RED CELL DISTRIBUTION WIDTH INDEPENDENTLY PREDICTS CARDIOVASCULAR EVENTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

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Abstract

Introduction and Aims: Red cell distribution width (RDW) is a measurement of size variability of the red blood cells, which easily tested during complete blood cell counts. Recent studies have shown RDWas an independent predictor of poor prognosis of cardiovascular events in patients with heart failure, prior myocardial infarction, acute coronary syndrome, coronary heart disease, peripheral arterial disease and vascular complication of diabetes. We aimed to evaluate predictive ability of RDW on prognosis of cardiovascular events in stage 1-5 chronic kidney disease (CKD) patients. Methods: 357 subjects with stage 1-5 CKD were followed for a mean of 38 (2 to 43) months. There were 71 patients with stage 1, 71 patients with stage 2, 70 patients with stage 3, 69 patients with stage 4 and 76 patients with stage 5 (predialysis) CKD. Fatal and nonfatal CV events were recorded during this period. RDW at baseline was determined from complete blood count differential. Endothelial dysfunction (flow mediated dilation, FMD), CRP and insulin resistance were determined along with routine biochemistry. We investigated if RDW could predict development of fatal and nonfatal CV events. We also looked at how RDW changed across CKD stages and whether RDW is related to insulin resistance and endothelial dysfunction. Results: 35 fatal and 88 nonfatal CV events occurred during the follow-up period. Among the fatal causes were death due to coronary heart disease (n=20), sudden death (n=4), stroke (n=8) and complicated peripheral vascular disease (n=3). Non-fatal cardiovascular events were registered as stroke (n=21), myocardial infarction (n=53), peripheral vascular disease (n=9) and aortic aneurysm (n=5). RDW showed a significant increase from stage-1 CKD to stage-5. RDW was inversely associated with FMD (r=-0.59; CI 95%; p<0.001). Univariate COX analysis demonstrated that RDW predicts composite (123 fatal and non-fatal) CV events independent of FMD and history of diabetes (hazard ratio 1.64; p<0.001). The hazard ratio was 1.66 for RDW after adjustment for age (in years), sex (women as reference), eGFR, hsCRP, diabetes (absence as reference) and medical history of cardiovascular disease (absence as reference) at baseline in multivariate COX analysis. Importantly, the predictive ability of RDW for cardiovascular events persisted even after adjustment for haemoglobin values. Kaplan-Meier analysis showed that an increased RDW over 13.5 was related to a significantly decreased survival time. The survival rate was 99% in the group of patients with RDW < 13.5 compared to 82% in the arm with RDW = 13.5 (p<0.001 by log-rank test). Conclusions: RDW increases while CKD stage increases. RDW is independently and inversely related with endothelial dysfunction. Increased RDW over 13.5 may be used as a complementary prognostic marker for predicting cardiovascular events in patients with CKD. Predictive ability of RDW was independent from hemoglobin level, uremia, and CRP values.

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RED CELL DISTRIBUTION WIDTH INDEPENDENTLY PREDICTS CARDIOVASCULAR EVENTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE. (2012). In NEPHROLOGY DIALYSIS TRANSPLANTATION.

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