Utility of CHA₂DS₂-VASc Score to Predict Mid-Term Clinical Outcomes in Hemodialysis Patients

Abstract

<b><i>Background:</i></b> The CHA<sub>2</sub>DS<sub>2</sub>-VASc score has been widely used to predict stroke in patients with atrial fibrillation (AF). Recently, it was reported that the CHA<sub>2</sub>DS<sub>2</sub>-VASc score helps predict cardiovascular disease (CVD) or all-cause mortality in patients with or without AF. However, few reports have examined the association between this score and mortality in hemodialysis (HD) patients. <b><i>Methods:</i></b> We analyzed 557 consecutive patients who initiated HD at our facilities between February 2005 and October 2017. The CHA<sub>2</sub>DS<sub>2</sub>-VASc score was calculated at the time of initiation of HD. Patients were then categorized into three groups according to their CHA<sub>2</sub>DS<sub>2</sub>-VASc scores: 0–1 (low), 2–3 (intermediate), and 4–9 (high). Multivariate Cox proportional hazards analysis was used to assess independent risk factors for 3-year all-cause mortality. <b><i>Results:</i></b> During the 3-year follow-up period, 153 (27.5%) patients died (cardiovascular death: <i>n</i> = 88). According to multivariate analysis, serum albumin (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.43–0.85, <i>p</i> = 0.003), creatinine (HR 0.91, 95% CI 0.84–0.99, <i>p</i> = 0.049), and CHA<sub>2</sub>DS<sub>2</sub>-VASc score (HR 1.33, 95% CI 1.20–1.46, <i>p</i> < 0.001) were associated with 3-year all-cause mortality. Compared with patients in the low CHA<sub>2</sub>DS<sub>2</sub>-VASc score group, those in the intermediate- and high-score groups had a higher risk for all-cause and CVD mortality (all-cause mortality: HR 1.77, 95% CI 1.23–2.55, <i>p</i> = 0.002 and HR 2.94, 95% CI 1.90–4.53, <i>p</i> < 0.001, respectively; CVD mortality: HR 1.82, 95% CI 1.27–2.59, <i>p</i> = 0.001 and HR 2.85, 95% CI 1.88–4.31, <i>p</i> < 0.001, respectively). <b><i>Conclusion:</i></b> The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is a valuable predictor of 3-year all-cause and CVD mortality in incident HD patients.

The prognostic value of CHA2DS2‐VASc and modified‐CHADS2 scores for cardiovascular events in diabetics and non‐diabetics haemodialysis patients

“…10 Another study of 557 HD patients concluded that the CHA 2 DS 2 -VASc score can predict 3-year all-cause and cardiovascular mortality in this population. 29 Modified-CHADS 2 score demonstrated the best discrimination compared with other scores for predicting ischemic stroke in patients with atrial fibrillation. 5 Moreover, in another study, modified-CHADS 2 score showed good performance across advanced CKD, both for discrimination and calibration, for ischemic stroke risk estimation in atrial fibrillation patients.…”

“…More specifically, high CHA 2 DS 2 ‐VASc score in ESRD patients undergoing HD was associated with increased incidence of myocardial infarction or stroke and also, a 4‐fold increased risk of all‐cause mortality, within the first year of HD 10 . Another study of 557 HD patients concluded that the CHA 2 DS 2 ‐VASc score can predict 3‐year all‐cause and cardiovascular mortality in this population 29 . Modified‐CHADS 2 score demonstrated the best discrimination compared with other scores for predicting ischemic stroke in patients with atrial fibrillation 5 .…”

Cardiovascular Events and Mortality in Patients on Hemodialysis: The Prognostic Value of the CHA2DS2-VASc Score

“…Previous studies have shown that this score is used for the estimation of not only cardiovascular, but also of all-cause mortality in persons with chronic kidney disease (CKD) with and without AF [6][7][8]. Moreover, it was used as a predictor of three-year all-cause and cardiovascular mortality in patients on HD [9]. Furthermore, a CHA 2 DS 2 -VASc score above 3.5 and the presence of a central venous catheter at the commencement of HD may predict one-year mortality in this population [10].…”

“…Table S1 (found in the Supplementary Materials) describes the parameters that consist of and determine the CHA 2 DS 2 -VASc score. This score is not often used in patients on HD and previous studies have tried to correlate it with cardiovascular and all-cause mortality at HD [6][7][8][9][10].…”

Survival benefits of oral anticoagulation therapy in acute kidney injury patients with atrial fibrillation: a retrospective study from the MIMIC-IV database

“…Additionally, there was an interaction between OAC and CHA2DS2-VASc on mortality. It could be that CHA2DS2-VASc score was strongly associated with all-cause mortality in hemodialysis patients, 19 and survival benefit is partially offset. Several studies show that altered clot properties resulting in denser clots with thinner fibres 20 and routine heparin during dialysis could lead to an increased bleeding risk in dialysis patients.…”