Establishment of a nomogram model for individualized prediction of the risk of arteriovenous fistula embolism occurrence in MHD patients

doi:10.3877/cma.j.issn.2095-3216.2023.02.004

Abstract

Abstract:

Objective

To construct a nomogram model for predicting the risk of arteriovenous fistula (AVF) embolism in patients with chronic renal failure (CRF) undergoing maintenance hemodialysis, and to evaluate the discrimination and consistency of the model.

Methods

A total of 254 CRF patients who underwent maintenance hemodialysis in our hospital from September 2017 to March 2021 were selected and divided into AVF embolization group of 54 cases and AVF unobstruction group of 200 cases according to whether AVF embolism occurred. Logistic regression was performed to analyze the risk factors of AVF embolism in CRF maintenance hemodialysis, and the R software was used to construct a nomogram model for predicting the risk of AVF embolism in CRF patients who underwent maintenance hemodialysis.

Results

In the AVF embolization group, the proportion of diabetes mellitus, the proportion of hypotension after dialysis, the proportion of blood hypercoagulability, calcium-phosphorus product, and serum phosphorus level were significantly higher than those in the AVF unobstruction group (P<0.05), while the proportion of L-carnitine use was significantly lower than that in the AVF unobstruction group (P<0.05). The results of multivariate logistic regression analysis showed that diabetes, post-dialysis hypotension, blood hypercoagulability, and high calcium-phosphorus product were risk factors for AVF embolism in CRF patients with maintenance hemodialysis (P<0.05), while the use of L-carnitine was a protective factor affecting the occurrence of AVF embolism in CRF patients with maintenance hemodialysis (P<0.05). The predicted value of the calibration curve of the nomogram model predicting the risk of AVF embolism in CRF patients with maintenance hemodialysis was basically consistent with the actual value, and the area under the receiver operating characteristic (ROC) curve was 0.849 (95%CI: 0.790-0.909) with a better discrimination.

Conclusion

The nomogram model constructed in this study showed good discrimination and consistency for predicting the risk of AVF embolism in CRF patients undergoing maintenance hemodialysis.

Key words: Chronic renal failure, Maintenance hemodialysis, Arteriovenous fistula, Embolization, Nomogram

Yilin Xu, Jun Liu, Wenying Zhang, Min Wei, Hailun Li. Establishment of a nomogram model for individualized prediction of the risk of arteriovenous fistula embolism occurrence in MHD patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(02): 81-86.

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References 25

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因素	AVF栓塞组(n＝54)	AVF畅通组(n＝200)	t/χ²值	P值
年龄(岁)[例(%)]			0.731	0.393
≥60	30(55.56)	98(49.00)
<60	24(44.44)	102(51.00)
性别[例(%)]			0.569	0.451
男	32(59.26)	107(53.50)
女	22(40.74)	93(46.50)
心脑血管疾病[例(%)]			1.372	0.241
有	16(29.63)	44(22.00)
无	38(70.37)	156(78.00)
糖尿病[例(%)]			19.818	<0.001
有	34(62.96)	60(30.00)
无	20(37.04)	140(70.00)
高血压[例(%)]			1.378	0.240
有	25(46.30)	75(37.50)
无	29(53.70)	125(62.50)
原发性肾病[例(%)]			0.996	0.802
糖尿病肾病	24(44.44)	83(41.50)
慢性肾小球肾炎	16(29.63)	60(30.00)
高血压肾炎	10(18.52)	47(23.50)
其他	4(7.41)	10(5.00)
血肿压迫[例(%)]			1.565	0.211
有	8(14.81)	18(9.00)
无	46(85.19)	182(91.00)
透析后低血压[例(%)]			11.727	0.001
有	34(62.96)	74(37.00)
无	20(37.04)	126(63.00)
血液状态[例(%)]			15.858	<0.001
正常	21(38.89)	137(68.50)
高凝	33(61.11)	63(31.50)
内瘘感染[例(%)]			1.388	0.239
有	5(9.26)	10(5.00)
无	49(90.74)	190(95.00)
血红蛋白(g/L)	102.84±18.24	98.67±18.94	1.447	0.149
白蛋白(g/L)	36.84±5.18	38.04±6.06	1.329	0.185
甲状旁腺激素(pmol/L)	44.19±8.16	42.85±7.69	1.121	0.263
C-反应蛋白(mg/L)	21.17±4.82	20.29±4.54	1.247	0.213
三酰甘油(mmol/L)	1.68±0.45	1.59±0.40	1.428	0.155
总胆固醇(mmol/L)	3.58±1.03	3.46±0.97	0.796	0.427
低密度脂蛋白胆固醇(mmol/L)	2.43±0.41	2.38±0.39	0.827	0.409
高密度脂蛋白胆固醇(mmol/L)	1.06±0.26	1.02±0.28	0.945	0.345
钙磷乘积(mg²/dl²)	59.24±6.24	50.67±5.86	9.405	<0.001
血磷(mmol/L)	2.30±0.80	1.82±0.75	4.114	<0.001
血钙(mmol/L)	2.43±0.29	2.36±0.31	1.492	0.137
内瘘首用时间[例(%)]			0.970	0.325
>30 d	27(50.00)	85(42.50)
≤30 d	27(50.00)	115(57.50)
透析次数[例(%)]			1.146	0.284
>8次	38(70.37)	125(62.50)
≤8次	16(29.63)	75(37.50)
使用左卡尼汀[例(%)]			16.705	<0.001
有	12(22.22)	107(53.50)
无	42(77.78)	93(46.50)
使用阿司匹林[例(%)]			1.104	0.293
有	30(55.56)	95(47.50)
无	24(44.44)	105(52.50)
使用叶酸[例(%)]			0.026	0.871
有	16(29.63)	57(28.50)
无	38(70.37)	143(71.50)
头静脉内径(mm)	22.71±2.18	23.06±2.21	1.036	0.301
桡动脉内径(mm)	21.39±2.96	21.72±3.08	0.704	0.482

因素	AVF栓塞组(n＝54)	AVF畅通组(n＝200)	t/χ²值	P值
年龄(岁)[例(%)]			0.731	0.393
≥60	30(55.56)	98(49.00)
<60	24(44.44)	102(51.00)
性别[例(%)]			0.569	0.451
男	32(59.26)	107(53.50)
女	22(40.74)	93(46.50)
心脑血管疾病[例(%)]			1.372	0.241
有	16(29.63)	44(22.00)
无	38(70.37)	156(78.00)
糖尿病[例(%)]			19.818	<0.001
有	34(62.96)	60(30.00)
无	20(37.04)	140(70.00)
高血压[例(%)]			1.378	0.240
有	25(46.30)	75(37.50)
无	29(53.70)	125(62.50)
原发性肾病[例(%)]			0.996	0.802
糖尿病肾病	24(44.44)	83(41.50)
慢性肾小球肾炎	16(29.63)	60(30.00)
高血压肾炎	10(18.52)	47(23.50)
其他	4(7.41)	10(5.00)
血肿压迫[例(%)]			1.565	0.211
有	8(14.81)	18(9.00)
无	46(85.19)	182(91.00)
透析后低血压[例(%)]			11.727	0.001
有	34(62.96)	74(37.00)
无	20(37.04)	126(63.00)
血液状态[例(%)]			15.858	<0.001
正常	21(38.89)	137(68.50)
高凝	33(61.11)	63(31.50)
内瘘感染[例(%)]			1.388	0.239
有	5(9.26)	10(5.00)
无	49(90.74)	190(95.00)
血红蛋白(g/L)	102.84±18.24	98.67±18.94	1.447	0.149
白蛋白(g/L)	36.84±5.18	38.04±6.06	1.329	0.185
甲状旁腺激素(pmol/L)	44.19±8.16	42.85±7.69	1.121	0.263
C-反应蛋白(mg/L)	21.17±4.82	20.29±4.54	1.247	0.213
三酰甘油(mmol/L)	1.68±0.45	1.59±0.40	1.428	0.155
总胆固醇(mmol/L)	3.58±1.03	3.46±0.97	0.796	0.427
低密度脂蛋白胆固醇(mmol/L)	2.43±0.41	2.38±0.39	0.827	0.409
高密度脂蛋白胆固醇(mmol/L)	1.06±0.26	1.02±0.28	0.945	0.345
钙磷乘积(mg²/dl²)	59.24±6.24	50.67±5.86	9.405	<0.001
血磷(mmol/L)	2.30±0.80	1.82±0.75	4.114	<0.001
血钙(mmol/L)	2.43±0.29	2.36±0.31	1.492	0.137
内瘘首用时间[例(%)]			0.970	0.325
>30 d	27(50.00)	85(42.50)
≤30 d	27(50.00)	115(57.50)
透析次数[例(%)]			1.146	0.284
>8次	38(70.37)	125(62.50)
≤8次	16(29.63)	75(37.50)
使用左卡尼汀[例(%)]			16.705	<0.001
有	12(22.22)	107(53.50)
无	42(77.78)	93(46.50)
使用阿司匹林[例(%)]			1.104	0.293
有	30(55.56)	95(47.50)
无	24(44.44)	105(52.50)
使用叶酸[例(%)]			0.026	0.871
有	16(29.63)	57(28.50)
无	38(70.37)	143(71.50)
头静脉内径(mm)	22.71±2.18	23.06±2.21	1.036	0.301
桡动脉内径(mm)	21.39±2.96	21.72±3.08	0.704	0.482

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
糖尿病	1.211	0.381	10.082	0.001	3.357	1.590~7.090
透析后低血压	1.148	0.392	8.579	0.003	3.153	1.462~6.799
血液状态	1.222	0.390	9.801	0.002	3.394	1.579~7.294
钙磷乘积	0.157	0.035	20.465	<0.001	1.170	1.093~1.252
血磷	0.254	0.302	0.707	0.401	1.289	0.713~2.328
使用左卡尼汀	－1.297	0.416	9.731	0.002	0.273	0.121~0.617
常量	－11.508	2.088	30.387	<0.001	0.000

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
糖尿病	1.211	0.381	10.082	0.001	3.357	1.590~7.090
透析后低血压	1.148	0.392	8.579	0.003	3.153	1.462~6.799
血液状态	1.222	0.390	9.801	0.002	3.394	1.579~7.294
钙磷乘积	0.157	0.035	20.465	<0.001	1.170	1.093~1.252
血磷	0.254	0.302	0.707	0.401	1.289	0.713~2.328
使用左卡尼汀	－1.297	0.416	9.731	0.002	0.273	0.121~0.617
常量	－11.508	2.088	30.387	<0.001	0.000

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