Red Blood Cell Distribution Width Is Associated With Adverse Kidney Outcomes in Patients With Chronic Kidney Disease

Abstract

BackgroundChronic kidney disease (CKD) is a global public health issue. Red blood cell distribution width (RDW) is a recently recognized potential inflammatory marker, which mirrors the variability in erythrocyte volume. Studies indicate that elevated RDW is associated with increased risk of mortality in CKD patients, while evidence regarding the impact of RDW on kidney outcome is limited.MethodsAltogether 523 patients with CKD stage 1–4 from a single center were enrolled. We identified the cutoff point for RDW level using maximally selected log-rank statistics. The time-averaged estimated glomerular filtration rate (eGFR) slope was determined using linear mixed effects models. Rapid CKD progression was defined by an eGFR decline >5 ml/min/1.73 m2/year. The composite endpoints were defined as doubling of serum creatinine, a 30% decline in initial eGFR or incidence of eGFR < 15 ml/min/1.73 m2, whichever occurred first. Multivariable logistic regression or Cox proportional hazards regression was performed, as appropriate.ResultsDuring a median follow-up of 26 [interquartile range (IQR): 12, 36] months, 65 (12.43%) patients suffered a rapid CKD progression and 172 (32.89%) composite kidney events occurred at a rate of 32.3/100 patient-years in the high RDW group, compared with 14.7/100 patient-years of the remainder. The annual eGFR change was clearly steeper in high RDW group {−3.48 [95% confidence interval (CI): −4.84, −2.12] ml/min/1.73 m2/year vs. −1.86 [95% CI: −2.27, −1.45] ml/min/1.73 m2/year among those with RDW of >14.5% and ≤14.5%, respectively, P for between-group difference <0.05}. So was the risk of rapid renal function loss (odds ratio = 6.79, 95% CI: 3.08–14.97) and composite kidney outcomes (hazards ratio = 1.51, 95% CI: 1.02–2.23). The significant association remained consistent in the sensitivity analysis.ConclusionIncreased RDW value is independently associated with accelerated CKD deterioration. Findings of this study suggest RDW be a potential indicator for risk of CKD progression.

Prediction of the left ventricular mass index in hypertensive patients using the product of red cell distribution width and mean corpuscular volume

“…Pusuroglu et al reported a negative correlation between the RDW and eGFR in hypertensive patients, [ 22 ] and similar findings were observed in chronic kidney disease. [ 33 ] However, in the present study, we did not find a significant correlation between anisocytosis and the eGFR.…”

Risk factors for cardio-cerebrovascular events among patients undergoing continuous ambulatory peritoneal dialysis and their association with serum magnesium

“…Increased RDW has been reported to be an emerging biomarker of abnormal red blood cell metabolism and survival, potentially representing oxidative stress, inflammation, and various diseases; thus, an increased RDW may be considered an indicator of inflammation [ 47 ]. Additionally, abnormally increased RDW has been identified as a negative prognostic factor in patients with advanced heart failure who have recently experienced decompensation, independent of the presence of anemia or malnutrition, that offers superior performance compared with more traditionally used indicators [ 48 ].…”

Red blood cell distribution width is a useful biomarker to predict bleeding and thrombosis risks in patients with immune thrombocytopenic purpura

“…RDW‐SD is calculated from the diameter‐of‐erythrocyte distribution curve at 20% above baseline and is expressed in femtolitres [ 22 , 23 , 24 ]. Originally, RDW was used to evaluate anisocytosis of red blood cells and to differentiate causes of anemia [ 25 , 26 , 27 , 28 , 29 ]. Recently, however, RDW has been employed in various clinical fields.…”