#4130 CHA2DS2-VASC SCORE AS A PREDICTOR OF CARDIOVASCULAR MORBIDITY AND MORTALITY AND ALL-CAUSE MORTALITY IN PATIENTS UNDERGOING CHRONIC HEMODIALYSIS
Authors: Azasevac Tijana , Knezevic Violeta , Atanaskovic Marko , Majstorovic Gordana Strazmester , Ljubicic Bojana , Petrovic Lada 
Published: June 2023

Abstract

Background and Aims
End stage kidney disease (ESKD) is a well-recognized risk factor for cardiovascular and all-cause mortality. The recognition of high-risk patients could lead to a different approach and better treatment of the patients undergoing chronic hemodialysis. The CHA2DS2-VASc score was originally used to predict the annual cerebral infarction in patients with atrial fibrillation. However, it is also a useful predictor of outcome in other cardiovascular conditions, independent of atrial fibrillation. The aim of this study was to assess whether CHA2DS2-VASc score may be used as a risk stratification tool for ESKD patients undergoing chronic hemodialysis.

Method
We performed a single-centre retrospective study of 201 adult patients undergoing chronic hemodialysis in our institution from January 2020 to December 2022 with a follow up period of at least 12 months. CHA2DS2-VASc score was calculated for each patient according to the data from January 1st 2020 or at the moment of haemodialysis initiation, if the date of the first dialysis was after that date. Patients were followed until January 1st 2023, or until their death or kidney transplantation. Demographic, clinical and laboratory parameters, as well as used medications, were analyzed. Occurrences of myocardial infarction, stroke, revascularization procedure, new hospitalization for heart failure, cardiovascular death, or all-cause mortality were recorded for each patient. Patients were divided into three groups according to their CHA2DS2-VASc score: low (0-2), intermediate (3), high (≥4).

Results
The group with a low CHA2DS2-VASc score (0-2)-group I included 80 (39.8%) patients, the group with a intermediate score (3)-group II included 62 (30.8%) patients, and the group with a high score (≥4)-group III included 59 (29.4%) patients. Mean follow-up time was 918±317 days. Patients in the group with higher CHA2DS2-VASc scores (group III) were predominantly females (group III 62.7% vs group II 45.2% vs group I 23.8%; p&lt;0.01) and older (group III 74.9±7.4 years vs group II 68.7±7.6 years vs group I 55.2±11.3 years; p&lt;0.01). They also had a higher prevalence of diabetes mellitus (group III 61.0% vs group II 45.2% vs group I 21.3%; p&lt;0.01) and vascular disease (group III 30.5% vs group II 12.9% vs group I 3.8%; p&lt;0.01). Major adverse cardiovascular events (MACE) were significantly more prevalent in patients with higher CHA2DS2-VASc scores (p&lt;0.01) (Fig. 1). All-cause mortality was significantly higher in group II and group III, compared to the group I (p&lt;0.05) (Fig. 1). The patients in the group II and group III had a significantly higher risk of all-cause mortality and cardiovascular mortality than the patients in the group I (p&lt;0.05) (Fig. 2). Using a group I as a reference, group II and group III had a higher risk of all-cause mortality (HR 1.92, 95% CI 1.01-3.66, p&lt;0.05 and HR 2.47, 95% CI 1.32- 4.63, p&lt;0.01, respectively) and cardiovascular mortality (HR 3.56, 95% CI 1.18-9.53, p&lt;0.05 and HR 6.58, 95% CI 2.48-17.46, p&lt;0.001, respectively). Each one-point increase in CHA2DS2-VASc score was associated with a two-fold increased risk of MACE and a 47% increased risk of all-cause mortality.

Conclusion
The CHA2DS2-VASc score is a simple, easy-to-calculate tool that can be used to identify high-risk ESKD patients undergoing chronic hemodialysis. Clinical utilization of the CHA2DS2-VASc score in risk stratification of these patients could intensify patient care and lead to better outcomes by reducing cardiovascular morbidity and mortality and all-cause mortality.