Red cell distribution width and renal outcome in patients with non-dialysis-dependent chronic kidney disease.

Sayoko Yonemoto,Satoshi Yamaguchi,Naohiko Fujii,Ayumi Matsumoto,Nobuhiro Hashimoto,Masamitsu Senda,Tatsufumi Oka,Takayuki Hamano,Yoshitaka Isaka,Keiichi Kubota,Karin Shimada,Yusuke Sakaguchi,Isao Matsui,Tatsuo Shimosawa

doi:10.1371/journal.pone.0198825

Sayoko Yonemoto, Satoshi Yamaguchi + Show 12 more

Open Access

https://doi.org/10.1371/journal.pone.0198825

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Journal: PloS one	Publication Date: Jun 11, 2018
Citations: 17	License type: CC BY 4.0

Affiliation: Osaka University, Hyogo Prefectural Nishinomiya Hospital

Abstract

Higher red cell distribution width (RDW) has been reported to predict mortality among patients with various diseases, including chronic kidney disease (CKD). However, whether RDW is associated with renal outcome remains unclear. We investigated the relationship between RDW and renal outcome in patients with non-dialysis-dependent CKD (NDD-CKD). This prospective, observational study of patients with CKD was conducted at a single nephrology department. First, we performed regression analyses for the decline in estimated glomerular filtration rate (eGFR) during the first 3 months of observation to determine its short-term association with RDW. Next, we categorized baseline RDW into two groups by its median (13.5%) and performed Cox regression analyses to investigate whether higher RDW was an independent predictor of renal outcomes defined as a composite of the initiation of dialysis and doubling of the serum creatinine concentration. Furthermore, we repeated the analyses to confirm whether the transition of the RDW category during the first 3 months would also predict renal outcomes. We enrolled 703 patients. Baseline RDW showed a non-linear association with the eGFR decline during the first 3 months, with a greater negative correlation at the lower end of the RDW distribution. Over a median follow-up of 1.8 years, 178 patients (25.3%) reached the renal endpoint. Multivariable Cox regression analyses showed that patients with higher RDW had a higher risk of developing renal outcomes (adjusted hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.05–2.07) than did those with lower RDW. Furthermore, patients with sustained, higher RDW demonstrated a significantly higher risk than did those with consistently lower RDW (adjusted HR: 1.65, 95% CI: 1.02–2.67). In conclusion, higher RDW was independently associated with worse renal outcome in patients with NDD-CKD. RDW could be an additional prognostic marker of the progression of CKD.

Highlights

Red cell distribution width (RDW) is a measure of the range of variation in the red cell volume, and it is routinely reported as a part of the standard complete blood count
We demonstrated that higher RDW was independently associated with the decline in renal function in the short-term observational period
We revealed that sustained, higher RDW within the first 3 months of observation was a significant risk factor of poor renal outcomes in this population

Summary

Introduction

Red cell distribution width (RDW) is a measure of the range of variation in the red cell volume, and it is routinely reported as a part of the standard complete blood count. According to recent studies [2,3,4,5,6,7], RDW may be associated with mortality in various populations, including patients with kidney disease, and could be a new, independent predictor in such patients. Higher RDW was associated with mortality, and was a stronger predictor of death than were traditional laboratory markers of anemia, such as transferrin saturation (TSAT) and ferritin levels [8, 9]. In a study from Taiwan on patients with chronic kidney disease (CKD) stages 3–5, higher RDW was associated with death from all-causes, cardiovascular disease (CVD), and infections [10]. Little is known about the relationship between RDW and renal outcome, including the progression of CKD

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