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Meng L, Ho P. A systematic review of prediction models on arteriovenous fistula: Risk scores and machine learning approaches. J Vasc Access 2024:11297298241237830. [PMID: 38658814 DOI: 10.1177/11297298241237830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE Failure-to-mature and early stenosis remains the Achille's heel of hemodialysis arteriovenous fistula (AVF) creation. The maturation and patency of an AVF can be influenced by a variety of demographic, comorbidity, and anatomical factors. This study aims to review the prediction models of AVF maturation and patency with various risk scores and machine learning models. DATA SOURCES AND REVIEW METHODS Literature search was performed on PubMed, Scopus, and Embase to identify eligible articles. The quality of the studies was assessed using the Prediction model Risk Of Bias ASsessment (PROBAST) Tool. The performance (discrimination and calibration) of the included studies were extracted. RESULTS Fourteen studies (seven studies used risk score approaches; seven studies used machine learning approaches) were included in the review. Among them, 12 studies were rated as high or unclear "risk of bias." Six studies were rated as high concern or unclear for "applicability." C-statistics (Model discrimination metric) was reported in five studies using risk score approach (0.70-0.886) and three utilized machine learning methods (0.80-0.85). Model calibration was reported in three studies. Failure-to-mature risk score developed by one of the studies has been externally validated in three different patient populations, however the model discrimination degraded significantly (C-statistics: 0.519-0.53). CONCLUSION The performance of existing predictive models for AVF maturation/patency is underreported. They showed satisfactory performance in their own study population. However, there was high risk of bias in methodology used to build some of the models. The reviewed models also lack external validation or had reduced performance in external cohort.
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Affiliation(s)
- Lingyan Meng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pei Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore
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2
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Wu CK, Lin CH. Integrating vascular access surveillance with clinical monitoring for stenosis prediction. J Nephrol 2024; 37:461-470. [PMID: 37980698 DOI: 10.1007/s40620-023-01799-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/27/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Arteriovenous fistula and arteriovenous graft are the most common types of vascular access for dialysis; stenosis and thrombosis are major complications leading to access failure and to an incresed risk of mortality. The aim of the present study was to assess the results of integrating strict vascular access blood flow surveillance with routine clinical monitoring for predicting vascular access stenosis in chronic hemodialysis patients. METHODS In this retrospective study, chronic dialysis patients with arteriovenous fistula or arteriovenous graft were included from a setting in which all patients underwent quarterly blood flow surveillance in 2017. The results of blood flow surveillance were confirmed by thorough physical examination. Predictive performance of blood flow surveillance models in detecting stenosis in patients with arteriovenous fistula or arteriovenous graft was evaluated. The predictive performance of the quarterly blood flow surveillance model was described by confusion matrix. Differences in accuracy, positive predictive value (PPV), and negative predictive value (NPV) between blood flow surveillance models with distinct blood flow thresholds were evaluated. RESULTS Of 397 included patients, 336 had an arteriovenous fistula and 61 had an arteriovenous graft. In 2017, 106 percutaneous transluminal angioplasty procedures were performed in patients with an arteriovenous fistula, and 63 in patients with an arteriovenous graft. The results revealed similar predictive performance of surveillance models using an absolute blood flow threshold of < 500 or < 400 mL/min in predicting stenosis in patients with arteriovenous fistula. Blood flow surveillance models for patients with an arteriovenous fistula had significantly higher accuracy than those for patients with an arteriovenous graft. Furthermore, the use of a relative threshold, defined as blood flow < 1000 mL/min and a 25% decline in blood flow, did not affect the predictive performance of blood flow surveillance models. CONCLUSION Blood flow surveillance models using thresholds of < 400 and < 600 mL/min, followed by thorough physical examination, showed an accuracy of 91.54% and 72.15% in predicting stenosis in patients with arteriovenous fistula and arteriovenous graft, respectively. These two blood flow surveillance models may be integrated with routine clinical monitoring to improve early detection and treatment of stenosis in hemodialysis patients.
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Affiliation(s)
- Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei, Taipei, Taiwan
| | - Chia-Hsun Lin
- School of Medicine, Fu-Jen Catholic University, New Taipei, Taipei, Taiwan.
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wenchang Rd., Shilin Dist., Taipei, 111045, Taiwan.
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3
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Barbieri C, Neri L, Stuard S, Mari F, Martín-Guerrero JD. From electronic health records to clinical management systems: how the digital transformation can support healthcare services. Clin Kidney J 2023; 16:1878-1884. [PMID: 37915897 PMCID: PMC10616428 DOI: 10.1093/ckj/sfad168] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Indexed: 11/03/2023] Open
Abstract
Healthcare systems worldwide are currently undergoing significant transformations in response to increasing costs, a shortage of healthcare professionals and the growing complexity of medical needs among the population. Value-based healthcare reimbursement systems are emerging as an attempt to incentivize patient-centricity and cost containment. From a technological perspective, the transition to digitalized services is intended to support these transformations. A Health Information System (HIS) is a technological solution designed to govern the data flow generated and consumed by healthcare professionals and administrative staff during the delivery of healthcare services. However, the exponential growth of digital capabilities and applied advanced analytics has expanded their traditional functionalities and brought the promise of automating administrative procedures and simple repetitive tasks, while enhancing the efficiency and outcomes of healthcare services by incorporating decision support tools for clinical management. The future of HIS is headed towards modular architectures that can facilitate implementation and adaptation to different environments and systems, as well as the integration of various tools, such as artificial intelligence (AI) models, in a seamless way. As an example, we present the experience and future developments of the European Clinical Database (EuCliD®). EuCliD is a multilingual HIS used by 20 000 nurses and physicians on a daily basis to manage 105 000 patients treated in 1100 clinics in 43 different countries. EuCliD encompasses patients' follow-up, automatic reporting and mobile applications while enabling efficient management of clinical processes. It is also designed to incorporate multiagent systems to automate repetitive tasks, AI modules and advanced dynamic dashboards.
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Affiliation(s)
- Carlo Barbieri
- Global Digital Transformation and Innovation, Clinical Digital Center of Excellence, Fresenius Medical Care, Crema Italy
| | - Luca Neri
- Global Medical Office, Clinical Advanced Analytics, Fresenius Medical Care, Crema Italy
| | - Stefano Stuard
- Global Medical Office, Clinical and Therapeutic Governance, Fresenius Medical Care, Naples, Italy
| | - Flavio Mari
- Global Digital Transformation and Innovation, Clinical Digital Center of Excellence, Fresenius Medical Care, Crema Italy
| | - José D Martín-Guerrero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE -UV, Universitat de València, Valencia, Spain
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Lomonte C, Corciulo S, Cortese D, Libutti P, Montinaro V, Gesualdo L. Rethinking an effective AV fistula-graft screening program. An "A B C". J Nephrol 2023; 36:1861-1865. [PMID: 37458910 DOI: 10.1007/s40620-023-01669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/29/2023] [Indexed: 10/01/2023]
Abstract
The goal of a vascular access screening program is to detect and preemptively correct hemodynamically significant stenosis, however, a practice pattern allowing to implement such a program still remains to be defined. Achieving balance between the increase in access-related procedures by adopting an aggressive screening program, and the risks associated with the absence of any screening program, i.e., failure or abandonment of the arterio-venous access with need for central venous catheter placement, can be extremely challenging. All major guidelines agree about the role of arterio-venous access monitoring, but the way surveillance should be managed is still a controversial issue. Preserving long-term vascular access function should be a goal for all hemodialysis teams, yet it ideally requires a multidisciplinary effort with a monitoring program, calling for a great deal of involvement by hemodialysis health professionals. In this context, the engagement of skilled nurses and the role of patient empowerment with collaborative decision-making may be the key to a successful vascular access screening program. Screening programs should be personalized, shared with the patients, and tailored according to vascular access type and site. In the near future, new devices and the use of artificial intelligence may allow to support interpretation of complex data and lead to the development of prediction models for vascular access failure.
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Affiliation(s)
- Carlo Lomonte
- Nephrology Unit, Miulli General Hospital, Acquaviva delle Fonti (Ba), Bari, Italy.
| | - Simone Corciulo
- Nephrology Unit, Miulli General Hospital, Acquaviva delle Fonti (Ba), Bari, Italy
| | - Denni Cortese
- Nephrology Department, University of Bari, Bari, Italy
| | - Pasquale Libutti
- Nephrology Unit, Miulli General Hospital, Acquaviva delle Fonti (Ba), Bari, Italy
| | - Vincenzo Montinaro
- Nephrology Unit, Miulli General Hospital, Acquaviva delle Fonti (Ba), Bari, Italy
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5
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Zhou G, Chen Y, Chien C, Revatta L, Ferdous J, Chen M, Deb S, De Leon Cruz S, Wang A, Lee B, Sabuncu MR, Browne W, Wun H, Mosadegh B. Deep learning analysis of blood flow sounds to detect arteriovenous fistula stenosis. NPJ Digit Med 2023; 6:163. [PMID: 37658233 PMCID: PMC10474109 DOI: 10.1038/s41746-023-00894-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023] Open
Abstract
For hemodialysis patients, arteriovenous fistula (AVF) patency determines whether adequate hemofiltration can be achieved, and directly influences clinical outcomes. Here, we report the development and performance of a deep learning model for automated AVF stenosis screening based on the sound of AVF blood flow using supervised learning with data validated by ultrasound. We demonstrate the importance of contextualizing the sound with location metadata as the characteristics of the blood flow sound varies significantly along the AVF. We found the best model to be a vision transformer trained on spectrogram images. Our model can screen for stenosis at a performance level comparable to that of a nephrologist performing a physical exam, but with the advantage of being automated and scalable. In a high-volume, resource-limited clinical setting, automated AVF stenosis screening can help ensure patient safety via early detection of at-risk vascular access, streamline the dialysis workflow, and serve as a patient-facing tool to allow for at-home, self-screening.
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Affiliation(s)
- George Zhou
- Weill Cornell Medicine, New York, NY, 10021, USA.
| | - Yunchan Chen
- Weill Cornell Medicine, New York, NY, 10021, USA
| | | | - Leslie Revatta
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Jannatul Ferdous
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Michelle Chen
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Shourov Deb
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Sol De Leon Cruz
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Alan Wang
- School of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, NY, 10044, USA
| | - Benjamin Lee
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Mert R Sabuncu
- School of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, NY, 10044, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - William Browne
- Department of Interventional Radiology, NewYork-Presbyterian Hospital, New York, NY, 10021, USA
| | - Herrick Wun
- Department of Vascular Surgery, NewYork-Presbyterian Hospital, New York, NY, 10021, USA.
| | - Bobak Mosadegh
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA.
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6
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Schneditz D, Ribitsch W, Keane DF. Intradialytic techniques for automatic and everyday access monitoring. Semin Dial 2023. [PMID: 37368415 DOI: 10.1111/sdi.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
Vascular access dysfunction is associated with reduced delivery of dialysis, unplanned admissions, patient symptoms, and loss of access, making assessment of vascular access a fundamental part of routine care in dialysis. Clinical trials to predict the risk of access thrombosis based on accepted reference methods of access performance have been disappointing. Reference methods are time-consuming, affect the delivery of dialysis, and therefore cannot repeatedly be used with every dialysis session. There is now a new focus on data continuously and regularly collected with every dialysis treatment, directly or indirectly associated with access function, and without interrupting or affecting the delivered dose of dialysis. This narrative review will focus on techniques that can be used continuously or intermittently during dialysis, taking advantage of methods integrated into the dialysis machine and which do not affect the delivery of dialysis. Examples include extracorporeal blood flow, dynamic line pressures, effective clearance, dose of delivered dialysis, and recirculation which are all routinely measured on most modern dialysis machines. Integrated information collected throughout every dialysis session and analyzed by expert systems and machine learning has the potential to improve the identification of accesses at risk of thrombosis.
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Affiliation(s)
- Daniel Schneditz
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
| | - Werner Ribitsch
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - David F Keane
- CÚRAM Science Foundation Ireland, Research Centre for Medical Devices, Health Research Board, Clinical Research Facility Galway, University of Galway, Galway, Ireland
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Doneda M, Poloni S, Bozzetto M, Remuzzi A, Lanzarone E. Surgical planning of arteriovenous fistulae in routine clinical practice: A machine learning predictive tool. J Vasc Access 2023:11297298221147968. [PMID: 36765450 DOI: 10.1177/11297298221147968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Arteriovenous fistula (AVF) is the preferred vascular access (VA) for hemodialysis, but it is associated with high non-maturation and failure rates. Predicting patient-specific AVF maturation and postoperative changes in blood flow volumes (BFVs) and vessel diameters is of fundamental importance to support the choice of optimal AVF location and improve VA survival. The goal of this study was to employ machine learning (ML) in order to give physicians a fast and easy-to-use tool that provides accurate patient-specific predictions, useful to make AVF surgical planning decisions. METHODS We applied a set of ML approaches on a dataset of 156 patients. Both parametric and non-parametric ML approaches, taking preoperative data as input, were exploited to predict maturation, postoperative BFVs, and diameters. The best approach associated with lowest cross-validation errors between predictions and real measurements was then chosen to provide estimates and quantify prediction errors. RESULTS The k-NN was the best approach to predict brachial BFV, AVF maturation, and other VA variables, and it was also associated with the least computational effort. With this approach, the confusion matrices proved the high accuracy of the prediction for AVF maturation (96.8%) and the low absolute error distribution for the continuous BFV and diameter variables. CONCLUSIONS Our data-based approach provided accurate patient-specific predictions for different AVF configurations, requiring short computational time as compared to a physical model we previously developed. By supporting VA surgical planning, this fast computing approach could allow AVF surgical planning and help reducing the rate of non-maturation, which might ultimately have a broad impact on the management of hemodialysis patients.
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Affiliation(s)
- Martina Doneda
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Institute for Applied Mathematics and Information Technology (IMATI), National Research Council of Italy (CNR), Milan, Italy
| | - Sofia Poloni
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Michela Bozzetto
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Andrea Remuzzi
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy
| | - Ettore Lanzarone
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy
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Hulsen T. Data Science in Healthcare: COVID-19 and Beyond. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063499. [PMID: 35329186 PMCID: PMC8950731 DOI: 10.3390/ijerph19063499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/14/2022] [Indexed: 02/05/2023]
Abstract
Data science is an interdisciplinary field that applies numerous techniques, such as machine learning (ML), neural networks (NN) and artificial intelligence (AI), to create value, based on extracting knowledge and insights from available 'big' data [...].
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Affiliation(s)
- Tim Hulsen
- Department of Hospital Services & Informatics, Philips Research, 5656AE Eindhoven, The Netherlands
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