Association of Red Blood Cell Life Span with Abnormal Changes in Cardiac Structure and Function in Non-Dialysis Patients with Chronic Kidney Disease Stages 3-5

Abstract

Introduction: With the invention and improvement of the carbon monoxide (CO) breath test, the role of shortened red blood cell life span (RBCLS) in renal anemia, an independent risk factor for cardiovascular events in patients with chronic kidney disease (CKD), is gradually attracting attention. Considering that heart failure is the leading cause of morbidity and mortality in patients with CKD, this study investigated the correlation between the RBCLS and the cardiac structure and function in non-dialysis patients with CKD stages 3−5, aiming to provide new ideas to improve the long-term prognosis of CKD patients. Methods: One hundred thirty-three non-dialysis patients with CKD stages 3−5 were tested for RBCLS. We compared the serological data, cardiac ultrasound results, and follow-up prognosis of patients with different RBCLS. Results: As the RBCLS shortened, the patients’ blood pressure, BNP, and CRP gradually increased, most significantly in patients with an RBCLS < 50 d. Patients with an RBCLS < 50 d had substantially lower hemoglobin (Hb), hematocrit, and albumin levels than those with an RBCLS ≥ 50 d. The cardiac ultrasound results show that patients with an RBCLS < 50 d had significantly larger atrial diameters than those with an RBCLS ≥ 50 d and were associated with more severe diastolic dysfunction. Patients with an RBCLS < 50 d had a 3.06 times greater risk of combined heart failure at baseline than those with an RBCLS ≥ 70 d and a higher risk of heart failure at follow-up. CKD stage 5 patients with an RBCLS < 50 d were more likely to develop heart failure and require renal replacement therapy earlier than patients with an RBCLS ≥ 50 d. Conclusions: In non-dialysis patients with CKD stages 3−5, there is a correlation between the red blood cell life span and cardiac structure and function. The RBCLS may also impact the renal prognosis of CKD patients.

Keywords: cardiac structure and function; chronic kidney disease; heart failure; red blood cell life span.

Figure 1

Distribution of RBCLS in patients with CKD stages 3–5.

Figure 2

Relationship between RBCLS and cardiac color Doppler ultrasound indicators. Each data point is an individual measurement. The pink line represents the linear regression fitting line. (a) LAD (beta = −10.98, p = 0.02); (b) LVDs (beta = −16.30, p = 0.002); (c) LVDd (beta = −10.82, p = 0.013); (d) IVST (beta = −21.12, p = 0.061); (e) LVPWT (beta = −36.03, p = 0.007); (f) LVM (beta = −0.12, p = 0.001); (g) LVEF (beta = 0.87, p = 0.025); (h) E/e (beta = −1.28, p = 0.012).

Figure 2

Relationship between RBCLS and cardiac color Doppler ultrasound indicators. Each data point is an individual measurement. The pink line represents the linear regression fitting line. (a) LAD (beta = −10.98, p = 0.02); (b) LVDs (beta = −16.30, p = 0.002); (c) LVDd (beta = −10.82, p = 0.013); (d) IVST (beta = −21.12, p = 0.061); (e) LVPWT (beta = −36.03, p = 0.007); (f) LVM (beta = −0.12, p = 0.001); (g) LVEF (beta = 0.87, p = 0.025); (h) E/e (beta = −1.28, p = 0.012).

Figure 3

Kaplan–Meier curves for time to renal replacement therapy and heart failure in patients with different RBCLS. (A) Kaplan–Meier curves for time to renal replacement therapy in patients with different RBCLS. (B) Kaplan–Meier curves for time to heart failure in patients with different RBCLS.