Stroke in hemodialysis patients and its association with CHA(2)DS(2)-VASC and HAS-BLED scores: a retrospective study

BACKGROUND: In the general population, the CHA(2)DS(2)-VASC and the HAS-BLED scores are helpful to predict cerebrovascular events and hemorrhage in patients with atrial fibrillation (AF). However, their predictive value remains controversial in the dialysis population. This study aims to explore the association between these scores and cerebral cardiovascular events in hemodialysis (HD) patients. METHODS: This is a retrospective study including all HD patients treated between January 2010 and December 2019 in two Lebanese dialysis facilities. Exclusion criteria are patients younger than 18 years old and patients with a dialysis vintage less than 6 months. RESULTS: A total of 256 patients were included (66.8% men; mean age 69.3 ± 13.9 years). The CHA(2)DS(2)-VASc score was significantly higher in patients with stroke (P = .043). Interestingly, this difference was significant in patients without AF (P = .017). Using receiver operating curve analysis, CHA(2)DS(2)-VASc score had an area under the curve (AUC) of 0.628 [95% confidence interval (CI): 0.539–0.718) and the best cut-off value for this score was 4. The HAS-BLED score was also significantly higher in patients with a hemorrhagic event (P < .001). AUC for HAS-BLED score was 0.756 (95% CI: 0.686–0.825) and the best cut-off value was also 4. CONCLUSIONS: In HD patients, CHA(2)DS(2)-VASc score can be associated with stroke and HAS-BLED score can be associated with hemorrhagic events even in patients without AF. Patients with a CHA(2)DS(2)-VASc score ≥4 are at the highest risk for stroke and adverse cardiovascular outcomes, and those with a HAS-BLED score ≥4 are at the highest risk for bleeding.