Stroke in Hemodialysis Patients and Its Association with CHA2DS2-VASC and Has-Bled Scores: A Retrospective Study


 
 
 In the general population, the CHA2DS2-VASC and the HAS-BLED scores are helpful to predict cerebrovascular events and hemorrhage in patients with atrial fibrillation. 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 patients.
 
 
 
 This is a retrospective study including all hemodialysis 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 six months.
 
 
 
 A total of 256 patients were included (66.8% men; mean age 69.3 ± 13.9 years). The CHA2DS2-VASc score was significantly higher in patients with stroke (p = 0.043). Interestingly, this difference was significant in patients without atrial fibrillation (p = 0.017). Using receiver operating curve (ROC) analysis, CHA2DS2-VASc score had an area under the curve (AUC) of 0.628 (95% 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 < 0.001). AUC for HAS-BLED score was 0.756 (95% CI, 0.686–0.825) and the best cut-off value was also 4.
 
 
 
 In hemodialysis patients, CHA2DS2-VASc score can be associated with stroke and HAS-BLED score can be associated with hemorrhagic events even in patients without atrial fibrillation. Patients with a CHA2DS2-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.
