| Part Ⅰ Status of Red Blood Cell Distribution Width in Hemodialysis Patient and the Related FactorsObjective: Red blood cell distribution width(RDW)is a measure of the heterogeneity in the size of erythrocytes,which is routinely included in the complete blood cell count.Recently,RDW has been analyzed to investigate the status and the related factorsin hemodialysis(HD)patients.Methods: 1.268 patients received hemodialysis from 2008-2017 were enrolled in the second affiliated hospital of Soochow University.48 healthy people were examined in the physical examination center of our hospital.Patients were consecutively recruited and followed up every two months in the following 10 years.Patients included received hemodialysis for at least three months and were absent from hematological diseases,such as aplastic anemia,acute myocardial infarction,malignant tumor,autoimmune disease,cirrhosis,severe liver failure,chronic obstructive pulmonary disease and incomplete clinical data.2.Enrollmented the demographic data,blood parameter,biochemistry data and Cardiac ultrasound index.Such as Age,gender,Complication,HD duration time(mons),Total Kt/V,RRF(ml/min),EPO,EPO/Hb,Hb(g/L),MCV(fl),Alb(g/L),CH(mmol/L),TG(mmol/L),BUN(mmol/L),PTH(pg/ml),BNP(pg/ml)and so on.3.First,a number of indicators,including the RDW in the HD group and the normal control group,were compared.Then the MHD patients were divided into survival group and death group,and the relative indexes between the two groups were compared.According to the quartile value of RDW,the MHD patients were divided into four groups.Above factors were compared across diffident groups by using ANOVA for continuous variables,or chi-squared test for categorical variable.The correlation between RDW and clinical and laboratory test indexes was analyzed by comparison of different methods.Calculations were performed using SPSS for Windows 17.0.Results: 1.The average value of RDW in 48 patients in group HD was 14.9±1.5,and the average value of RDW in the healthy control group was 13.6±1.6.The results showed that the difference between the two groups was statistically significant(P<0.001).2.Compared with survival group,in the death group the value of RDW(15.5±1.6 vs 14.3±1.3,P<0.001),age(70.5±13.3 vs 54.8±14.1,P<0.001),diabetes(47 vs 46,P=0.004),EPO(13763.6±4913.8 vs 9936.7±5465.2,P<0.001)、EPO/Hb(126.2±68.7 vs 82.9±47.2,P<0.001),Log Fer(2.42±0.56 vs 2.15±0.48,P=0.007),Scr(887.18±387.8 vs 804.2±219.8,P=0.028),P(1.98±0.48 vs 1.80±0.49,P=0.004),PTH(504.2±352.9 vs 392.7±304.5,P=0.023),Log CRP(1.31±0.45 vs 0.76±0.23,P<0.001),Log BNP(6.0±1.6 vs 3.6±0.9,P<0.001)were increased significantly.While the HD duration time(32.6 vs 47.9,P <0.001),total KT/V(1.56±0.46 vs 1.71±0.53,P=0.021),RRF(2.40±2.25 vs 4.15±3.4,P<0.001),Hb(108.3±23.84 vs 119.0±19.76,P <0.001),Fe(8.2±6.1 vs 12.4±6.5,P<0.001),Alb(29.5±3.9 vs 39.0±4.4,P<0.001),PAB(294.1±121.8 vs 327.6±107.3,P=0.029)were significantly reduced.3.According to the RDW quartile,found that age(P<0.01),HD duration time(P <0.001),RRF(P=0.023),EPO(P<0.001),EPO/Hb(P<0.001),Hb(P=0.034),Fe(P<0.001),Alb(P=0.001),PAB(P=0.012),Log CRP(P<0.001),Log BNP(P<0.001)were statistically different between the four groups.4.By a simple linear stepwise regression analysis found that RDW with age(r=0.454,P<0.001),EPO(r=0.202,P=0.009),EPO/Hb(r=0.230,P<0.001)、Log Fer(r=0.191,P=0.042),Log CRP(r=0.420,P<0.001),Log BNP(r=0.166,P=0.011)were positively correlated,and RDW with HD duration time(r=-0.413,P<0.001),RRF(r=-0.188,P=0.002),Hb(r=-0.157,P=0.011),MCV(r=-0.194,P=0.002),Fe(r=-0.361,P<0.001),Alb(r=-0.181,P=0.003)and PAB(r=-0.178,P=0.008)showed a negative correlation.5.By using the backward stepwise multiple linear regression analysis,only age(0.019±0.009,P=0.045),HD duration time(-0.010±0.005,P=0.044),RRF(-0.086± 0.037,P=0.021),EPO/Hb(0.113±0.057,P=0.048),MCV(-0.048±0.020,P=0.018),Fe(-0.040±0.020,P=0.050),Alb(-0.051±0.021,P=0.020),Log CRP(0.750±0.354,P=0.037),LogBNP(0.041±0.020,P=0.041)were associated with RDW.Conclusion: 1.Compared with the healthy control group,the results showed that the level of RDW in the HD group was significantly higher,and the difference was statistically significant 2.The MHD patients divided into survival group and death group,were compared the RDW,age,diabetes,HD duration time,total KT/V,RRF,EPO,EPO/Hb,Hb,Fe,Log Fer,PAB,Scr,P,PTH,Log CRP and Log BNP.The results showed these indicators were statistical differences.3.Different RDW horizontal groups,including age,blood penetration,RRF,EPO,EPO/Hb,Hb,Fe,Alb,PAB,Log CRP and log BNP.,there were statistical differences among the four groups.4.The related factors of RDW are age,HD duration time,RRF,EPO/Hb,MCV,Fe,Alb,Log CRP and Log BNP.Part Ⅱ Evaluation of the prognosis of patients with maintenance hemodialysis by the distribution width of red blood cellsObjective: Red blood cell distribution width(RDW)is a measure of the heterogeneity in the size of erythrocytes,which is routinely included in the complete blood cell count.Recently,RDW has been found to be an independent predictor of all-cause mortality in heart failure,stroke and critically ill patients.The purpose of this study was to investigate whether RDW is associated with all-cause mortality and cardiovascular mortality in hemodialysis dialysis patients.Methods: 1.Two hundred and sixty eight patients received hemodialysis from 2008-2017 were enrolled in the second affiliated hospital of Soochow University.The main end point was all-cause mortality and cardiovascular mortality.Patients were consecutively recruited and followed up every two months in the following 10 years.Patients included received hemodialysis for at least three months and were absent from hematological diseases,such as aplastic anemia,severe arrhythmia,acute myocardial infarction,malignant tumor,autoimmune disease,cirrhosis,severe liver failure,chronic obstructive pulmonary disease and incomplete clinical data.2.Enrollmented the demographic data,blood parameter,biochemistry data and Cardiac ultrasound index.Such as Age,gender,Complication,HD duration time(mons),RRF(ml/min),Total Kt/V,Hemoglobin(g/L),MCV(fl),Alb(g/L),CH(mmol/L),TG(mmol/L),BUN(mmol/L),PTH(pg/ml),BNP(pg/ml),LVMI(g/m2),LAD(mm).3.The patients were grouped with RDW four quantiles to compare number of deaths,median survival and cumulative survival among all-cause group and cardiovascular group respectivly.The survival curves were analyzed by kaplan-meier analysis.4.Cox regression analysis was used to assess whether RDW was an independent risk factor for all-cause and cardiovascular mortality in HD patients.5.Use the subject’s working characteristic curve(ROC)to evaluate the value of RDW prediction assessment for all-cause mortality and cardiovascular mortality of the HD patient.Calculations were performed using SPSS for Windows 17.0Results: 1.K-M survival curves showed that RDW can predict HD patients with all-cause and cardiovascular mortality.All-cause mortality and cardiovascular mortality increase with the level of RDW quartile.The highest quartile of RDW had the highest mortality rate.2.Single factor COX regression analysis found that all-cause mortality of the MHD patients with RDW,age,diabetes,total KT/V,RRF,Hb,Fe,TF,Fer,Alb,PAB,P,CRP,BNP,LVMI and LAD correlation.The increase of cardiovascular mortality in HD patients is associated with high level RDW,patient age,hypertension,low level n PCR,hyperphosphatemia,high CRP,high BNP,high level of LVMI and LAD.Multivariate Cox regression analysis showed that RDW was an independent risk factor of all-cause death and cardiovascular death in HD patients.3.Further studies have found that RDW greater than 15.7% is the independent risk factor for the occurrence of all-cause death events and cardiovascular death events in the MHD patients(HR=3.098,95%CI:1.072-8.950,P=0.037;HR=2.661,95%CI:1.111-8.342,P=0.048).4.The area under the ROC curve of all-cause death was 0.708(P<0.001),and the area under the ROC curve of cardiovascular death was 0.670(P<0.001).Conclusion: 1.RDW can predict all-cause death and cardiovascular death in HD patients.And in higher level RDW group,all-cause mortality and cardiovascular mortality increased significantly.2.RDW is an independent risk factor for all-cause mortality and for cardiovascular mortality.3.RDW is an independent predictor of all-cause mortality and cardiovascular mortality. |
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