Kidney Week

Abstract: TH-PO0588

Outcome-Specific Prognostic Roles of Red Cell Distribution Width (RDW) and Neutrophil-to-Lymphocyte Ratio in Patients with Nondialysis-Dependent CKD

Session Information

• CKD: From Global Burden to Precision Care - Epidemiology, Demographics, Geographies, and Risk Factors
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Hwang, Yunkyeong, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (the Republic of)

Yunkyeong Hwang, MD

• Jo, Janghyun, Chungnam National University, Daejeon, Korea (the Republic of)

Janghyun Jo, MS, MSc

• Han, Suyeon, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (the Republic of)

Suyeon Han, MD

• Park, Hwajin, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (the Republic of)

Hwajin Park, MD

• Hong, Yu Ah, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (the Republic of)

Yu Ah Hong, MD, PhD

• Chang, Yoon-Kyung, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (the Republic of)

Yoon-Kyung Chang, MD, PhD

• Choi, Dae Eun, Chungnam National University Hospital, Daejeon, Korea (the Republic of)

Dae Eun Choi, MD, PhD

Background

RDW, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are routine hematologic indices proposed as prognostic markers in chronic kidney disease (CKD). Whether these markers differ in prognostic relevance for renal progression versus mortality, and whether their effects are mutually independent, remains unclear.

Methods

This retrospective cohort study included 2,692 patients with non-dialysis CKD followed at a single center (2015–2022). Optimal cut-offs were derived by ROC analysis for 3-year dialysis-free survival. Dialysis-free and overall survival were assessed by Kaplan–Meier analysis and multivariable Cox regression, adjusted for age, sex, kidney function, comorbidities, and nutritional parameters. RDW-stratified analyses with interaction testing evaluated marker independence.

Results

Over median follow-up of 2,413 days, 451 patients (16.8%) initiated dialysis and 239 (8.9%) died. Adjusted HRs are shown in the Table. In RDW-stratified analyses, NLR remained predictive of dialysis in both low-RDW (HR 1.60, 95% CI 1.15–2.21) and high-RDW strata (HR 1.67, 95% CI 1.22–2.28); no significant RDW–NLR interaction was observed (p=0.57 for dialysis; p=0.87 for mortality).

Conclusion

RDW and NLR exhibit distinct, complementary prognostic roles in non-dialysis CKD. RDW captures systemic vulnerability predicting both renal progression and death, while NLR provides additional prognostic value specifically for dialysis risk. These findings support outcome-specific risk stratification using readily available hematologic indices.

Acknowledgment

Supported by KHIDI Korean ARPA-H Project (RS-2025-25456780) and Chungnam National University research fund (2025-1076-01).

Adjusted HRs for Dialysis and Mortality by Marker

*p<0.05; NS=not significant

Funding

• Government Support – Non-U.S.