{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:59:57Z","timestamp":1790873997536,"version":"4.1.0"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In hemodialysis patients, arteriovenous fistulas (AVF) are the preferred vascular access for most hemodialysis patients. However, aneurysms of the AVF can lead to severe complications, including rupture and life-threatening exsanguination. To address this risk, we recently developed, trained, and validated a convolutional neural network capable of classifying digital images of arteriovenous aneurysms captured via mobile devices as showing either \u201cAdvanced\u201d or \u201cNot Advanced\u201d aneurysms. This cloud-based aneurysm classification application (ACA) aims to facilitate early detection of advanced aneurysms, potentially reducing morbidity and improving outcomes. Our study aimed to compare the diagnostic performance of ACA with in-person aneurysm assessments by physicians specialized in vascular access care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a single-masked, multicenter, observational, cross-sectional study at two vascular care centers with a catchment area of 21 hemodialysis clinics. Using mobile devices, research staff captured images of arteriovenous accesses and uploaded them to the cloud. The ACA then computed the probability of \u201cAdvanced\u201d and \u201cNot Advanced\u201d aneurysms. Separately, physicians masked to the ACA results performed thorough physical and ultrasound examinations of the AVF and classified aneurysms as \u201cAdvanced\u201d or \u201cNot Advanced\u201d. Physician classifications served as the ground truth for ACA performance analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We analyzed 720 images from 120 incenter hemodialysis patients (six images per patient). Mean patient age was 62 years, 66 were male. Physicians classified 26 patients (22%) having \u201cAdvanced\u201d aneurysms and 94 (78%) having \u201cNot Advanced\u201d aneurysms. The ACA achieved an AUROC of 0.908 (95% confidence interval: 0.843\u20130.963). At the maximum Youden index, ACA classified 42 aneurysms (35%) as \u201cAdvanced\u201d and 78 (65%) as \u201cNot Advanced,\u201d yielding a sensitivity of 96% and a specificity of 82%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The ACA demonstrated promising accuracy in this initial masked evaluation. Further validation in larger, independent cohorts and under real-world conditions is warranted before broader clinical deployment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.0000001231","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:08:42Z","timestamp":1790870922000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Cloud-Based AI Application for Classifying Arteriovenous Hemodialysis Vascular Access Aneurysms"],"prefix":"10.2215","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4087-3212","authenticated-orcid":false,"given":"Zijun","family":"Dong","sequence":"first","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanjie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0860-7651","authenticated-orcid":false,"given":"Lin-Chun","family":"Wang","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8542-5742","authenticated-orcid":false,"given":"Andrea Nandorine","family":"Ban","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Ren","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lela","family":"Tisdale","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8286-0981","authenticated-orcid":false,"given":"Maggie","family":"Han","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1299-1170","authenticated-orcid":false,"given":"Denzil","family":"Douglas","sequence":"additional","affiliation":[{"name":"Azura Vascular Care, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3441-8566","authenticated-orcid":false,"given":"Piotr","family":"Starakiewicz","sequence":"additional","affiliation":[{"name":"Azura Vascular Care, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Shtaynberg","sequence":"additional","affiliation":[{"name":"Azura Vascular Care, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Fuca","sequence":"additional","affiliation":[{"name":"Azura Vascular Care, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Kozyra","sequence":"additional","affiliation":[{"name":"Azura Vascular Care, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0277-8962","authenticated-orcid":false,"given":"Sindhuri","family":"Prakash-Polet","sequence":"additional","affiliation":[{"name":"Azura Vascular Care, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria G.","family":"Bittencourt","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rosales M.","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Thijssen","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3242-5529","authenticated-orcid":false,"given":"Dean C.","family":"Preddie","sequence":"additional","affiliation":[{"name":"Azura Vascular Care, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4373-412X","authenticated-orcid":false,"given":"Peter","family":"Kotanko","sequence":"additional","affiliation":[{"name":"Renal Research Institute, New York, NY, United States."},{"name":"Icahn School of Medicine at Mount Sinai, New York, NY, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,1]]},"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001231","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:08:42Z","timestamp":1790870922000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001231"}},"subtitle":["Findings from a Masked Multicenter Derivation Cohort Study"],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":0,"URL":"https:\/\/doi.org\/10.2215\/cjn.0000001231","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"assertion":[{"value":"2026-04-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-24","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}