Red blood cell distribution width is a predictor of chronic kidney disease progression and all-cause mortality

The aim of this study was to investigate the association of RDW with all-cause mortality and disease progression in patients with CKD in stage 3-4.

This longitudinal observational cohort study of patients with CKD was conducted at a single center. We categorized baseline RDW into two groups by its median (14.9 %). The associations between baseline RDW values and all-cause mortality over 56 months were examined in unadjusted and adjusted models. The effect of RDW value on renal outcomes and mortality was evaluated by using Cox regression analysis.

A total of 261 patients were enrolled in the study. During an average follow-up of 56 months, 19.8 % of patients died. The area under the ROC curve for RDW for all-cause mortality was 0.746, with sensitivity of 0.74 and specificity of 0.69 for a cut-off point of 14.3 %. The incidence of all-cause mortality in the group with increased RDW was significantly higher than in the normal RDW group (p < 0.001). The Cox proportional hazard model showed that the elevated RDW level was an independent risk factor for all-cause mortality in patients with CKD in stage 3-4.

RDW is a powerful and independent prognostic marker for predicting all-cause mortality and disease progression in stage 3-4 of CKD (Tab. 4, Fig. 4, Ref. 29).