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. 2025;149(9):493-504.
doi: 10.1159/000543720. Epub 2025 Feb 11.

CHA2DS2-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in a Prospective Cohort of Hemodialysis Patients of Predominantly African Ancestry: The PROHEMO

Gabriel Brayan Gutiérrez-Peredo  1 , Andrea Jimena Gutiérrez-Peredo  2 , Iris Montaño-Castellón  2 , Marinho Marques da Silva Neto  3 , Fernanda Albuquerque da Silva  2   4 , Marcia Tereza Silva Martins  2   5 , Cacia Mendes Matos  2   6 , Jean Michell Correia Monteiro  7 , Pedro Guimarães Silva  7 , Gildete Barreto Lopes  2   7 , Marcelo Barreto Lopes  2   7   8   9 , Luis Claudio Correia  9   10 , Roberto Pecoits-Filho  11   12 , Keith C Norris  13 , Antonio Alberto Lopes  2   7   14   15 , Roberto Pecoits-Filho
Affiliations

CHA2DS2-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in a Prospective Cohort of Hemodialysis Patients of Predominantly African Ancestry: The PROHEMO

Gabriel Brayan Gutiérrez-Peredo et al. Nephron. 2025.

Abstract

<p>Background: Patients with chronic kidney disease undergoing maintenance hemodialysis (MHD) have an increased mortality. The CHA2DS2-VASc score, initially used for stroke prediction in atrial fibrillation, is relevant for various cardiovascular conditions. This study evaluates its effectiveness in predicting cardiovascular and all-cause mortality in MHD patients.

Methods: Data are from the "Prospective Study of the Prognosis of Patients on Chronic Hemodialysis" (PROHEMO) in Salvador, Brazil. Patients were divided by CHA2DS2-VASc scores: ≤2 and >2. Cox regression estimated hazard ratios (HR) for death, both unadjusted and adjusted for confounders. We assessed the distribution of each score variable and its association with mortality. A modified CHA2DS2-VASc score was created due to the low percentage of patients over 75 (1.3%) and normotensive (4.6%).

Results: A total of 237 patients (mean age 51.6 years; 57.0% male) were included in the study. There were 55 deaths, 21 from cardiovascular causes. For patients with a CHA2DS2-VASc score >2, the unadjusted hazard of all-cause mortality was doubled (HR = 2.05; 95% CI: 1.20, 3.49) compared to those with a score ≤2, and the risk for cardiovascular deaths was more than threefold (HR = 3.53; 95% CI: 1.46, 8.54). These ratios remained consistent after adjusting for covariates. In the most comprehensive Cox model, the HR for all-cause mortality was 2.43 (95% CI: 1.38, 4.23) and for cardiovascular mortality was 3.52 (95% CI: 1.40, 8.84), similar to results from the modified CHA2DS2-VASc score.

Conclusions: The results support the CHA2DS2-VASc score as a practical tool for identifying MHD patients at higher risk of mortality, especially from cardiovascular causes. </p>.

Keywords: CHA2DS2-VASc score; Cardiovascular mortality; Chronic kidney disease; Hemodialysis.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose. Informed consent to participate in the study was obtained from all patients. The manuscript does not contain any individual person’s data in any form.

Figures

Fig. 1.
Fig. 1.
Flow diagram.
Fig. 2.
Fig. 2.
Cumulative incidence of death in hemodialysis patients based on the scores. a, b All-cause mortality with the original CHA2DS2-VASc score (≤2 vs >2) compared to the modified version of the CHA2DS2-VASc score (≤2 vs >2). c, d Cardiovascular mortality with the original CHA2DS2-VASc score (≤2 vs >2) compared to the modified version of the CHA2DS2-VASc score (≤2 vs >2).
Fig. 3.
Fig. 3.
Hazard ratios for the association between CHA2DS2-VASc score >2 and mortality in MHD patients. a All-cause mortality with the original CHA2DS2-VASc score >2. b All-cause mortality with the modified CHA2DS2-VASc score >2. c Cardiovascular mortality with the orginal CHA2DS2-VASc score >2. d Cardiovascular mortality with the modified CHA2DS2-VASc score >2. Model 1: No Adjustment; Model 2: Includes hemoglobin, creatinine and albumin as variables; Model 3: Phosphorus and Parathormone more variables in model 2; Model 4: Chronic liver disease, neoplasia/cancer, months of hemodialysis, plus variables in model 3.
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