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

Area of Science:

• Nephrology
• Cardiology
• Neurology

Background:

• CHA2DS2-VASC and HAS-BLED scores are established predictors of cerebrovascular events and hemorrhage in atrial fibrillation patients.
• Their utility in the hemodialysis population is debated.
• This study investigates their predictive value in hemodialysis patients for cerebral cardiovascular events.

Purpose of the Study:

• To evaluate the association between CHA2DS2-VASC and HAS-BLED scores and cerebral cardiovascular events in hemodialysis patients.
• To determine the predictive accuracy of these scores in this specific patient group.
• To identify optimal cut-off values for risk stratification.

Main Methods:

• Retrospective study of 256 hemodialysis patients from January 2010 to December 2019.
• Exclusion criteria included age under 18 and dialysis vintage less than 6 months.
• Analysis involved comparing scores between patients with and without stroke or hemorrhagic events, using receiver operating curve analysis.

Main Results:

• CHA2DS2-VASC score was higher in patients with stroke (P=.043), notably in those without atrial fibrillation (P=.017).
• HAS-BLED score was significantly higher in patients with hemorrhagic events (P<.001).
• Optimal cut-off values were 4 for both CHA2DS2-VASC (AUC=0.628) and HAS-BLED (AUC=0.756) scores.

Conclusions:

• CHA2DS2-VASC and HAS-BLED scores are associated with stroke and hemorrhagic events, respectively, in hemodialysis patients, even without atrial fibrillation.
• A CHA2DS2-VASC score ≥4 identifies patients at high risk for stroke and adverse cardiovascular outcomes.
• A HAS-BLED score ≥4 identifies patients at high risk for bleeding.