Miri Schamroth Pravda1, Keren Cohen Hagai2, Guy Topaz3,4, Nili Schamroth Pravda5, Nadeen Makhoul6, Mony Shuvy7, Sydney Benchetrit2,6, Abid Assali4,6, David Pereg8,9. 1. Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel. 2. Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel. 3. Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel. 4. Department of Cardiology, Meir Medical Center, Kfar Saba, Israel. 5. Department of Cardiology, Rabin Medical Center, Petach Tikvah, Israel. 6. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 7. Heart Institute, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel. 8. Department of Cardiology, Meir Medical Center, Kfar Saba, Israel, davidpe@tauex.tau.ac.il. 9. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, davidpe@tauex.tau.ac.il.
Abstract
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 CHA2DS2-VASc score may be used for risk stratification of this population. METHODS: Included were patients undergoing chronic hemodialysis at Meir Medical Center. The CHA2DS2-VASc score was calculated for each patient at the initiation of hemodialysis. Patients were classified into 3 groups according to the CHA2DS2-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 CHA2DS2-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 CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc score was strongly associated with adverse outcomes and may be used for risk stratification of these patients.
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 CHA2DS2-VASc score may be used for risk stratification of this population. METHODS: Included were patients undergoing chronic hemodialysis at Meir Medical Center. The CHA2DS2-VASc score was calculated for each patient at the initiation of hemodialysis. Patients were classified into 3 groups according to the CHA2DS2-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 CHA2DS2-VASc scores. During the first year of hemodialysis, 109 (23.8%) patientsdied, 17 (3.7%) had a stroke, and 28 (6.1%) had a myocardial infarction. Compared to patients in the low CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc score was strongly associated with adverse outcomes and may be used for risk stratification of these patients.
Authors: Ewelina Rogalska; Anna Kurasz; Łukasz Kuźma; Hanna Bachórzewska-Gajewska; Sławomir Dobrzycki; Marek Koziński; Bożena Sobkowicz; Anna Tomaszuk-Kazberuk Journal: Int J Environ Res Public Health Date: 2022-08-21 Impact factor: 4.614