ArticleBMC nephrology2025
Construction and verification of a prediction model for arteriovenous fistula failure in elderly dialysis patients based on clinical characteristics and laboratory indexes.
Article in BMC nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveIn elderly patients (≥ 60 years) undergoing autogenous arteriovenous fistula (AVF) creation, early prediction of 12-month failure can guide optimisation and surveillance.
methodsWe conducted a single-centre retrospective cohort study with a temporal split: patients from June 2022–June 2023 comprised the development cohort (n = 153), and those from July 2023–June 2024 comprised the validation cohort (n = 77). All predictors were measured within 7 days before surgery. Candidate variables were prespecified from prior evidence. Logistic regression with stepwise selection retained age ≥ 70 years, diabetes mellitus, serum IL-6, and CRP. We assessed discrimination (AUROC with 95% CI), calibration (slope, intercept, Hosmer–Lemeshow), overall accuracy (Brier score), and clinical utility (decision-curve analysis). Bootstrap resampling (B = 200) was used for internal optimism correction.
resultsAmong 230 patients, the 12-month AVF failure rate was 40.0% (92/230). Independent predictors were age ≥ 70 years (OR = 1.058, 95% CI 1.009–1.109), diabetes (OR = 1.654, 95% CI 1.104–2.476), IL-6 (OR = 1.034, 95% CI 1.004–1.064), and CRP (OR = 1.133, 95% CI 1.019–1.260). The final model equation was: logit(p) = − 0.842 + 0.056(Age) + 0.503(Diabetes) + 0.033(IL-6) + 0.125(CRP). Discrimination was strong: AUROC = 0.889 (95% CI 0.816–0.962) in the training cohort and 0.835 (95% CI 0.744–0.926) in validation. Optimism-corrected C-statistic = 0.872. Calibration slope was 0.93, intercept − 0.02; Hosmer–Lemeshow χ²=6.78, P = 0.276. Brier score = 0.13. DCA confirmed positive net benefit between 10 and 30% risk thresholds.
conclusionIn elderly AVF candidates, a four-predictor model integrating age, diabetes, IL-6, and CRP showed strong discrimination and acceptable calibration. While clinically promising, transportability requires multicentre validation, and the added value of IL-6 should be weighed against local testing availability.
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