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Granal M, Brokhes-Le Calvez S, Dimitrov Y, Chantrel F, Borni-Duval C, Muller C, Délia M, Krummel T, Hannedouche T, Ducher M, Fauvel JP. External validation of the 2-year mortality prediction tool in hemodialysis patients developed using a Bayesian network. Clin Kidney J 2024; 17:sfae095. [PMID: 38915433 PMCID: PMC11195611 DOI: 10.1093/ckj/sfae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Indexed: 06/26/2024] Open
Abstract
Background In recent years, a number of predictive models have appeared to predict the risk of medium-term mortality in hemodialysis patients, but only one, limited to patients aged over 70 years, has undergone sufficiently powerful external validation. Recently, using a national learning database and an innovative approach based on Bayesian networks and 14 carefully selected predictors, we have developed a clinical prediction tool to predict all-cause mortality at 2 years in all incident hemodialysis patients. In order to generalize the results of this tool and propose its use in routine clinical practice, we carried out an external validation using an independent external validation database. Methods A regional, multicenter, observational, retrospective cohort study was conducted to externally validate the tool for predicting 2-year all-cause mortality in incident and prevalent hemodialysis patients. This study recruited a total of 142 incident and 697 prevalent adult hemodialysis patients followed up in one of the eight Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL) Alsace dialysis centers. Results In incident patients, the 2-year all-cause mortality prediction tool had an area under the receiver curve (AUC-ROC) of 0.73, an accuracy of 65%, a sensitivity of 71% and a specificity of 63%. In prevalent patients, the performance for the external validation were similar in terms of AUC-ROC, accuracy and specificity, but was lower in term of sensitivity. Conclusion The tool for predicting all-cause mortality at 2 years, developed using a Bayesian network and 14 routinely available explanatory variables, obtained satisfactory external validation in incident patients, but sensitivity was insufficient in prevalent patients.
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Affiliation(s)
- Maelys Granal
- Department of Nephrology, Hospices Civils de Lyon, Hôpital Edouard Herriot, UMR 5558 CNRS Lyon, Université Lyon 1, Lyon, France
| | | | - Yves Dimitrov
- Renal Research Division, AURAL Strasbourg, Strasbourg, France
- Department of Nephrology, CH Haguenau, Haguenau, France
| | - François Chantrel
- Renal Research Division, AURAL Strasbourg, Strasbourg, France
- Department of Nephrology Groupe Hospitalier de la Région Mulhouse et Sud Alsace, Hôpital Emile Muller, Strasbourg, France
| | | | - Clotilde Muller
- Renal Research Division, AURAL Strasbourg, Strasbourg, France
- Department of Nephrology Groupe Hospitalier Saint-Vincent, Clinique Ste-Anne, Service de Néphrologie, Strasbourg, France
| | - May Délia
- Renal Research Division, AURAL Strasbourg, Strasbourg, France
| | - Thierry Krummel
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Néphrologie et Hémodialyse, Strasbourg, France
| | | | - Micher Ducher
- Department of Nephrology, Hospices Civils de Lyon, Hôpital Edouard Herriot, UMR 5558 CNRS Lyon, Université Lyon 1, Lyon, France
| | - Jean-Pierre Fauvel
- Department of Nephrology, Hospices Civils de Lyon, Hôpital Edouard Herriot, UMR 5558 CNRS Lyon, Université Lyon 1, Lyon, France
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Pena Prado A, Caron A. [Implementing vascular access protection indicators (VAPI) in dialysis: an innovation in quality of care]. REVUE DE L'INFIRMIERE 2024; 73:30-33. [PMID: 38643999 DOI: 10.1016/j.revinf.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Between 2013 and 2021, indicators of vascular access protection (IPAV) integrating a census of haematomas and multiple punctures were set up on the active file of chronic kidney failure patients with a vascular access dialyzed in Monaco's private haemodialysis center. They could help reduce the occurrence of complications and improve the quality of care offered to patients. This article reports on the results obtained before and after the introduction of this quality approach.
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Affiliation(s)
- Angeline Pena Prado
- Centre d'hémodialyse privé de Monaco, Elsan, 32-34 quai Jean-Charles-Rey, 98000 Monaco.
| | - Alexandre Caron
- Cemka, 43 boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France
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Guillouet E, Tomadesso C, Flores BA, Henri P, Lanot A, Morello R, Guillouet S. Impact of simulation-based training in addition to theoretical training versus theoretical training of nurses alone in the occurrence of adverse events related to arteriovenous fistula puncture in chronic hemodialysis patients: study for a cluster randomized controlled trial (SIMFAV2). Trials 2023; 24:500. [PMID: 37550740 PMCID: PMC10405400 DOI: 10.1186/s13063-023-07513-8] [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: 05/31/2023] [Accepted: 07/12/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The technique of arteriovenous fistula (AVF) puncture is currently taught by colleagues within hemodialysis units. Even if the main principles of the technique are well known and common to all hemodialysis units, strong rationales are still missing to standardize fine practices such as the relative position of the needles, the angle of the needle at puncture, and the position of the bevel at the time of puncture and after the needle is in the vascular lumen. METHODS We are conducting a prospective, comparative, center-randomized, multicenter study involving 8 hemodialysis centers. The primary objective is to compare the number of adverse events related to AVF puncture between a group receiving theoretical training plus simulation-based training (4 centers) and a group receiving only theoretical training (4 centers). The study will include all adult patients who are scheduled to have an AVF puncture performed by a hemodialysis-trained nurse during a scheduled chronic dialysis session. DISCUSSION We hypothesize that a training program for nurses on the AVF approach in procedural simulation versus theoretical input alone would decrease the adverse events related to AVF punctures and would be beneficial for the patient. This study is innovative for several reasons. First, simulation-based training in continuing education among professionals is not widely used. Furthermore, training allows for the standardization of practices within the team, both technically and relationally. TRIAL REGISTRATION ClinicalTrials.gov NCT05302505 . Registered on March 17, 2022.
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Affiliation(s)
- Erwan Guillouet
- NorSimS Simulation Center, Caen University Hospital, Caen, France
| | | | | | - Patrick Henri
- Department of Nephrology, Caen University Hospital, Caen, France
| | - Antoine Lanot
- Department of Nephrology, Caen University Hospital, Caen, France
| | - Rémy Morello
- Clinical Research Department, Caen University Hospital, Caen, France
| | - Sonia Guillouet
- Department of Nephrology, Caen University Hospital, Caen, France.
- Health Training and Research Center, Caen University, Caen, France.
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