Key result
An increased CHA2DS2-VASc score at the start of hemodialysis predicted stroke, heart failure, and all-cause mortality independent of the presence of atrial fibrillation (P<0.0001).
Why the study?
Cardiovascular events are the leading cause of morbidity and mortality in hemodialysis patients, and the ability of the CHA2DS2-VASc score to predict stroke, major cardiovascular events, and mortality in end-stage kidney disease needed evaluation.
Does the CHA2DS2-VASc score predict stroke, major cardiovascular events, and mortality in hemodialysis patients with and without atrial fibrillation?
Cohort (n=237)
Does the CHA2DS2-VASc score predict stroke, major cardiovascular events, and mortality in hemodialysis patients with and without atrial fibrillation?
p-value: p=<0.0001
The CHA2DS2-VASc score can predict stroke, heart failure, and all-cause mortality in hemodialysis patients independent of the presence of atrial fibrillation.
May aid risk stratification in hemodialysis; leaves open clinical utility pending prospective validation.
Background and Objectives: Cardiovascular events are the leading cause of morbidity and mortal-ity in hemodialysis (HD) patients. Identifying risk factors can help in the effort to reduce cardi-ovascular risk and improve life expectancy. The purpose of this study was to evaluate the ability of CHA2DS2-VASc score [risk index of stroke in atrial fibrillation (AF)] in patients with end stage kidney disease, to predict stroke, major cardiovascular events and mortality. Materials and Meth-ods: CHA2DS2-VASc and HAS-BLED (bleeding risk from use of anticoagulation in AF) scores were calculated in 237 HD patients, [99 women, median age 76 (15) years], at time they com-menced on HD. The scores’ ability to predict long term cardiovascular morbidity and mortality was estimated, both in those with and without AF. Results: CHA2DS2-VASc score was signifi-cantly increased in AF (n=69) compared to non-AF (n=168) patients, 5 (2.5) versus 4 (2), p<0.0001, respectively. Increased CHA2DS2-VASc score was associated with 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 both groups, respectively. C statistics indicated that CHA2DS2-VASc score performed modest discrimination in this HD population with and without AF for heart failure, stroke, and all-cause mortality, but for cardiovascular mortality in AF group only. Conclusions: Increased CHA2DS2-VASc score at time starting on HD, can predict stroke, heart failure and all-cause mortality in HD patients in-dependent of the presence of AF. Risk of cardiovascular mortality could be predicted only on patients with AF.
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Tourountzis et al. (2023) conducted a cohort in End stage kidney disease on hemodialysis (n=237). CHA2DS2-VASc score was evaluated on Stroke, major cardiovascular events, and mortality (p=<0.0001). An increased CHA2DS2-VASc score at the start of hemodialysis predicted stroke, heart failure, and all-cause mortality independent of the presence of atrial fibrillation (P<0.0001).
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