Key result
High CHA2DS2-VASc linked to ~4-fold higher 1-year major events in hemodialysis patients.
Why the study?
Patients with end-stage renal disease undergoing chronic hemodialysis have high mortality and cardiovascular risk, and the utility of the CHA2DS2-VASc score for risk stratification in this population was unclear.
Cohort (n=457)
No
Odds Ratio: 4.2 (95% CI 2.3–7.5)
p-value: p=< 0.01
Supports CHA2DS2-VASc for prognostication in hemodialysis; hypothesis-generating and requires prospective validation before guiding care.
BACKGROUND: Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis are at high mortality and cardiovascular risk. This study was aimed to assess whether the CHA2DS2-VASc score may be used for risk stratification of this population. METHODS: Included were patients undergoing chronic hemodialysis at Meir Medical Center. The CHA2DS2-VASc score was calculated for each patient at the initiation of hemodialysis. Patients were classified into 3 groups according to the CHA2DS2-VASc score: 0-3 (low), 4-5 (intermediate), and ≥6 (high). The primary endpoint was the composite of all-cause mortality, myocardial infarction, and stroke during the first year of hemodialysis. RESULTS: Of the 457 patients with ESRD, 181 (40%) had low, 193 (42%) intermediate, and 83 (18%) high CHA2DS2-VASc scores. During the first year of hemodialysis, 109 (23.8%) patients died, 17 (3.7%) had a stroke, and 28 (6.1%) had a myocardial infarction. Compared to patients in the low CHA2DS2-VASc score group, those in the intermediate and high score groups had higher risk for the composite endpoint (OR: 2.6, 95% CI: 1.6-4.2, p < 0.01 and OR: 4.2, 95% CI: 2.3-7.5, p < 0.01, respectively). Each 1-point increase in CHA2DS2-VASc score was associated with a 38% increased risk for the composite endpoint, a 19% increased risk for 1-year myocardial infarction, and a 29% increased risk for 1-year stroke. CONCLUSIONS: Patients with ESRD are at an extremely high mortality and cardiovascular risk within the first year of hemodialysis. The CHA2DS2-VASc score was strongly associated with adverse outcomes and may be used for risk stratification of these patients.
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Pravda et al. (2020) conducted a cohort in End-stage renal disease undergoing chronic hemodialysis (n=457). High CHA2DS2-VASc score (≥6) vs. Low CHA2DS2-VASc score (0-3) was evaluated on Composite of all-cause mortality, myocardial infarction, and stroke during the first year of hemodialysis (OR 4.2, 95% CI 2.3-7.5, p=< 0.01). Compared to a low score, a high CHA2DS2-VASc score (≥6) increased the risk of the 1-year composite of mortality, MI, and stroke in hemodialysis patients (OR 4.2; 95% CI 2.3-7.5; p<0.01).
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