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. 2021 Dec 21;11(1):24310.
doi: 10.1038/s41598-021-03530-2.

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

Kyung Don Yoo #  1 , Hyung Jung Oh #  2 , Sehoon Park  3 , Min Woo Kang  3 , Yong Chul Kim  3 , Jae Yoon Park  4 , Jeonghwan Lee  5 , Jong Soo Lee  1 , Dong Ki Kim  3   6   7 , Chun Soo Lim  5   6   7 , Yon Su Kim  3   6   7 , Jung Pyo Lee  8   9   10 ; Korean Association for the study of Renal Anemia and artificial Intelligence (KARAI)
Collaborators, Affiliations

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

Kyung Don Yoo et al. Sci Rep. .

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.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Distribution of red blood cell distribution width (RDW) for the study cohort.
Figure 3
Figure 3
Survival analysis of all-cause mortality among the baseline red blood cell distribution width (RDW) groups. The threshold between normal and high RDW was defined as the upper level of the third quartile (RDW ≥ 13.8%).
Figure 4
Figure 4
Nonlinear association between red blood cell distribution width (RDW) values and mortality risk. Adjustments were made for age, sex, estimated glomerular filtration rate, and hemoglobin level. (A) Univariate analysis. (B) Multivariate analysis.
Figure 5
Figure 5
Multivariate Cox regression analysis of high-RDW vs. normal-RDW mortality by subgroup. The adjusted covariates were age, sex, estimated glomerular filtration rate, hemoglobin level, history of diabetes mellitus, history of hypertension, serum albumin level, urinary albumin grade, history of red blood cell transfusion, and use of erythropoietin-stimulating agents. GFR glomerular filtration rate, RDW red blood cell distribution width.
See this image and copyright information in PMC

References

    1. Evans TC, Jehle D. The red blood cell distribution width. J. Emerg. Med. 1991;9:71–74. doi: 10.1016/0736-4679(91)90592-4. - DOI - PubMed
    1. Bujak K, et al. The prognostic role of red blood cell distribution width in coronary artery disease: A review of the pathophysiology. Dis. Markers. 2015;2015:824624. doi: 10.1155/2015/824624. - DOI - PMC - PubMed
    1. Lippi G, et al. Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients. Scand. J. Clin. Lab. Invest. 2008;68:745–748. doi: 10.1080/00365510802213550. - DOI - PubMed
    1. Zhang T, Li J, Lin Y, Yang H, Cao S. Association between red blood cell distribution width and all-cause mortality in chronic kidney disease patients: A systematic review and meta-analysis. Arch. Med. Res. 2017;48:378–385. doi: 10.1016/j.arcmed.2017.06.009. - DOI - PubMed
    1. Liu, Z., Wang, S., Yao, X., Xing, J. Prognostic value of red blood cell distribution width in acute kidney injury patients: A systematic review and meta-analysis. bioRxiv preprint (2019).

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