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Abstract: SA-PO1022

Clinical Significance of Red Cell Distribution Width (RDW) in ESRD Initiated with Hemodialysis (HD)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ito, Takeshi, Anjo Kosei Hospital, Anjo-cho, Japan
  • Morinaga, Takatoshi, Anjo Kosei Hospital, Anjo-cho, Japan
  • Inaguma, Daijo, Fujita Health University, Toyoake, Japan
  • Fukatsu, Atsushi, Fukatsu Medical Clinic, Anjo, Japan
  • Tamai, Hirofumi, Anjo Kosei Hospital, Anjo-cho, Japan
Background

RDW is routinely measured in complete blood count indicating the variation of erythrocyte volume. RDW is affected by nutritional and inflammatory status. Recently worse survival of high RDW patients has been reported in coronary disease, chronic kidney disease, HD and peritoneal dialysis. To evaluate the clinical significance of RDW in ESRD, we studied 1) correlation of clinical data with RDW, 2) influence of HD and 3) prognostic value in survival.

Methods

Subjects were 873 patients in 17 centers participating in Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) from 2011 to 2013. Subjects were divided into two categories (RDW Low< 15.5, High ≥ 15.5%). RDW and clinical parameters obtained at the initiation of hemodialysis (RDW-1) including laboratory data and comorbidities were analyzed statistically. RDW after stable hemodialysis was established (RDW-2) was compared with RDW-1 and categorized in four groups High-High (H-H) 43.4%, High-Low (H-L) 6.5%, Low-High (L-H) 9.0%, Low-Low (L-L) 41.0%. Factors affecting these changes were studied. Correlation in each category with mortality was analyzed using Kaplan-Meier method. All-cause, CVD, infection and malignancy mortality were compared using multivariate Cox proportional hazard analysis.

Results

RDW-1 was correlated with high CRP (p=0.003) and low total cholesterol (p=0.027) but not with other parameters.
84% was remained in the same category after initiation of HD, and H-H group showed highest mortality, L-H next, and L-L was lower and interestingly H-L was lowest (Log rank test: P<0.001). Characteristics of this small group was that brain natriuretic peptide was higher than other group (p<0.033) while ejection fraction was similar suggesting the complication of uremic cardiopathy which was recovered by HD.
During a median follow-up duration of 1,297 days, 228 subjects died. All-cause (HR 1.41: 95%CI 1.07-1.86), CVD (1.65: 1.07-2.61) and infection (2.72: 1.44-5.60) mortality were higher in High RDW. No correlation with malignancy was noted. (HR1.09: 95%CI 0.58-2.11).

Conclusion

In ESRD patients, RDW is influenced by inflammation and nutrition. In HD patients, low RDW at baseline and lowered RDW after HD suggests better prognosis. In HD patients with high RDW, infection and CVD are statistically higher as a cause of death.