Preoperative Dialysis Dose and Postoperative Outcomes in Patients Receiving Maintenance Hemodialysis
Bibliographic record
Abstract
Key Points Little is known about preoperative hemodialysis dosing for patients with ESKD. Among patients receiving maintenance hemodialysis, preoperative decreases in Kt/V urea were significantly associated with postoperative mortality. The connection between preoperative hemodialysis practices and postoperative outcomes warrants further investigation. Background Little is known about preoperative hemodialysis dosing for patients with ESKD. We assessed whether changes in preoperative hemodialysis dose (compared with and controlling for baseline dose) are associated with postoperative mortality in patients receiving maintenance hemodialysis. Methods We identified fee-for-service Medicare beneficiaries receiving hemodialysis for ESKD who underwent surgical procedures between January 1, 2011, and November 30, 2020. Follow-up ended December 31, 2020. The primary exposure was preoperative change in Kt/V urea , defined as the difference between the Kt/V urea in the hemodialysis session proximal to the procedure and the mean Kt/V urea for the preceding 180 days. The primary outcome was postoperative 30-day mortality. The relation between preoperative change in Kt/V urea and the primary outcome was modeled using a Cox proportional hazards regression model, adjusted for mean and SD of Kt/V urea in the 180 days preceding the procedure, and for other covariates. Results Among 151,240 procedures (median age, 65 years [25%–75% range, 56–73], 63,437 [41.9%] in women), 31,825 (21.0%) had a preoperative change in Kt/V urea of <−0.10, 43,790 (29.0%) had a preoperative change of −0.10 to <0, 45,058 (29.8%) had a preoperative change of 0 to <+0.10, and 30,567 (20.2%) had a preoperative change of ≥+0.10. The median Kt/V urea for the 180 days before the procedure was 1.58 (25th–75th percentiles, 1.45–1.74). In adjusted analysis, compared with patients with a preoperative change in Kt/V urea of 0 to <+0.10, 30-day mortality was 1.50 (95% confidence interval, 1.32 to 1.70) times higher with a preoperative Kt/V urea change of ≤−0.10 and 1.16 (95% confidence interval, 1.02 to 1.31) times higher with a preoperative Kt/V urea change of −0.10 to <0. Increases in preoperative Kt/V urea that were >0.10 were not significantly associated with 30-day mortality. Conclusions Among Medicare beneficiaries receiving maintenance hemodialysis, preoperative decreases in Kt/V urea (compared with and controlling for mean Kt/V urea ) were significantly associated with postoperative mortality.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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".