Key result
An increased CHA2DS2-VASc score at hemodialysis initiation predicted stroke (p<0.0001) and all-cause mortality (p<0.0001) in patients with and without atrial fibrillation.
Why the study?
Cardiovascular events are the leading cause of morbidity and mortality in hemodialysis patients, and evaluating risk scores like CHA2DS2-VASc may help predict strokes, major cardiovascular events, and mortality in end-stage kidney disease.
Does the CHA2DS2-VASc score predict strokes, major cardiovascular events, and mortality in patients on hemodialysis?
Cohort (n=237)
Does the CHA2DS2-VASc score predict strokes, major cardiovascular events, and mortality in patients on hemodialysis?
p-value: p=<0.0001
The CHA2DS2-VASc score can predict strokes, heart failure, and all-cause mortality in hemodialysis patients regardless of the presence of atrial fibrillation.
CHA2DS2-VASc may aid risk stratification in hemodialysis; leaves open prospective validation before clinical adoption.
Background and Objectives: Cardiovascular events are the major cause of morbidity and mortality in patients on hemodialysis (HD). Identifying risk factors can help in the effort to reduce cardiovascular risk and improve life expectancy. The objective of this study was to evaluate the ability of the CHA2DS2-VASc score—the risk index of stroke in atrial fibrillation (AF)—to predict strokes, major cardiovascular events, and mortality in patients with end-stage kidney disease. Materials and Methods: The CHA2DS2-VASc and HAS-BLED scores (the bleeding risk from the use of anticoagulation in AF) were calculated in 237 HD patients, 99 women with a median age of 76 (15) years, at the time they commenced HD. The scores’ ability to predict long term cardiovascular morbidity and mortality was estimated, both in those with and without AF. Among the exclusion criteria were the change of dialysis method or loss of follow-up, HD due to acute renal failure, and incompliance with medical instructions, thus the sample is not representative of a broader population. Results: The CHA2DS2-VASc score was higher in AF (n = 69) compared to non-AF (n = 168) patients, 5 (2.5) vs. 4 (2), p < 0.0001, respectively. An increased CHA2DS2-VASc score was correlated with cardiovascular events, namely, heart failure (p = 0.007, p = 0.024), stroke (p < 0.0001, p < 0.0001), and risk of all-cause mortality (p < 0.0001, p < 0.0001) in AF and non-AF groups, respectively. The C statistics indicated that the referred score showed modest discrimination in AF and non-AF patients on HD for heart failure, stroke, and all-cause mortality, however for cardiovascular mortality this was found only in the AF group. Conclusions: An increased CHA2DS2-VASc score at the time of HD initiation can predict strokes, heart failure, and all-cause mortality in HD patients independent of the presence of AF. The risk of cardiovascular mortality could only be predicted in patients with AF.
No takes yet. Share an insight, caveat, or question.
Tourountzis et al. (2024) conducted a cohort in End-stage kidney disease on hemodialysis (n=237). CHA2DS2-VASc score was evaluated on Heart failure, stroke, and all-cause mortality (p=<0.0001). An increased CHA2DS2-VASc score at hemodialysis initiation predicted stroke (p<0.0001) and all-cause mortality (p<0.0001) in patients with and without atrial fibrillation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: