20 March 20, 2023), and the Cochrane Library to identify studies comparing the use of CVC with AVa as the initial vascular access in hemodialysis patients aged ≥ 65 years. The primary outcome of interest was all-cause mortality. We pooled the hazard ratio (HR) and 95% confidence intervals (CIs) of the included studies using a random-effect model. The Newcastle-Ottawa Scale was employed to assess the risk of bias for each included study. RESULTS: = 74.9). CONCLUSION: In this analysis, we observed an increased risk of death in elderly patients initiating dialysis with CVC compared to those using AVa. However, the retrospective cohort studies included in this analysis are susceptible to selection bias, indicating that further randomized controlled trials are necessary to confirm these findings. FUNDING: This systematic review and meta-analysis were not funded. REGISTRATION: The protocol of this systematic review has been registered in the PROSPERO registry (CRD42023435577; https://www.crd.york.ac.uk/prospero ).
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 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 | 0.015 | 0.039 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.056 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".