Evaluating Intervention Rates for Dysfunctional Arteriovenous Fistulas: Post-hoc Analysis of the IN.PACT AV Access Trial
Bibliographic record
Abstract
RATIONALE & OBJECTIVE: A key target of the Kidney Disease Outcomes Quality Initiative (KDOQI) 2019 vascular access guidelines is to have ≤3 percutaneous or surgical interventions per year to maintain arteriovenous fistula (AVF) patency. We hypothesized that the number of interventions to maintain long-term AVF patency as conducted in a rigorous clinical trial could be adequately documented and compared against KDOQI targets and that the use of drug-coated balloons (DCB) could reduce the rate of thrombosis and interventions to maintain AVF patency more than the standard percutaneous transluminal angioplasty (PTA) with an uncoated balloon. STUDY DESIGN: Post-hoc analysis of the IN.PACT AV Access randomized clinical trial. SETTING & PARTICIPANTS: Outpatient adult hemodialysis patients with previously matured AVFs that had de novo or nonstented restenotic lesions enrolled between April 2017 and May 2018 in the United States, Japan, and New Zealand. EXPOSURE: Patients were randomized to receive PTA with the IN.PACT AV DCB or a standard balloon. OUTCOME: Rate of interventions to maintain access target lesion and access circuit patency and rate of access circuit thrombosis were calculated in both intervention groups and compared against the KDOQI 2019 guideline targets. RESULTS: Of the 330 participants randomized, 133 patients completed their 3-year visits. The number of interventions per AVF-year to maintain access circuit patency through 36 months was 1.39 for the DCB group and 1.66 for the standard PTA group (rate difference, -0.28 [95% CI, -0.47 to -0.08], P = 0.01). The access circuit thrombosis rate was 0.041 in the DCB group and 0.069 in the standard PTA group (rate difference, -0.028 [95% CI, -0.065 to 0.0082], P = 0.1). LIMITATIONS: Exclusion of AVF with prior thrombosis and small sample size at 36 months. CONCLUSIONS: Both DCB and standard PTA groups met the KDOQI targets of ≤3 percutaneous or surgical interventions per year to maintain AVF patency. The need for reinterventions to maintain patency and thrombosis rate was reduced with the use of DCB compared with standard PTA through 36 months.
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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 | 0.016 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.006 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 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".