Red blood cell distribution width as a predictor of mortality among patients regularly visiting the nephrology outpatient clinic

Abstract

The association between increased red blood cell distribution width (RDW) and mortality among patients treated on an outpatient basis in the nephrology outpatient clinic is unclear. Therefore, our study aimed to investigate the association between baseline and time-averaged RDW and mortality risk in patients treated in our nephrology outpatient clinic. Our multi-center retrospective analysis was based on data of 16,417 outpatient nephrology patients with available baseline renal function and RWD values. The median baseline RDW was 13.0% (range, 10.0–32.1%). The high-RDW group was defined as the top quartile (≥ 13.8%, n = 4302). The crude mortality rate was 15.0% (n = 1806) at a median follow-up of 127.5 months. From the results of the multivariate Cox proportional hazards regression model adjusted for covariates, including eGFR, hemoglobin, and factors of anemia treatment, patients with a high time-averaged RDW had increased mortality risk (adjusted hazard ratio, 1.505; 95% confidence interval, 1.326–1.708; P < 0.001), irrespective of sex, presence of anemia, and chronic kidney disease, except in individuals aged < 45 years. Thus, increased baseline and time-averaged RDW were significantly associated with increased mortality in patients aged > 45 years treated on an outpatient basis in the nephrology clinic.

The estimated mediating roles of anemia-related variables in the association between kidney function and mortality: a National Health and Nutrition Examination Survey (NHANES) study

“…Nabais et al 46 also showed that a higher RDW value was associated with both 6-month overall mortality and 6-month mortality related to acute coronary syndrome (ACS). Recently, we also showed that an increased time-averaged RDW value was significantly associated with increased mortality in CKD patients aged > 45 years 47 . The results of our study were similar to those of previous studies on the reverse relationships between the RDW and mortality.…”

Association Between Hemoglobin-to-Red Cell Distribution Width Ratio and Bone Mineral Density in the Elderly in the United States: Evidence from NHANES

“…This phenomenon might be attributed to insu cient oxygen transport caused by lower levels of Hb, which in turn affects bone tissue remodeling and maintenance [28]. Additionally, RDW, as a measure of the variability in red blood cell size, has been shown in previous studies to be closely related to chronic in ammation [39][40], oxidative stress [41], and poor nutritional status [42]. HRR is highlighted as a novel marker of in ammation, and lower levels could potentially re ect the presence of chronic diseases or systemic in ammation [22] [32].…”

Red blood cell distribution width predicts mortality of adult patients receiving veno-arterial extracorporeal membrane oxygenation

“…Despite this, having a simple biomarker that can be obtain from quick and easily accessible blood laboratory test can potentially reflect baseline illness severity may still be helpful for clinicians to risk stratify potential VA-ECMO candidates. 26,27 Also, since this is a single institution study, subtle difference in management and patient cohort from our institution may not be generalizable to other centers with different patient population and alternative management strategies. In addition, while we demonstrated a strong association between RDW and 30-days and 1-year mortality, the specificity was only 60% for 30-days mortality and 63% for 1-year mortality.…”