{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T21:24:57Z","timestamp":1787088297530,"version":"build-2736575974"},"reference-count":24,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Arteriovenous fistula (AVF) stenosis is an important complication of hemodialysis that may impair dialysis adequacy and patient outcomes. Conventional AVF monitoring relies largely on subjective physical assessment and may delay recognition of abnormal vascular access findings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This prospective pilot study aimed to assess the feasibility of serial electronic stethoscope monitoring for detecting abnormal AVF sounds before routine nursing assessment, and explore factors associated with a high-risk AVF phenotype, defined as percutaneous transluminal angioplasty within the preceding 3 years.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a 3-month prospective study at the National Taiwan University Hospital Yunlin Branch Hemodialysis Center from March to June 2023. Thirty adults receiving maintenance hemodialysis through a functional AVF were enrolled; 29 completed follow-up and generated 1462 acoustic recordings. AVF sounds were recorded 2-6 times weekly at 2 standardized sites: approximately 3 cm proximal to the anastomosis and the arterial needle insertion site. Signals were analyzed using short-time Fourier transform and expressed as decibels relative to full scale. Clinical, demographic, laboratory, and dialysis-related data were collected. Because recordings were clustered within patients, risk-factor analyses were performed at the patient level. Associations with the prespecified high-risk AVF phenotype were explored using Fisher exact tests and Firth penalized logistic regression because only 9 patients met the high-risk definition.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n An exploratory in-sample candidate threshold for abnormal AVF sounds was derived at <\u221228.59 decibels relative to full scale using a 3SD rule. Because the threshold was developed, refined, and evaluated within the same small dataset, it requires independent external validation. One participant had stenosis confirmed by duplex Doppler before acoustic monitoring began. In this illustrative case, the acoustic signal remained abnormal and was recognized approximately 1 month before routine bedside nursing assessment, although not before imaging. All stenotic recordings originated from this single participant and therefore do not constitute independent evidence of diagnostic performance. In exploratory patient-level analyses, the high-risk phenotype was associated with diabetes mellitus (odds ratio [OR] 12.6, 95% CI 2.2-138.1;\n P<\/jats:italic>\n =.005), hypertension (OR 12.9, 95% CI 1.3-31.7;\n P<\/jats:italic>\n =.033), and BMI \u226425 kg\/m\u00b2 (OR 19.0, 95% CI 2.0-2568;\n P<\/jats:italic>\n =.011). Fresenius FX-series dialyzer use was not significant on exact testing (OR 4.4, 95% CI 0.9-28.5;\n P<\/jats:italic>\n =.11). Estimates were imprecise because of the limited number of high-risk patients.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Serial electronic stethoscope monitoring was feasible. In one illustrative patient with Doppler-confirmed stenosis, persistent acoustic abnormalities were recognized before routine nursing assessment but not before imaging. The candidate acoustic threshold and exploratory correlates of high-risk AVF status require confirmation in larger, externally validated prospective cohorts before clinical implementation.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/97202","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:55:08Z","timestamp":1784530508000},"page":"e97202-e97202","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors of Arteriovenous Fistula Stenosis in Hemodialysis Patients Using Electronic Stethoscope Monitoring: Prospective Pilot Cohort Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3297-645X","authenticated-orcid":false,"given":"Wen-Yi","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8452-2942","authenticated-orcid":false,"given":"Yi-Chen","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4187-6888","authenticated-orcid":false,"given":"Bor-Wen","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1235-1943","authenticated-orcid":false,"given":"Feng-Jung","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"R1","unstructured":"International comparisons. 2025 USRDS annual data report: epidemiology of kidney disease in the United States. National Institute of Diabetes and Digestive and Kidney Diseases. United States Renal Data System. URL: https:\/\/usrds-adr.niddk.nih.gov\/2025\/end-stage-renal-disease\/11-international-comparisons [Accessed 02-08-2026]"},{"key":"R2","unstructured":"2024 Taiwan renal registry data report. Taiwan Society of Nephrology. 2025. URL: https:\/\/www.tsn.org.tw\/en\/twrds_detail.html?year=2024 [Accessed 02-08-2026]"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1111\/sdi.12828","article-title":"Vascular access for hemodialysis: a perpetual challenge","volume":"32","author":"Murea","journal-title":"Semin Dial"},{"issue":"4 Suppl 2","key":"R4","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1053\/j.ajkd.2019.12.001","article-title":"KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update","volume":"75","author":"Lok","journal-title":"Am J Kidney Dis"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1053\/j.ajkd.2016.07.031","article-title":"Sleep disorders, restless legs syndrome, and uremic pruritus: diagnosis and treatment of common symptoms in dialysis patients","volume":"69","author":"Scherer","journal-title":"Am J Kidney 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flow\/resistance index ratio (Q) as a marker of stenosis and future thrombotic events in native arteriovenous fistulas","volume":"7","author":"Colombo","journal-title":"Front Surg"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00894-9","article-title":"Deep learning analysis of blood flow sounds to detect arteriovenous fistula stenosis","volume":"6","author":"Zhou","journal-title":"NPJ Digit Med"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"160","DOI":"10.5152\/dir.2014.14348","article-title":"Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency","volume":"21","author":"Aktas","journal-title":"Diagn Interv Radiol"},{"key":"R16","volume":"91","author":"Zhou","journal-title":"Ann Ital 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