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Association between Hemoglobin-To-Red Cell Distribution Width Ratio and Left Ventricular Hypertrophy in Non-Dialysis

Li Wang1,2,3,4, Lin Zhang1,2,3,4, Fangfang Xiang1,2,3,4

  • 1Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.

Nephron
|December 16, 2025
PubMed

Insights

The hemoglobin-to-red cell distribution width ratio (HRR) is linked to lower risk of left ventricular hypertrophy (LVH) in chronic kidney disease (CKD) patients. Lower HRR may indicate increased cardiovascular risk in non-dialysis CKD stages 3-5.

Area of Science:

  • Nephrology
  • Cardiology
  • Biomarkers

Background:

  • Left ventricular hypertrophy (LVH) is a significant cardiovascular complication in chronic kidney disease (CKD).
  • Anemia and nutritional deficiencies are key drivers of LVH in CKD.
  • The hemoglobin-to-red cell distribution width ratio (HRR) may reflect these underlying factors, but its role in LVH development in CKD is not well-established.

Purpose of the Study:

  • To investigate the association between the hemoglobin-to-red cell distribution width ratio (HRR) and left ventricular hypertrophy (LVH).
  • To evaluate HRR as a potential biomarker for cardiovascular risk in patients with non-dialysis chronic kidney disease (CKD) stages 3-5.

Main Methods:

  • A cross-sectional study included 195 patients with non-dialysis CKD stages 3-5.
  • Echocardiography diagnosed LVH (LV mass index >115 g/m² men, >95 g/m² women).
  • Logistic regression, subgroup, and restricted cubic spline analyses assessed the HRR-LVH association, with mediation analysis exploring the roles of intact parathyroid hormone (iPTH) and N-terminal pro-brain natriuretic peptide (NT-proBNP).

Main Results:

  • Patients with LVH exhibited significantly lower HRR compared to those without LVH (0.62 vs. 0.81, P<0.001).
  • HRR showed an inverse association with LVH (adjusted OR 0.41 per SD increase, P=0.005).
  • The highest HRR tertile was associated with the lowest risk of LVH (adjusted OR 0.23, P=0.044), with iPTH and NT-proBNP mediating a portion of this relationship.

Conclusions:

  • The hemoglobin-to-red cell distribution width ratio (HRR) may serve as a simple and effective marker for cardiovascular risk stratification in CKD patients.
  • Further prospective research is warranted to determine if interventions targeting HRR can reduce the incidence of LVH.
Abstract

Keywords:
Cardiovascular riskChronic kidney diseaseHemoglobin-to-red blood cell distribution width ratioLeft ventricular hypertrophy

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