A High Red Blood Cell Distribution Width Predicts Failure of Arteriovenous Fistula

Abstract

In hemodialysis patients, a native arteriovenous fistula (AVF) is the preferred form of permanent vascular access. Despite recent improvements, vascular access dysfunction remains an important cause of morbidity in these patients. In this prospective observational cohort study, we evaluated potential risk factors for native AVF dysfunction. We included 68 patients with chronic renal disease stage 5 eligible for AVF construction at the Department of General and Vascular Surgery, Central Clinical Hospital Ministry of Internal Affairs, Warsaw, Poland. Patient characteristics and biochemical parameters associated with increased risk for AVF failure were identified using Cox proportional hazards models. Vessel biopsies were analyzed for inflammatory cells and potential associations with biochemical parameters. In multivariable analysis, independent predictors of AVF dysfunction were the number of white blood cells (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.24 to 2.25; p<0.001), monocyte number (HR 0.02; 95% CI 0.00 to 0.21; p = 0.001), and red blood cell distribution width (RDW) (HR 1.44; 95% CI 1.17 to 1.78; p<0.001). RDW was the only significant factor in receiver operating characteristic curve analysis (area under the curve 0.644; CI 0.51 to 0.76; p = 0.046). RDW>16.2% was associated with a significantly reduced AVF patency frequency 24 months after surgery. Immunohistochemical analysis revealed CD45-positive cells in the artery/vein of 39% of patients and CD68-positive cells in 37%. Patients with CD68-positive cells in the vessels had significantly higher white blood cell count. We conclude that RDW, a readily available laboratory value, is a novel prognostic marker for AVF failure. Further studies are warranted to establish the mechanistic link between high RDW and AVF failure.

The Prognostic Value of Red Blood Cell Distribution Width in Patients on Maintenance Hemodialysis

“…The pathogenesis of RDW increasing in dialysis patients is complex. As shown in previous studies, RDW may reflect anemia and anemia-related nutrient deficiency, abnormal erythropoietin production or erythropoietin hyporesponsiveness [26,27] , impaired renal function [28] , shorter telomere lengths [29] , hypoxia [30] , oxidative stress [31] , endothelial dysfunction [32] , inflammation [33] , malnutrition [34] , volume status [34] , aging [23,24] , reduced physiological reserve [35] , thrombosis [36] , increased erythrocyte fragmentation [37] , and so on. All these conditions are prevalent in dialysis patients and may influence erythropoiesis and erythrocyte survival by both direct and indirect effects, thus leading to an increased RDW.…”

Post‐operative arterio‐venous fistula blood flow influences primary and secondary patency following access surgery

“…A genetic predisposition has been implicated, and a recent study investigating the link between several genes associated with endothelial function, vascular remodelling, and coagulation on AVF patency has found a statistically significant correlation between single nucleotide polymorphisms of LNP1 and Factor V Leiden (a mutated form of human factor V-one of several substances that helps blood clot) with a higher rate of failed fistulae (Verschuren et al 2013). Inherent haematological and inflammatory factors could also be important, with a postulated link between elevated inflammatory markers, white cell count and red cell width on thrombogenesis in early AVF failure (Bojakowski et al 2012). (2006).…”

RDW to Platelet Ratio: A Novel Noninvasive Index for Predicting Hepatic Fibrosis and Cirrhosis in Chronic Hepatitis B

“…For example, the circulating platelet count has been proposed as a biomarker of liver fibrosis and cirrhosis [12]. An elevated red cell distribution width (RDW) has been reported to be associated with mortality and other severe adverse outcomes in cardiac, renal and infectious diseases, even in the general population [13], [14], [15], [16]. Other studies have found an association between low hemoglobin (Hb) concentrations and mortality [17].…”