Red cell distribution width and renal outcome in patients with non-dialysis-dependent chronic kidney disease
Higher red cell distribution width (RDW) has been reported to predict mortality among patients with various diseases, including chronic kidney disease (CKD). However, whether RDW is associated with renal outcome remains unclear. We investigated the relationship between RDW and renal outcome in patie...
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| creator | Yonemoto, Sayoko Hamano, Takayuki Fujii, Naohiko Shimada, Karin Yamaguchi, Satoshi Matsumoto, Ayumi Kubota, Keiichi Hashimoto, Nobuhiro Oka, Tatsufumi Senda, Masamitsu Sakaguchi, Yusuke Matsui, Isao Isaka, Yoshitaka |
| description | Higher red cell distribution width (RDW) has been reported to predict mortality among patients with various diseases, including chronic kidney disease (CKD). However, whether RDW is associated with renal outcome remains unclear. We investigated the relationship between RDW and renal outcome in patients with non-dialysis-dependent CKD (NDD-CKD). This prospective, observational study of patients with CKD was conducted at a single nephrology department. First, we performed regression analyses for the decline in estimated glomerular filtration rate (eGFR) during the first 3 months of observation to determine its short-term association with RDW. Next, we categorized baseline RDW into two groups by its median (13.5%) and performed Cox regression analyses to investigate whether higher RDW was an independent predictor of renal outcomes defined as a composite of the initiation of dialysis and doubling of the serum creatinine concentration. Furthermore, we repeated the analyses to confirm whether the transition of the RDW category during the first 3 months would also predict renal outcomes. We enrolled 703 patients. Baseline RDW showed a non-linear association with the eGFR decline during the first 3 months, with a greater negative correlation at the lower end of the RDW distribution. Over a median follow-up of 1.8 years, 178 patients (25.3%) reached the renal endpoint. Multivariable Cox regression analyses showed that patients with higher RDW had a higher risk of developing renal outcomes (adjusted hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.05-2.07) than did those with lower RDW. Furthermore, patients with sustained, higher RDW demonstrated a significantly higher risk than did those with consistently lower RDW (adjusted HR: 1.65, 95% CI: 1.02-2.67). In conclusion, higher RDW was independently associated with worse renal outcome in patients with NDD-CKD. RDW could be an additional prognostic marker of the progression of CKD. |
| doi_str_mv | 10.1371/journal.pone.0198825 |
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However, whether RDW is associated with renal outcome remains unclear. We investigated the relationship between RDW and renal outcome in patients with non-dialysis-dependent CKD (NDD-CKD). This prospective, observational study of patients with CKD was conducted at a single nephrology department. First, we performed regression analyses for the decline in estimated glomerular filtration rate (eGFR) during the first 3 months of observation to determine its short-term association with RDW. Next, we categorized baseline RDW into two groups by its median (13.5%) and performed Cox regression analyses to investigate whether higher RDW was an independent predictor of renal outcomes defined as a composite of the initiation of dialysis and doubling of the serum creatinine concentration. Furthermore, we repeated the analyses to confirm whether the transition of the RDW category during the first 3 months would also predict renal outcomes. We enrolled 703 patients. Baseline RDW showed a non-linear association with the eGFR decline during the first 3 months, with a greater negative correlation at the lower end of the RDW distribution. Over a median follow-up of 1.8 years, 178 patients (25.3%) reached the renal endpoint. Multivariable Cox regression analyses showed that patients with higher RDW had a higher risk of developing renal outcomes (adjusted hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.05-2.07) than did those with lower RDW. Furthermore, patients with sustained, higher RDW demonstrated a significantly higher risk than did those with consistently lower RDW (adjusted HR: 1.65, 95% CI: 1.02-2.67). In conclusion, higher RDW was independently associated with worse renal outcome in patients with NDD-CKD. RDW could be an additional prognostic marker of the progression of CKD.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0198825</identifier><identifier>PMID: 29889895</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Analysis ; Anemia ; Biology and Life Sciences ; Blood diseases ; Blood tests ; Care and treatment ; Chronic kidney failure ; Confidence intervals ; Creatinine ; Creatinine - blood ; Development and progression ; Dialysis ; Epidermal growth factor receptors ; Erythrocyte Indices - physiology ; Ethics ; Female ; Glomerular Filtration Rate ; Hematopoiesis ; Hemodialysis ; Hospitals ; Humans ; Inflammation ; Internal medicine ; Kidney - physiopathology ; Kidney diseases ; Kidneys ; Laboratories ; Male ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Nephrology ; Patient outcomes ; Patients ; Physical Sciences ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Proteins ; Regression analysis ; Renal Insufficiency, Chronic - pathology ; Research and Analysis Methods ; Risk Factors ; Selenium ; Severity of Illness Index ; Statistical analysis ; Studies ; University graduates ; Womens health</subject><ispartof>PloS one, 2018-06, Vol.13 (6), p.e0198825-e0198825</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Yonemoto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Yonemoto et al 2018 Yonemoto et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c776t-be845b188907ad68a8c4b76164c461f9645ba0e482442a0c80031804a40fd1f73</citedby><cites>FETCH-LOGICAL-c776t-be845b188907ad68a8c4b76164c461f9645ba0e482442a0c80031804a40fd1f73</cites><orcidid>0000-0001-7128-0482</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995355/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995355/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29889895$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Shimosawa, Tatsuo</contributor><creatorcontrib>Yonemoto, Sayoko</creatorcontrib><creatorcontrib>Hamano, Takayuki</creatorcontrib><creatorcontrib>Fujii, Naohiko</creatorcontrib><creatorcontrib>Shimada, Karin</creatorcontrib><creatorcontrib>Yamaguchi, Satoshi</creatorcontrib><creatorcontrib>Matsumoto, Ayumi</creatorcontrib><creatorcontrib>Kubota, Keiichi</creatorcontrib><creatorcontrib>Hashimoto, Nobuhiro</creatorcontrib><creatorcontrib>Oka, Tatsufumi</creatorcontrib><creatorcontrib>Senda, Masamitsu</creatorcontrib><creatorcontrib>Sakaguchi, Yusuke</creatorcontrib><creatorcontrib>Matsui, Isao</creatorcontrib><creatorcontrib>Isaka, Yoshitaka</creatorcontrib><title>Red cell distribution width and renal outcome in patients with non-dialysis-dependent chronic kidney disease</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Higher red cell distribution width (RDW) has been reported to predict mortality among patients with various diseases, including chronic kidney disease (CKD). However, whether RDW is associated with renal outcome remains unclear. We investigated the relationship between RDW and renal outcome in patients with non-dialysis-dependent CKD (NDD-CKD). This prospective, observational study of patients with CKD was conducted at a single nephrology department. First, we performed regression analyses for the decline in estimated glomerular filtration rate (eGFR) during the first 3 months of observation to determine its short-term association with RDW. Next, we categorized baseline RDW into two groups by its median (13.5%) and performed Cox regression analyses to investigate whether higher RDW was an independent predictor of renal outcomes defined as a composite of the initiation of dialysis and doubling of the serum creatinine concentration. Furthermore, we repeated the analyses to confirm whether the transition of the RDW category during the first 3 months would also predict renal outcomes. We enrolled 703 patients. Baseline RDW showed a non-linear association with the eGFR decline during the first 3 months, with a greater negative correlation at the lower end of the RDW distribution. Over a median follow-up of 1.8 years, 178 patients (25.3%) reached the renal endpoint. Multivariable Cox regression analyses showed that patients with higher RDW had a higher risk of developing renal outcomes (adjusted hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.05-2.07) than did those with lower RDW. Furthermore, patients with sustained, higher RDW demonstrated a significantly higher risk than did those with consistently lower RDW (adjusted HR: 1.65, 95% CI: 1.02-2.67). In conclusion, higher RDW was independently associated with worse renal outcome in patients with NDD-CKD. RDW could be an additional prognostic marker of the progression of CKD.</description><subject>Aged</subject><subject>Analysis</subject><subject>Anemia</subject><subject>Biology and Life Sciences</subject><subject>Blood diseases</subject><subject>Blood tests</subject><subject>Care and treatment</subject><subject>Chronic kidney failure</subject><subject>Confidence intervals</subject><subject>Creatinine</subject><subject>Creatinine - blood</subject><subject>Development and progression</subject><subject>Dialysis</subject><subject>Epidermal growth factor receptors</subject><subject>Erythrocyte Indices - physiology</subject><subject>Ethics</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Hematopoiesis</subject><subject>Hemodialysis</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Internal medicine</subject><subject>Kidney - physiopathology</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nephrology</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Physical Sciences</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Proteins</subject><subject>Regression analysis</subject><subject>Renal Insufficiency, Chronic - pathology</subject><subject>Research and Analysis Methods</subject><subject>Risk Factors</subject><subject>Selenium</subject><subject>Severity of Illness Index</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>University graduates</subject><subject>Womens 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Yusuke</au><au>Matsui, Isao</au><au>Isaka, Yoshitaka</au><au>Shimosawa, Tatsuo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Red cell distribution width and renal outcome in patients with non-dialysis-dependent chronic kidney disease</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-06-11</date><risdate>2018</risdate><volume>13</volume><issue>6</issue><spage>e0198825</spage><epage>e0198825</epage><pages>e0198825-e0198825</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Higher red cell distribution width (RDW) has been reported to predict mortality among patients with various diseases, including chronic kidney disease (CKD). However, whether RDW is associated with renal outcome remains unclear. We investigated the relationship between RDW and renal outcome in patients with non-dialysis-dependent CKD (NDD-CKD). This prospective, observational study of patients with CKD was conducted at a single nephrology department. First, we performed regression analyses for the decline in estimated glomerular filtration rate (eGFR) during the first 3 months of observation to determine its short-term association with RDW. Next, we categorized baseline RDW into two groups by its median (13.5%) and performed Cox regression analyses to investigate whether higher RDW was an independent predictor of renal outcomes defined as a composite of the initiation of dialysis and doubling of the serum creatinine concentration. Furthermore, we repeated the analyses to confirm whether the transition of the RDW category during the first 3 months would also predict renal outcomes. We enrolled 703 patients. Baseline RDW showed a non-linear association with the eGFR decline during the first 3 months, with a greater negative correlation at the lower end of the RDW distribution. Over a median follow-up of 1.8 years, 178 patients (25.3%) reached the renal endpoint. Multivariable Cox regression analyses showed that patients with higher RDW had a higher risk of developing renal outcomes (adjusted hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.05-2.07) than did those with lower RDW. Furthermore, patients with sustained, higher RDW demonstrated a significantly higher risk than did those with consistently lower RDW (adjusted HR: 1.65, 95% CI: 1.02-2.67). In conclusion, higher RDW was independently associated with worse renal outcome in patients with NDD-CKD. RDW could be an additional prognostic marker of the progression of CKD.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29889895</pmid><doi>10.1371/journal.pone.0198825</doi><tpages>e0198825</tpages><orcidid>https://orcid.org/0000-0001-7128-0482</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-06, Vol.13 (6), p.e0198825-e0198825 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2053295555 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Analysis Anemia Biology and Life Sciences Blood diseases Blood tests Care and treatment Chronic kidney failure Confidence intervals Creatinine Creatinine - blood Development and progression Dialysis Epidermal growth factor receptors Erythrocyte Indices - physiology Ethics Female Glomerular Filtration Rate Hematopoiesis Hemodialysis Hospitals Humans Inflammation Internal medicine Kidney - physiopathology Kidney diseases Kidneys Laboratories Male Medicine Medicine and Health Sciences Middle Aged Mortality Nephrology Patient outcomes Patients Physical Sciences Prognosis Proportional Hazards Models Prospective Studies Proteins Regression analysis Renal Insufficiency, Chronic - pathology Research and Analysis Methods Risk Factors Selenium Severity of Illness Index Statistical analysis Studies University graduates Womens health |
| title | Red cell distribution width and renal outcome in patients with non-dialysis-dependent chronic kidney disease |
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