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预测血液透析患者动静脉内瘘钙化的列线图的开发与验证

Development and validation of a nomogram for predicting calcification of arteriovenous access in hemodialysis patients.

作者信息

Li Xueying, Wang Xiaocui, Yan Bonan, Zhou Yuanke, Li Ling, Huang Xiaopeng, Wang Qiqi, Tang Enjie

机构信息

Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Chengdu University of Traditional Chinese Medicine, Chengdu, China.

出版信息

Ren Fail. 2025 Dec;47(1):2542980. doi: 10.1080/0886022X.2025.2542980. Epub 2025 Aug 12.

Abstract

BACKGROUND

In patients with end-stage renal disease (ESRD), vascular calcification significantly impairs hemodialysis (HD) vascular access functionality, compromising both dialysis efficacy and long-term patency. Early risk prediction of vascular calcification facilitates timely clinical interventions to preserve vascular access integrity.

METHODS

A cross-sectional analysis was performed. Risk factors for vascular calcification in CKD patients were identified from the literature and Kidney Disease: Improving Global Outcomes guidelines. All variable selection and model training procedures were conducted on the training set. Univariate logistic regression was performed for all candidate variables. A nomogram was then constructed based on the final multivariate logistic model to facilitate clinical interpretation.

RESULT

A total of 136 HD patients were included. The predictive model, relying on arteriovenous (AV) access usage time, hip circumference, and diabetes status, is reliable and clinically actionable tool for predicting AV access calcification. Its robust performance across validation and subgroup analyses supports its potential for integration into routine clinical practice.

CONCLUSION

This study developed a nomogram-based predictive model for calcification, providing a simple, cost-effective, and reliable tool for early risk assessment. Monitoring hip circumference may serve as a practical approach for identifying high-risk patients, allowing for timely intervention and improved vascular access outcomes.

摘要

背景

在终末期肾病(ESRD)患者中,血管钙化显著损害血液透析(HD)血管通路功能,影响透析效果和长期通畅性。血管钙化的早期风险预测有助于及时进行临床干预,以维持血管通路的完整性。

方法

进行了一项横断面分析。从文献和《改善全球肾脏病预后组织(KDIGO)指南》中确定慢性肾脏病(CKD)患者血管钙化的危险因素。所有变量选择和模型训练程序均在训练集上进行。对所有候选变量进行单因素逻辑回归。然后基于最终的多因素逻辑模型构建列线图,以方便临床解读。

结果

共纳入136例血液透析患者。该预测模型基于动静脉(AV)通路使用时间、臀围和糖尿病状态,是预测AV通路钙化的可靠且具有临床可操作性的工具。其在验证和亚组分析中的稳健表现支持其整合到常规临床实践中的潜力。

结论

本研究开发了一种基于列线图的钙化预测模型,为早期风险评估提供了一种简单、经济有效且可靠的工具。监测臀围可能是识别高危患者的实用方法,从而能够及时进行干预并改善血管通路结局。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d5e0/12351696/f8a817edfbe8/IRNF_A_2542980_F0001_B.jpg

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