Development and validation of a risk prediction model for autologous arteriovenous fistula thrombosis in patients receiving maintenance hemodialysis.

IF 3 3区医学 Q1 UROLOGY & NEPHROLOGY

Renal Failure Pub Date : 2025-12-01 Epub Date: 2025-05-13 DOI:10.1080/0886022X.2025.2477832

Jinping Ying, Genlian Cai, Yujiao Zhang, Minmin Zhu, Mengyan Pan, Ping Zhang

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Abstract

Background: Thrombosis can lead to fistula failure and affect the smooth progress of hemodialysis. This study aims to develop and validate a nomogram for predicting the risk of autologous arteriovenous fistula thrombosis in patients undergoing maintenance hemodialysis.

Methods: A total of 1,016 patients who underwent hemodialysis at a tertiary A hospital in East China from February 2020 to March 2024 were retrospectively enrolled. The participants were randomly divided into a training set (711 people) and a validation set (305 people) at a ratio of 7:3. A risk prediction model was established according to the results of multivariate logistic regression analysis. The performance of the model was evaluated with the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve analysis, the Hosmer-Lemeshow (H-L) test and decision curve analysis (DCA).

Results: The incidence of autologous arteriovenous fistula thrombosis in patients on maintenance hemodialysis was 32%. High-sensitivity C-reactive protein (hs-CRP), catheterization history, hemodialysis duration, autologous arteriovenous fistula stenosis and non-high-density lipoprotein cholesterol (non-HDL-C) were independent risk factors for autologous arteriovenous fistula thrombosis. These five predictors were used to construct a predictive nomogram. The AUC was 0.818 in the training set and 0.826 in the validation set. The calibration curve of the nomogram was close to the standard curve, indicating that the model was well calibrated. The DCA results confirmed that the model provided good net clinical benefits.

Conclusion: In this study, a predictive nomogram for arteriovenous fistula thrombosis was established and validated.

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维持性血液透析患者自体动静脉瘘血栓形成风险预测模型的建立与验证。

背景：血栓形成可导致瘘管失效，影响血液透析的顺利进行。本研究旨在建立并验证一种预测维持性血液透析患者自体动静脉瘘血栓形成风险的nomogram方法。方法：对2020年2月至2024年3月在华东地区某三级甲等医院接受血液透析治疗的1016例患者进行回顾性研究。参与者被随机分为训练组（711人）和验证组（305人），比例为7:3。根据多因素logistic回归分析结果，建立了风险预测模型。采用受试者工作特征（ROC）曲线下面积（AUC）、校正曲线分析、Hosmer-Lemeshow （H-L）检验和决策曲线分析（DCA）对模型的性能进行评价。结果：维持性血液透析患者自体动静脉瘘血栓的发生率为32%。高敏c反应蛋白（hs-CRP）、置管史、血液透析时间、自体动静脉瘘狭窄和非高密度脂蛋白胆固醇（non-HDL-C）是自体动静脉瘘血栓形成的独立危险因素。这五个预测因子被用来构建一个预测模态图。训练集的AUC为0.818，验证集的AUC为0.826。图的标定曲线与标准曲线接近，表明模型标定良好。DCA结果证实该模型提供了良好的净临床效益。结论：本研究建立并验证了动静脉瘘血栓形成的预测图。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Renal Failure 医学-泌尿学与肾脏学

CiteScore

3.90

自引率

13.30%

发文量

374

审稿时长

1 months

期刊介绍： Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.