Abstract

Red blood cell distribution width (RDW) is a robust marker of adverse clinical outcomes in various populations. However, the clinical significance of a progressive rise in RDW is undetermined in end-stage renal disease (ESRD) patients. The purpose of this study was to determine the prognostic importance of a change in RDW in ESRD patients. Three hundred twenty-six incident dialysis patients were retrospectively analyzed. Temporal changes in RDW during 12 months after dialysis initiation were assessed by calculating the coefficients by linear regression. Patients were divided into two groups: an RDW-decreased group who had negative coefficient values (n = 177) and an RDW-increased group who had positive values (n = 149). The associations between rising RDW and mortality and cardiovascular (CV) events were investigated. During a median follow-up of 2.7 years (range, 1.0–7.7 years), 75 deaths (24.0%) and 60 non-fatal CV events (18.4%) occurred. The event-free survival rate for the composite of end-points was lower in the RDW-increased group (P = 0.004). After categorizing patients according to baseline RDW, the event-free survival rate was lowest in patients with a baseline RDW >14.9% and increased RDW, and highest in patients with a baseline RDW ≤14.9% and decreased RDW (P = 0.02). In multivariate analysis, rising RDW was independently associated with the composite of end-points (hazard ratio = 1.75, P = 0.007), whereas the baseline RDW was not. This study shows that a progressive rise in RDW independently predicted mortality and CV events in ESRD patients. Rising RDW could be an additive predictor for adverse CV outcomes ESRD patients.

Highlights

  • Red blood cell distribution width (RDW) is a quantitative measure of the size variability of circulating erythrocytes and is reported as part of the standard complete blood cell count in clinical practice

  • This study showed that a progressive rise in RDW independently predicted all-cause mortality and CV events in end-stage renal disease (ESRD) patients

  • These associations remained significant after adjustments for markers of anaemia, nutrition, haeomoglobin variability, baseline and follow-up RDW, and other CV risk factors, and after subdividing the patients according to the baseline RDW value and change in RDW

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Summary

Introduction

Red blood cell distribution width (RDW) is a quantitative measure of the size variability of circulating erythrocytes and is reported as part of the standard complete blood cell count in clinical practice. RDW is elevated in conditions of ineffective erythropoiesis or increased erythrocyte destruction [1]. Research has demonstrated the significance of RDW as a prognostic marker for cardiovascular (CV) morbidity and mortality in various diseases, PLOS ONE | DOI:10.1371/journal.pone.0126272. Rising RDW as a Predictor in ESRD Patients. Ministry of Science, ICT and future Planning (2014R1A1A3A04050919) Research has demonstrated the significance of RDW as a prognostic marker for cardiovascular (CV) morbidity and mortality in various diseases, PLOS ONE | DOI:10.1371/journal.pone.0126272 May 11, 2015

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