Machine Learning Algorithms as new screening framework for recommendation of Appropriate Vascular Access and Stroke Reduction

Hemodialysis (HD) is a life-saving treatment for End Stage Renal Disease (ESRD) patients who have lost both kidneys. Despite that central venous catheter (CVC) placement is a common vascular access to be able to do HD, but risk of cardiovascular diseases, including stroke in patients with ESRD is 5–30 times greater than that in the general population. Specially, cerebrovascular accident (CVA) is one of significant complications after CVC insertion and the average annual stroke incidence is reported 19.5 per 10000 [person-years] in 2019. So, it is important to understand the set of factors that affect the incidence of CVA in this vulnerable population of patients. 

468 HD patients who underwent vascular access surgery over 2013-2018 in Hasheminejad Kidney Center were studied included 368 cuffed tunneled CVC and 100 non-cuffed CVC.

Studied patients aged 12-86 (mean age, 54.85) years, containing 324 females and 144 males, during 5 years. Finally, 19 patients (4.06% of all HD patients) with CVA identified. Of these, more than three fourths, 15 (78.95%) and 12 (63.16%), of them were hypertensive and diabetic, respectively, with an overall proportion 52.63% (10 individuals) of them were males and the remaining were females. One of CVA patients has 37 years and the rest of the patients are 50 to 73 years old (mean = 61). Risk factor of CVA most is happened in HD patients with CVC insertion before AVF (16 of 19 =84.21%).

There was no occasion to emphasize on young or old ages as the warning signs of stroke in HD patients. But it was concluded that “CVC placement before AVF”, “hypertension” and “diabetes mellitus” are CVA risk factors, respectively; and eventually "In ESRD patients, CVC placement can increase Risk of CVA incident" the investigators conclude. Funding: This work was supported by the Iran National Science Foundation (INSF) in post-doctoral course of the first author (MR-NNA-97006815)