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Tourountzis T, Lioulios G, Stasini F, Skarlatou Z, Stai S, Christodoulou M, Moysidou E, Ginikopoulou E, Stangou M. Cardiovascular Events and Mortality in Patients on Hemodialysis: The Prognostic Value of the CHA 2DS 2-VASc Score. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:144. [PMID: 38256404 PMCID: PMC10820266 DOI: 10.3390/medicina60010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Cardiovascular events are the major cause of morbidity and mortality in patients on hemodialysis (HD). Identifying risk factors can help in the effort to reduce cardiovascular risk and improve life expectancy. The objective of this study was to evaluate the ability of the CHA2DS2-VASc score-the risk index of stroke in atrial fibrillation (AF)-to predict strokes, major cardiovascular events, and mortality in patients with end-stage kidney disease. Materials and Methods: The CHA2DS2-VASc and HAS-BLED scores (the bleeding risk from the use of anticoagulation in AF) were calculated in 237 HD patients, 99 women with a median age of 76 (15) years, at the time they commenced HD. The scores' ability to predict long term cardiovascular morbidity and mortality was estimated, both in those with and without AF. Among the exclusion criteria were the change of dialysis method or loss of follow-up, HD due to acute renal failure, and incompliance with medical instructions, thus the sample is not representative of a broader population. Results: The CHA2DS2-VASc score was higher in AF (n = 69) compared to non-AF (n = 168) patients, 5 (2.5) vs. 4 (2), p < 0.0001, respectively. An increased CHA2DS2-VASc score was correlated with cardiovascular events, namely, 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 AF and non-AF groups, respectively. The C statistics indicated that the referred score showed modest discrimination in AF and non-AF patients on HD for heart failure, stroke, and all-cause mortality, however for cardiovascular mortality this was found only in the AF group. Conclusions: An increased CHA2DS2-VASc score at the time of HD initiation can predict strokes, heart failure, and all-cause mortality in HD patients independent of the presence of AF. The risk of cardiovascular mortality could only be predicted in patients with AF.
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Affiliation(s)
- Theodoros Tourountzis
- Protypo Dialysis Center, Hemodialysis Unit, 55535 Thessaloniki, Greece; (T.T.); (F.S.); (Z.S.); (E.G.)
| | - Georgios Lioulios
- Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (S.S.); (M.C.); (E.M.)
| | - Fotini Stasini
- Protypo Dialysis Center, Hemodialysis Unit, 55535 Thessaloniki, Greece; (T.T.); (F.S.); (Z.S.); (E.G.)
| | - Zoi Skarlatou
- Protypo Dialysis Center, Hemodialysis Unit, 55535 Thessaloniki, Greece; (T.T.); (F.S.); (Z.S.); (E.G.)
| | - Stamatia Stai
- Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (S.S.); (M.C.); (E.M.)
| | - Michalis Christodoulou
- Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (S.S.); (M.C.); (E.M.)
| | - Eleni Moysidou
- Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (S.S.); (M.C.); (E.M.)
| | - Evdoxia Ginikopoulou
- Protypo Dialysis Center, Hemodialysis Unit, 55535 Thessaloniki, Greece; (T.T.); (F.S.); (Z.S.); (E.G.)
| | - Maria Stangou
- Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (G.L.); (S.S.); (M.C.); (E.M.)
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Huang PS, Cheng JF, Chen JJ, Wu CK, Wang YC, Hwang JJ, Tsai CT. CHA2DS2VASc score predicts risk of end stage renal disease in patients with atrial fibrillation: Long-term follow-up study. Heliyon 2023; 9:e13978. [PMID: 36879966 PMCID: PMC9984850 DOI: 10.1016/j.heliyon.2023.e13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Background End stage renal disease (ESRD) is an increasing worldwide epidemic disease. CHA2DS2-VASc score is a well-established predictor of cardiovascular outcome among atrial fibrillation (AF) patients. Objective The aim of this study was to test whether CHA2DS2-VASc score is a good predictor for incident ESRD events. Methods This is a retrospective cohort study (from January 2010 to December 2020) with median follow-up of 61.7 months. Clinical parameters and baseline characteristics were recorded. The endpoint was defined as ESRD with dialysis dependent. Results The study cohort comprised 29,341 participants. Their median age was 71.0 years, 43.2% were male, 21.5% had diabetes mellitus, 46.1% had hypertension, and mean CHA2DS2-VASc score was 2.89. CHA2DS2-VASc score was incrementally associated with the risk of ESRD status during follow-up. Using the univariate Cox model, we found a 26% increase in ESRD risk with an increase of one point in the CHA2DS2-VASc score (HR 1.26 [1.23-1.29], P < 0.001). And using the multi-variate Cox model adjusted by initial CKD stage, we still observed a 5.9% increase in risk of ESRD with a one-point increase in the CHA2DS2-VASc score (HR 1.059 [1.037-1.082], P < 0.001). The CHA2DS2-VASC score and the initial stage of CKD were associated with the risk of ESRD development in patients with AF. Conclusions Our results first confirmed the utility of CHA2DS2-VASC score in predicting progression to ESRD in AF patients. The efficiency is best in CKD stage 1.
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Affiliation(s)
- Pang-Shuo Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Fang Cheng
- Division of Multidiciplinary Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jien-Jiun Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chih Wang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
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