Red Cell Distribution Width and Mortality in Hemodialysis Patients

Vashistha, Tania; Streja, Elani; Molnar, Miklos Z.; Rhee, Connie M.; Moradi, Hamid Reza; Soohoo, Melissa; Kövesdy, Csaba P.; Kalantar-Zadeh, Kamyar

doi:10.1053/j.ajkd.2015.11.020

Cited by 76 publications

(85 citation statements)

References 27 publications

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“…In this study, the significant correlations, though weak, with dialysis vintage, nutritional and inflammatory factors observed were consistent with the previous findings in dialysis patients [12,14,15,34,38] . Besides, patients with higher RDW were more likely to be older and belonged to the female gender.…”

Section: Discussionsupporting

confidence: 93%

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

et al. 2016

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Aims: To examine the association between red blood cell distribution width (RDW) and mortality in hemodialysis (HD) patients. Methods: Three hundred fifty six patients on HD for >3 months were enrolled and followed for 2 years. Patients were divided into 2 groups according to the median RDW value. Patient survival and risk factors for mortality were investigated. Results: The 2-year survival rate was significantly lower in the high-RDW group (>14.9%; log-rank = 10.00, p = 0.0016). RDW (hazard ratio (HR) 1.34, 95% CI 1.04-1.71, p = 0.021), hemoglobin (HR 0.98, 95% CI 0.96-1.00, p = 0.023) and albumin (HR 0.90, 95% CI 0.82-0.99, p = 0.026) were independent predictors of mortality. Receiver operating characteristic curves of RDW to predict 2-year mortality had an area under the curve of 0.6487 (95% CI 0.5714-0.7260). Conclusions: Abnormal RDW was common in HD patients and significantly related with poor outcomes in these patients.

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Section: Discussionsupporting

confidence: 93%

“…Besides, patients with higher RDW were more likely to be older and belonged to the female gender. The relation between RDW and ageing has been convincingly reported in many literatures, while its relation with gender was controversial [38] . Some studies found no significant gender differences in RDW values.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…noted a positive correlation between malnutrition and RDW in a cohort of 1293 patients receiving peritoneal dialysis and observed that RDW emerged as an independent predictor of cardiovascular mortality [35]. Similar associations were also observed in patients receiving hemodialysis and kidney transplant recipients [12, 13, 25]. In this study, we found that RDW was negatively correlated with the levels of malnutrition parameters (albumin, prealbumin and serum triglyceride), showing that undernutrition may be associated with increases in RDW.…”

Section: Discussionmentioning

confidence: 70%

“…In addition to being linked to renal function, an elevated RDW has also been associated with higher mortality in patients with CKD [9], kidney transplant recipients [25] and patients with AKI who are receiving continuous renal replacement therapy [15]. Moreover, a recent study investigated the impact of RDW on mortality in patients receiving hemodialysis and concluded that RDW may be a better predictor of mortality than hemoglobin, ferritin, and iron saturation values [12]. A similar association was noted in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).…”

Section: Discussionmentioning

confidence: 99%

Red Blood Cell Distribution Width is an Independent Predictor of AKI and Mortality in Patients in the Coronary Care Unit

Hu¹,

Liu²,

Fu³

et al. 2017

Kidney Blood Press Res

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Background/Aims: We investigated the hypothesis that RDW is an independent predictor of acute kidney injury (AKI) and mortality in patients in the coronary care unit (CCU). Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU at Zhongnan Hospital of Wuhan University from January 1, 2014 to June 1, 2015. AKI was defined based on the KDIGO-AKI criteria. The survivors were followed up for up to 2 years after hospital discharge. The primary endpoint of the study was the incidence of AKI, while the secondary endpoints of the study were in-hospital mortality and 2-year mortality. Results: RDW was significantly correlated with the acute physiology and chronic health evaluation II (APACHEII) score, hemoglobin, mean corpuscular volume, inflammatory marker levels, nutrition and renal function at the time of CCU admission. The incidence of AKI was much higher in the high RDW group (RDW ≥14.0%) than in the low RDW group, a finding that was confirmed by multivariable logistic regression, which showed that RDW was independently associated with the incidence of AKI (odds ratio (OR), 1.059, 95% coincidence interval (95% CI), 1.024-1.095, P=0.001). A total of 61 patients died during their hospital stay, and baseline RDW was also an independent predictor of in-hospital mortality (hazard ratio (HR), 1.129, 95% CI 1.005-1.268, P=0.041). Patients with a high RDW exhibited significantly higher 2-year mortality than patients with a low RDW during a median follow-up period of 19.8 months (P<0.001), and RDW independently predicted the risk of 2-year mortality (HR, 1.189, 95% CI 1.045 to 1.354, P=0.009) in the multivariate Cox proportional hazard analysis after adjustments for other clinical and laboratory variables. Conclusion: RDW is an independent predictor of AKI and mortality in patients in the CCU.

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“…It has been linked to ischemic cerebrovascular disease and to poorer outcome after ischemic stroke [33]. Higher values of RDW have also recently shown to be associated with increased mortality of ESRD patients [34, 35]. RDW is being extensively studied and both the mechanisms linking ESRD to higher RDW, and higher RDW to cerebral ischemia and mortality are yet to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

Low Cerebral Oxygenation Is Associated with Cognitive Impairment in Chronic Hemodialysis Patients

Kovářová¹,

Valeriánová²,

Kmentova³

et al. 2018

Nephron

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Background/Aims: High rates of cognitive impairment (CI) are an alarming problem in patients undergoing chronic hemodialysis (HD). Its pathophysiology remains unclear and there are indications that brain ischemia might be one of the key causes. Cerebral tissue oxygenation, as measured by near-infrared spectroscopy, is known to be decreased in HD patients. However, it is unknown whether CI is associated or not associated with lower cerebral oxygenation in these patients. The primary aim of our study was to probe this possible association. Our secondary aim was to assess other factors possibly related to cerebral ischemia and CI. Methods: Thirty-nine patients treated by chronic HD were included in this cross-sectional study. All measurements were performed before the initiation of an HD session. The Montreal Cognitive Assessment (MoCA) was administered according to published recommendations. Regional saturation of oxygen (rSO2) of the left frontal lobe was measured using the INVOS 5100C device. Basic medical history and laboratory data were recorded, and handgrip strength was analyzed. We used the unpaired t test to compare the rSO2 and other variables between cognitively normal patients (MoCA score ≥26) and those who displayed CI (MoCA score <26). Multiple linear regression analysis was used to adjust for principal confounders. Results: Cognitively impaired patients had lower brain rSO2 values compared to cognitively normal patients (48 ± 9 vs. 57 ± 10%, p = 0.01). Among other variables, higher red cell distribution width (15.8 ± 1.9 vs. 13.8 ± 1.6%, p = 0.01) and lower hand grip strength (49.2 ± 23.3 vs. 99.3 ± 31.4 lbs, p < 0.001) also displayed a significant association with CI. The relation between rSO2 and MoCA score was significant after adjustment for age and gender (p = 0.007). Conclusion: Decreased brain oxygenation is associated with weaker cognitive performance in patients undergoing chronic HD. Further understanding the causes of cerebral ischemia in HD patients could lead to the prevention of cognitive decline in this population.

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Red Cell Distribution Width and Mortality in Hemodialysis Patients

Cited by 76 publications

References 27 publications

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

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

Red Blood Cell Distribution Width is an Independent Predictor of AKI and Mortality in Patients in the Coronary Care Unit

Low Cerebral Oxygenation Is Associated with Cognitive Impairment in Chronic Hemodialysis Patients

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