Clinical outcomes of stroke in hemodialysis patients: a retrospective single-center study

Cohen-Hagai, Keren; Nacasch, Naomi; Rozenberg, Ilan; Korzets, Ze’ev; Einbinder, Yael; Zitman‐Gal, Tali; Benchetrit, Sydney

doi:10.1007/s11255-019-02218-x

Cited by 6 publications

(8 citation statements)

References 15 publications

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“…This is in accordance with large previous studies, which showed that the main risk factors for stroke were older age, atrial fibrillation, previous stroke, DM, hyperphosphatemia, low body weight and hypertension 30,31 . Furthermore, stroke has been significantly associated with a decline in patients' functional capacity and an increase in mortality 32 . A major problem in ESRD is the anticoangulation treatment.…”

Section: Discussionsupporting

confidence: 90%

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The prognostic value of CHA₂DS₂‐VASc and modified‐CHADS₂ scores for cardiovascular events in diabetics and non‐diabetics haemodialysis patients

et al. 2023

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Aim CHA2DS2‐VASc and modified‐CHADS2 score can easily estimate the risk of stroke in atrial fibrillation. Study's purpose was to evaluate these in haemodialysis patients, and assess the effect of diabetes mellitus (DM). Methods The scores calculated in 237 haemodialysis patients, 121 diabetics (58 females) and 116 non‐diabetics (41 females). Results correlated to cardiovascular events (acute myocardial infarction, atrial fibrillation, heart failure, peripheral arterial disease, stroke, mortality). Results CHA2DS2‐VASc score correlated with the occurrence of stroke and heart failure (p < .01, p < .01), (p < .01, p < .01), respectively in diabetics and non‐diabetics. CHA2DS2‐VASc score could predict the risk of all‐cause mortality in both groups, p = .03, p < .01, respectively, however, the risk of cardiovascular death could be predicted in non‐diabetics, p < .01. Modified‐CHADS2 score associated with heart failure (p = .04), cardiovascular (p < .01) and all‐cause mortality (p < .01) only on non‐diabetics. C statistics indicated that the first score showed modest discrimination in patients with and without DM, for stroke and all‐cause mortality. The second score performed modestly only on patients without DM for all‐cause mortality. Both scores showed poor calibration. Stroke was a common cause of cardiovascular death (OR = 3.52, 95% CI = 1.92–6.47, p < .01) and associated with central venous catheter (OR = 2.19, 95% CI = 1.12–4.27, p = .02) and pre‐existing atrial fibrillation (OR = 1.94, 95% CI = 1.06–3.58, p = .03). Conclusion CHA2DS2‐VASc score correlated with stroke, heart failure and all‐cause mortality in haemodialysis patients with and without DM. The risk of cardiovascular death could be predicted only in non‐diabetics patients. Modified‐CHADS2 score correlated with heart failure, cardiovascular and all‐cause mortality only on non‐diabetics. Both had modest discrimination and poor calibration.

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Section: Discussionsupporting

confidence: 90%

“…30,31 Furthermore, stroke has been significantly associated with a decline in patients' functional capacity and an increase in mortality. 32 A major problem in ESRD is the anticoangulation treatment. It is suggested that the use of vitamin K antagonists may be harmful in HD patients with increased bleeding risk or poorly regulated INR.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of CHA₂DS₂‐VASc and modified‐CHADS₂ scores for cardiovascular events in diabetics and non‐diabetics haemodialysis patients

et al. 2023

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“…HD patient groups had the presence of comorbidities such as hypertension, diabetes, congestive heart failure, left ventricular hypertrophy (LVH), AF, peripheral vascular disease, and pulmonary disease more than the general population. The OR for death in HD group of stroke patients compared to the general population with stroke was 2.53 (CI: 1.4-4.58) with increased mortality at the hospitalization phase, at 30 days and one year after the stroke [32].…”

Section: Mortality and Outcome Of Stroke In Esrdmentioning

confidence: 93%

“…Studies have reported that stroke is one of the leading causes of mortality in dialysis patients. A cohort study conducted by Cohen-Hagai et al showed that ischemic strokes are common in the HD group compared to the general population with the unfortunate outcome due to longer duration of hospital stay, decreased nutritional condition at discharge, no change in recovery despite rehabilitation programs, and higher mortality [32]. HD patient groups had the presence of comorbidities such as hypertension, diabetes, congestive heart failure, left ventricular hypertrophy (LVH), AF, peripheral vascular disease, and pulmonary disease more than the general population.…”

Section: Mortality and Outcome Of Stroke In Esrdmentioning

confidence: 99%

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Current Trends Featuring the Bridge Between Stroke and End-Stage Renal Disease: A Review

Akku¹,

Jayaprakash²,

Ogbue³

et al. 2020

Cureus

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The relationship between end-stage renal disease (ESRD) and cerebral stroke is graded and cumulative, having a significant impact on morbidity and mortality. Ischemic stroke is more prevalent than hemorrhagic stroke and both stroke types have modifiable and non-modifiable risk factors. The presence of risk factors such as hypertension, diabetes, and atrial fibrillation (AF) before stroke occurrence in dialysis patients has a significant impact on the outcomes such as a discharge to rehabilitation, in-hospital mortality with the worst prognosis when compared to the general population. ESRD patients with either peritoneal or hemodialysis (HD) are at increased risk of stroke than the general population, with a high mortality rate at the commencement of dialysis and gradually decreases. Primary and secondary prevention of risk factors plays a significant role in this susceptible population and helps to mitigate better treatment and outcomes. Our review article focuses on the mechanisms, outcomes, treatment, and preventive aspects of stroke in the ESRD population.

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Cardiovascular Events and Mortality in Patients on Hemodialysis – the Prognostic Value of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score

Tourountzis,

Lioulios,

Stasini

et al. 2023

Preprint

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Background and Objectives: Cardiovascular events are the leading cause of morbidity and mortal-ity in hemodialysis (HD) patients. Identifying risk factors can help in the effort to reduce cardi-ovascular risk and improve life expectancy. The purpose of this study was to evaluate the ability of CHA2DS2-VASc score [risk index of stroke in atrial fibrillation (AF)] in patients with end stage kidney disease, to predict stroke, major cardiovascular events and mortality. Materials and Meth-ods: CHA2DS2-VASc and HAS-BLED (bleeding risk from use of anticoagulation in AF) scores were calculated in 237 HD patients, [99 women, median age 76 (15) years], at time they com-menced on HD. The scores’ ability to predict long term cardiovascular morbidity and mortality was estimated, both in those with and without AF. Results: CHA2DS2-VASc score was signifi-cantly increased in AF (n=69) compared to non-AF (n=168) patients, 5 (2.5) versus 4 (2), p<0.0001, respectively. Increased CHA2DS2-VASc score was associated with heart failure (p=0.007, p=0.024), stroke (p<0.0001, p<0.0001) and risk of all-cause mortality (p<0.0001, p<0.0001), in both groups, respectively. C statistics indicated that CHA2DS2-VASc score performed modest discrimination in this HD population with and without AF for heart failure, stroke, and all-cause mortality, but for cardiovascular mortality in AF group only. Conclusions: Increased CHA2DS2-VASc score at time starting on HD, can predict stroke, heart failure and all-cause mortality in HD patients in-dependent of the presence of AF. Risk of cardiovascular mortality could be predicted only on patients with AF.

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Clinical outcomes of stroke in hemodialysis patients: a retrospective single-center study

Cited by 6 publications

References 15 publications

The prognostic value of CHA₂DS₂‐VASc and modified‐CHADS₂ scores for cardiovascular events in diabetics and non‐diabetics haemodialysis patients

The prognostic value of CHA₂DS₂‐VASc and modified‐CHADS₂ scores for cardiovascular events in diabetics and non‐diabetics haemodialysis patients

Current Trends Featuring the Bridge Between Stroke and End-Stage Renal Disease: A Review

Cardiovascular Events and Mortality in Patients on Hemodialysis – the Prognostic Value of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score

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Clinical outcomes of stroke in hemodialysis patients: a retrospective single-center study

Cited by 6 publications

References 15 publications

The prognostic value of CHA2DS2‐VASc and modified‐CHADS2 scores for cardiovascular events in diabetics and non‐diabetics haemodialysis patients

The prognostic value of CHA2DS2‐VASc and modified‐CHADS2 scores for cardiovascular events in diabetics and non‐diabetics haemodialysis patients

Current Trends Featuring the Bridge Between Stroke and End-Stage Renal Disease: A Review

Cardiovascular Events and Mortality in Patients on Hemodialysis – the Prognostic Value of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score

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Product

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The prognostic value of CHA₂DS₂‐VASc and modified‐CHADS₂ scores for cardiovascular events in diabetics and non‐diabetics haemodialysis patients

The prognostic value of CHA₂DS₂‐VASc and modified‐CHADS₂ scores for cardiovascular events in diabetics and non‐diabetics haemodialysis patients