Predictors of Filter and Circuit Clotting in Incident Hemodialysis Patients
Bibliographic record
Abstract
Background: Frequent circuit clotting during maintenance hemodialysis (HD) compromises treatment adequacy. While anticoagulation is routinely used to mitigate this risk, it is often limited by bleeding events. Alternatives such as citrate or saline flushes are costly or less effective. Data to guide evidence-based practice remain scarce. We evaluated the link between circuit/filter clotting and anticoagulation use, vascular access, and blood flow. Methods: We conducted a retrospective cohort study of incident HD patients from 2017 to 2022. Data were extracted from the dialysis information system. Predictors included the use anticoagulation, access type, blood flow, age, and HD vintage. Clotting was graded using a standardized 4-point scale; grade 4 indicated a fully clotted circuit. We used multivariate mixed-effects ordinal logistic regression and reported odds ratios for higher clotting severity. A secondary binary model assessed the odds of full circuit clotting (grade 4) versus any other grade. Results: We included 409 patients and 172,103 treatments. Median age was 63 years and 64% were male. Anticoagulation was used in 78% of treatments. Clotting severity was distributed as follows: 42% grade 1, 46% grade 2, 11% grade 3, and 0.63% grade 4. Anticoagulation was associated with significantly lower odds of higher clotting severity (Odds Ratio [OR] = 0.82, 95% Confidence Interval [CI]: 0.80–0.85) and full circuit clotting (OR = 0.40, 95% CI: 0.34–0.48) (Figure). Access type, particularly arteriovenous grafts, was significantly associated with higher clotting severity (OR = 1.21, 95% CI: 1.01–1.46), but not with full circuit clotting, suggesting an effect limited to less severe forms. Conclusion: Although full circuit clotting was rare, absence of anticoagulation significantly increased the odds of both higher clotting severity and complete clotting. Access type may contribute to milder forms and affect adequacy. These findings add to a sparse body of evidence and may inform practice by prompting intentional consideration of appropriate anticoagulation. Funding: Government Support – Non-U.S.Effect of Selected Predictors on the Risk of Clotting
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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 | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".