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. 2022 Dec 9;16(3):596-602.
doi: 10.1093/ckj/sfac260. eCollection 2023 Mar.

Stroke in hemodialysis patients and its association with CHA2DS2-VASC and HAS-BLED scores: a retrospective study

Marc Sab  1   2 , Dania Chelala  1   2 , Mabel Aoun  1   3 , Rabih Azar  1   2 , Tony Abdel Massih  1   2
Affiliations

Stroke in hemodialysis patients and its association with CHA2DS2-VASC and HAS-BLED scores: a retrospective study

Marc Sab et al. Clin Kidney J. .

Abstract

Background: In the general population, the CHA2DS2-VASC and the HAS-BLED scores are helpful to predict cerebrovascular events and hemorrhage in patients with atrial fibrillation (AF). However, their predictive value remains controversial in the dialysis population. This study aims to explore the association between these scores and cerebral cardiovascular events in hemodialysis (HD) patients.

Methods: This is a retrospective study including all HD patients treated between January 2010 and December 2019 in two Lebanese dialysis facilities. Exclusion criteria are patients younger than 18 years old and patients with a dialysis vintage less than 6 months.

Results: A total of 256 patients were included (66.8% men; mean age 69.3 ± 13.9 years). The CHA2DS2-VASc score was significantly higher in patients with stroke (P = .043). Interestingly, this difference was significant in patients without AF (P = .017). Using receiver operating curve analysis, CHA2DS2-VASc score had an area under the curve (AUC) of 0.628 [95% confidence interval (CI): 0.539-0.718) and the best cut-off value for this score was 4. The HAS-BLED score was also significantly higher in patients with a hemorrhagic event (P < .001). AUC for HAS-BLED score was 0.756 (95% CI: 0.686-0.825) and the best cut-off value was also 4.

Conclusions: In HD patients, CHA2DS2-VASc score can be associated with stroke and HAS-BLED score can be associated with hemorrhagic events even in patients without AF. Patients with a CHA2DS2-VASc score ≥4 are at the highest risk for stroke and adverse cardiovascular outcomes, and those with a HAS-BLED score ≥4 are at the highest risk for bleeding.

Keywords: CHA2DS2-VASc; HAS-BLED; atrial fibrillation; chronic hemodialysis; stroke.

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Figures

Figure 1:
Figure 1:
ROC curve for the CHA2DS2-VASC score for prediction of stroke.
Figure 2:
Figure 2:
ROC curve for the HAS-BLED score for prediction of stroke.
See this image and copyright information in PMC

References

    1. USRDS 2006 annual data report: atlas of end-stage renal disease in the United States. Bethesda, MD: US Renal Data System, 2006n.d.
    1. Seliger SL, Gillen DL, Longstreth WTet al. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int 2003;64:603–9. 10.1046/j.1523-1755.2003.00101.x. - DOI - PubMed
    1. Ovbiagele B, Sanossian N, Liebeskind DS.et al. Indices of kidney dysfunction and discharge outcomes in hospitalized stroke patients without known renal disease. Cerebrovasc Dis 2009;28:582–8. 10.1159/000247602. - DOI - PubMed
    1. Gage BF, Waterman AD, Shannon Wet al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864. 10.1001/jama.285.22.2864. - DOI - PubMed
    1. Delanaye P, Bouquegneau A, Dubois Eet al. Fibrillation auriculaire et anticoagulation chez le patient hémodialysé: une decision difficile. Nephrol Ther 2017;13:9–66. - PubMed