Higher red blood cell distribution width to platelet count ratio is associated with increased cardiovascular events...

Red blood cell distribution width to platelet count ratio (RPR) has garnered increasing attention as a novel inflammation marker. However, its association with cardiovascular events (CVE) in end-stage renal disease patients undergoing peritoneal dialysis (PD) is largely unknown.

1,222 PD patients, from 4 centers, were retrospectively recruited between January 1, 2012-December 31, 2017. Baseline data were collected ~ 3 months after starting PD treatment, and patients divided into 2 groups (low RPR [n = 710], high RPR [n = 512]), based on the optimal RPR cut-off of 0.084 identified by receiver operating characteristic curve analysis. The relationship between RPR with new CVE, cardiovascular disease mortality, and all-cause mortality was analyzed using restricted cubic spline (RCS) and Kaplan-Meier survival curve analyses. Associations between RPR and patient characteristics were identified using uni- and multi-variate Cox logistic regression analyses, adjusted for baseline patient characteristics, co-morbidities, and laboratory parameters. Competitive risk analysis was conducted to assess the effects of other follow-up endpoint events on CVEs.

77 new CVEs and 212 deaths occurred during the follow-up period. High RPR, versus low, had significantly higher rates of new CVEs under Kaplan-Meier analysis; this was still present even after adjusting for specific baseline characteristics, co-morbidities, and laboratory parameters under multivariate Cox regression analysis. RCS analysis also revealed that the relationship between RPR and CVE was non-linear, with RPR ~ 0.06-0.15 being associated with higher CVE risk.

Higher RPR may serve as an independent prognostic marker for CVE risk in PD patients, providing a non-invasive, cost-effective marker for early CVE detection.