Abstract
Background: Vascular access surveillance of dialysis patients is a challenging task for clinicians. We derived and validated an arteriovenous fistula failure model (AVF-FM) based on machine learning. Methods: The AVF-FM is an XG-Boost algorithm aimed at predicting AVF failure within three months among in-centre dialysis patients. The model was trained in the derivation set (70% of initial cohort) by exploiting the information routinely collected in the Nephrocare European Clinical Database (EuCliD®). Model performance was tested by concordance statistic and calibration charts in the remaining 30% of records. Features importance was computed using the SHAP method. Results: We included 13,369 patients, overall. The Area Under the ROC Curve (AUC-ROC) of AVF-FM was 0.80 (95% CI 0.79–0.81). Model calibration showed excellent representation of observed failure risk. Variables associated with the greatest impact on risk estimates were previous history of AVF complications, followed by access recirculation and other functional parameters including metrics describing temporal pattern of dialysis dose, blood flow, dynamic venous and arterial pressures. Conclusions: The AVF-FM achieved good discrimination and calibration properties by combining routinely collected clinical and sensor data that require no additional effort by healthcare staff. Therefore, it can potentially enable risk-based personalization of AVF surveillance strategies.
Highlights
IntroductionAVFs may develop dysfunction and lower blood flow due to a series of biological changes that can lead to the formation of a stenosis and subsequent thrombosis
AVF failure endpoint within three months based on routinely recorded clinical information readily available in health information systems for dialysis patients
We considered onlyatAVFs treatments performed using as vascular access, in the period
Summary
AVFs may develop dysfunction and lower blood flow due to a series of biological changes that can lead to the formation of a stenosis and subsequent thrombosis. This event has a severe impact on the clinical status of dialysis patients; in the best scenario, endovascular and surgical interventions can restore a satisfactory AVF flow; if not, a central venous catheter (CVC) needs to be placed for interim dialysis access. We derived and validated an arteriovenous fistula failure model (AVF-FM) based on machine learning. Methods: The AVF-FM is an XG-Boost algorithm aimed at predicting AVF failure within three months among in-centre dialysis patients.
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