The Risk of Stroke Using CHA2 DS2 -VASc Score in Hemodialysis Patients at a Tertiary Hospital in Riyadh, Saudi Arabia

Patients undergoing hemodialysis are at increased risk of stroke. However, less known about the impact of some ofthe stroke risk factors, and the value of stroke risk scores in determining the risk in those patients. Our main goal. To assess therisk factors for stroke in hemodialysis patients and the use of the new CHA2DS2-VASc score for stroke assessment.Methods: Single center, retrospective cohort study of 336 patients undergoing hemodialysis from June 24, 2018, to September6, 2018, was recruited. Baseline demographics, clinical, and laboratory data were collected. We calculated the CHA2DS2-VAScscore for stroke assessment in all patients and categorized them into high, moderate and low risk patients according to CHA2DS2-VASc score and subcategorized them to two groups atrial fibrillation (AFib) and Non- Atrial fibrillation (Non AFib) patients.Results: 336 patients were included in our study; the majority of patients were at high risk with a CHA2DS2-VAScScore mean of 2.9± 1.5, although history of stroke was observed only in 15 patients (4.46%). According to CHA2DS2- VASc score,280 patients were at high risk, 172 (51.19%) were high-risk patients on treatment (anticoagulant or antiplatelet) and 108(32.14%)patients were high risk patients not on treatment 48 were at moderate risk (14.28%) and 8 were at low risk (2.38 %). Patientswere divided into subgroups as non-AFib and AFib. In non-AFib patients 320 (95.23%), high-risk patients 103 (32.18%) were nottreated; high-risk patients with treatment are 162 (50.62%), moderate patients were 47 (14.68%), 8(2.5%) was in low risk. AFibpatients were 16 with a mean CHA2DS2-VASc score of 4.4±1.1. Patients with AFib were all at high risk except 1 was at moderaterisk (6.25%). There were 11 (68.75%) patients on treatment and 5 (31.25%) patients not on treatment. The risk factors for strokethat were statistically significant in increasing score risk for all patients were: age > 65 (95% CI, -2.04– -1.29; p = 0.000), beingfemale (95% CI, -1.36– -0.68; p = 0.000) hypertension (95% CI, -2.59– -1.37; p = 0.000), diabetes (95% CI, -2.10– -1.50; p =0.000), CVD (95% CI, -2.07– -1.24; p=0.000), history of stroke or TIA (95% CI, -3.70– -2.03; p = 0.000), CHF or LVEF (95%CI, -2.28– - 0.91; p = 0.000).Conclusions: The risk of stroke in hemodialysis patients is significant according to the use of CHA2DS2-VAScscore in Non-AFib hemodialysis patients shows supportive evidence of increased risk of stroke in those patients, which suggestthe importance of close monitoring of patients with stroke risk factors by the nephrologist and the stroke team which will lead tothe initiation of early prophylaxis in those patients.