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

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 CHA(2)DS(2)-VASc score may be used for risk stratification of this population.Methods:Included were patients undergoing chronic hemodialysis at Meir Medical Center. The CHA(2)DS(2)-VASc score was calculated for each patient at the initiation of hemodialysis. Patients were classified into 3 groups according to the CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-VASc score was strongly associated with adverse outcomes and may be used for risk stratification of these patients.