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CHRONIC KIDNEY DISEASE. ANAEMIA. FP389. RED CELL DISTRIBUTION WIDTH AMONG PATIENTS. WITH CHRONIC KIDNEY DISEASE AND ITS ...
Nephrology Dialysis Transplantation 30 (Supplement 3): iii195–iii204, 2015 doi:10.1093/ndt/gfv176.13

CHRONIC KIDNEY DISEASE. ANAEMIA FP389

RED CELL DISTRIBUTION WIDTH AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE AND ITS CORRELATION WITH IRON INDICES

Sayoko Yonemoto1, Takayuki Hamano2, Naohiko Fujii1, Isao Matsui3 and Yoshitaka Isaka3 1 Hyogo Prefectural Nishinomiya Hospital, Department of Internal Medicine, Nishinomiya, Japan, 2Osaka University Graduate School of Medicine, Department of Comprehensive Kidney Disease Research, Suita, Japan, 3Osaka University Graduate School of Medicine, Department of Geriatric Medicine and Nephrology, Suita, Japan Introduction and Aims: Red cell distribution width (RDW) is a measure of the size variability of the red blood cell population and it is increased in patients with iron deficiency, inflammation, and the other disturbances of hematopoiesis. Recently, the elevation of RDW was reported to be associated with poor prognosis of heart failure in patients not only with cardiac disease but also with chronic kidney disease (CKD). In this study, we investigated RDW among CKD patients and its correlation with iron indices. Methods: The study population consisted of 457 predialysis and 489 dialysis outpatients in the nephrology departments of two hospitals in Japan. We measured RDW-CV, erythrocyte indices and the iron markers such as serum iron, TIBC, and ferritin, simultaneously. We utilized linear regression analyses and restricted cubic spline analyses to estimate the correlation between RDW and iron markers. Results: As for predialysis patients, most patients (89.7%) were in CKD stages 3 to 5 (mean eGFR was 31.9±21.2 ml/min/1.73m2). For all patients, the median age was 71, and 38.3% were female. The mean hemoglobin level was 11.3±1.6g/dL and the median RDW was 13.4%. There were negative correlations between RDW and mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC).Of them, MCHC had the strongest correlation with RDW. As CKD stage progressed, RDW increased gradually and once patients received dialysis treatment, RDW decreased slightly. As for iron markers, RDW had U-shaped associations with transferrin saturation (TSAT) and ferritin in CKD (including 5D) patients. When TSAT and ferritin were about 25 to 30% and 150 to 200ng/mL, respectively, RDW was lowest and considered to be ideal state for hematopoiesis. These non-linear associations between RDW and iron markers hold true both in predialysis and dialysis patients. Conclusions: RDW was increased with CKD progression. The U-shaped associations between iron markers and RDW might shed light on the ideal ranges of these markers in terms of hematopoiesis.The slight improvement of RDW in dialysis stage might be the effect of regular erythropoietin stimulating agent therapy.

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