Assessment of the CHA2DS2-VASc Score in Predicting Mortality and Adverse Cardiovascular Outcomes of Patients on Hemodialysis

Abstract

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.