Departments of Nephrology (YS, AG, ST) and Cardiology (MK), Meram School of Medicine, Selcuk University, Konya, Turkey; and Departments of Nephrology (MIY, KC, SV, HUU, MG, ED, HC, TE) and Radiology (MS), Gülhane School of Medicine, Ankara, Turkey.
Am J Med Sci. 2014 Feb;347(2):118-24. doi: 10.1097/MAJ.0b013e3182996a96.
Red cell distribution width (RDW) is a measure of erythrocyte size variability and has been shown as an independent predictor of mortality. The aim of this article was to evaluate the association of RDW with endothelial dysfunction in patients with chronic kidney disease (CKD).
Patients with 1 to 5 stages of CKD were included in the study. Endothelial function was assessed with flow-mediated dilatation (FMD). Estimated glomerular filtration rate (eGFR) and carotid intima media thickness (CIMT) were determined. Clinicodemographic characteristics, biochemical values, complete blood counts, ferritin, C-reactive protein (CRP) and cholesterol levels were recorded. Spearman's correlation was used to determine correlates of RDW. Multivariate linear regression model was used to assess independent associates of FMD.
Overall, 367 patients with CKD 1 to 5 were included in the study. RDW showed a significant increase from stage 1 to stage 5 CKD. Median RDW was 13.5. Patients with RDW values higher than median had significantly lower hemoglobin, eGFR and FMD values and higher CIMT and CRP values compared with patients who had RDW values below median. RDW showed a significant positive correlation with the presence of diabetes mellitus, CIMT and CRP, whereas a significant negative correlation with eGFR, ferritin and FMD. Multivariate analysis showed independent predictors of FMD as RDW, presence of diabetes, hemoglobin, eGFR, CRP, and serum albumin.
Multivariate regression model revealed RDW as a significant predictor of FMD independent of major confounding factors, such as diabetes, inflammation, anemia and kidney function in CKD.
红细胞分布宽度（RDW）是红细胞大小变异的衡量指标，已被证明是死亡率的独立预测因子。本文旨在评估 RDW 与慢性肾脏病（CKD）患者内皮功能障碍的相关性。
本研究纳入了 1 至 5 期 CKD 患者。采用血流介导的扩张（FMD）评估内皮功能。测定估算肾小球滤过率（eGFR）和颈动脉内膜中层厚度（CIMT）。记录临床人口统计学特征、生化值、全血细胞计数、铁蛋白、C 反应蛋白（CRP）和胆固醇水平。采用 Spearman 相关分析确定 RDW 的相关因素。采用多元线性回归模型评估 FMD 的独立相关因素。
共有 367 例 1 至 5 期 CKD 患者纳入本研究。RDW 从 CKD 1 期到 5 期呈显著升高趋势。RDW 的中位数为 13.5。RDW 值高于中位数的患者血红蛋白、eGFR 和 FMD 值明显较低，而 CIMT 和 CRP 值明显较高。RDW 与糖尿病、CIMT 和 CRP 呈显著正相关，与 eGFR、铁蛋白和 FMD 呈显著负相关。多元分析显示，FMD 的独立预测因子为 RDW、糖尿病、血红蛋白、eGFR、CRP 和血清白蛋白。
多元回归模型显示，RDW 是 CKD 患者 FMD 的独立预测因子，独立于糖尿病、炎症、贫血和肾功能等主要混杂因素。
