Protypo Dialysis Center, Hemodialysis Unit, 55535 Thessaloniki, Greece.
Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
Medicina (Kaunas). 2024 Jan 12;60(1):144. doi: 10.3390/medicina60010144.
: Cardiovascular events are the major cause of morbidity and mortality in patients on hemodialysis (HD). Identifying risk factors can help in the effort to reduce cardiovascular risk and improve life expectancy. The objective of this study was to evaluate the ability of the CHADS-VASc score-the risk index of stroke in atrial fibrillation (AF)-to predict strokes, major cardiovascular events, and mortality in patients with end-stage kidney disease. : The CHADS-VASc and HAS-BLED scores (the bleeding risk from the use of anticoagulation in AF) were calculated in 237 HD patients, 99 women with a median age of 76 (15) years, at the time they commenced HD. The scores' ability to predict long term cardiovascular morbidity and mortality was estimated, both in those with and without AF. Among the exclusion criteria were the change of dialysis method or loss of follow-up, HD due to acute renal failure, and incompliance with medical instructions, thus the sample is not representative of a broader population. : The CHADS-VASc score was higher in AF ( = 69) compared to non-AF ( = 168) patients, 5 (2.5) vs. 4 (2), < 0.0001, respectively. An increased CHADS-VASc score was correlated with cardiovascular events, namely, heart failure ( = 0.007, = 0.024), stroke ( < 0.0001, < 0.0001), and risk of all-cause mortality ( < 0.0001, < 0.0001) in AF and non-AF groups, respectively. The C statistics indicated that the referred score showed modest discrimination in AF and non-AF patients on HD for heart failure, stroke, and all-cause mortality, however for cardiovascular mortality this was found only in the AF group. : An increased CHADS-VASc score at the time of HD initiation can predict strokes, heart failure, and all-cause mortality in HD patients independent of the presence of AF. The risk of cardiovascular mortality could only be predicted in patients with AF.
心血管事件是血液透析（HD）患者发病率和死亡率的主要原因。确定风险因素有助于降低心血管风险并延长预期寿命。本研究的目的是评估 CHADS-VASc 评分（房颤患者中风风险指数）预测终末期肾病患者中风、主要心血管事件和死亡率的能力。
在开始 HD 治疗时，我们计算了 237 名 HD 患者（99 名女性，中位年龄 76 [15] 岁）的 CHADS-VASc 和 HAS-BLED 评分（房颤患者抗凝出血风险）。我们评估了这些评分在有无房颤的患者中预测长期心血管发病率和死亡率的能力。排除标准包括透析方法改变或失访、因急性肾衰竭而进行 HD 以及不遵守医嘱，因此该样本不能代表更广泛的人群。
房颤患者的 CHADS-VASc 评分（ = 69）高于非房颤患者（ = 168），分别为 5（2.5）和 4（2）， < 0.0001。增加的 CHADS-VASc 评分与心血管事件相关，即心力衰竭（ = 0.007， = 0.024）、中风（ < 0.0001， < 0.0001）和全因死亡率（ < 0.0001， < 0.0001）在房颤和非房颤组中分别。C 统计数据表明，在开始 HD 时，该评分对房颤和非房颤 HD 患者的心力衰竭、中风和全因死亡率具有适度的区分能力，但心血管死亡率的风险仅在房颤组中发现。
在开始 HD 时增加的 CHADS-VASc 评分可预测 HD 患者中风、心力衰竭和全因死亡率，与房颤的存在无关。心血管死亡率的风险只能在房颤患者中预测。
