Kim Da Won, Lee Munpyo, Lee Kwon Jae, Lee Yeon Hee, Kim Dongryul, Shin Seok Joon, Yoon Hye Eun
Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2022 May;41(3):351-362. doi: 10.23876/j.krcp.21.078. Epub 2022 Mar 3.
Little is known about how the interaction between red blood cell distribution width (RDW) and vascular calcification (VC) affects cardiovascular (CV) events and mortality in end-stage kidney disease (ESKD) patients. This study investigated the combined prognostic effect of RDW and VC in ESKD patients starting dialysis.
A retrospective single-center study of 582 ESKD patients was conducted. VC was assessed by calculating the aortic calcification index (ACI) using computed tomography. Patients were divided into low ACI-low RDW, low ACI-high RDW, high ACI-low RDW, and high ACI-high RDW groups based on median ACI (17.12) and RDW (14.3) values. The association between RDW and VC and the composite endpoint of CV events and death was analyzed.
During a median follow-up of 3.1 years (range, 1.5-5.5 years), 165 CV events (28.4%) and 124 deaths (21.4%) occurred. Cox regression showed that the low ACI-high RDW (adjusted hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.04-2.66; p = 0.03) and high ACI-low RDW (adjusted HR, 1.95; 95% CI, 1.21-3.14; p = 0.006) groups had a greater risk of CV events and death than the low ACI-low RDW group. The high ACI-high RDW group had the greatest risk (adjusted HR, 2.23; 95% CI, 1.42-3.52; p = 0.001). The effect of the interaction between ACI and RDW on CV events and mortality was statistically significant (p = 0.005).
High RDW and VC interact to increase the risk of CV events and death in ESKD patients.
关于红细胞分布宽度（RDW）与血管钙化（VC）之间的相互作用如何影响终末期肾病（ESKD）患者的心血管（CV）事件和死亡率，目前知之甚少。本研究调查了RDW和VC对开始透析的ESKD患者的联合预后影响。
对582例ESKD患者进行了一项回顾性单中心研究。通过计算机断层扫描计算主动脉钙化指数（ACI）来评估VC。根据ACI中位数（17.12）和RDW中位数（14.3）值，将患者分为低ACI-低RDW、低ACI-高RDW、高ACI-低RDW和高ACI-高RDW组。分析了RDW与VC之间的关联以及CV事件和死亡的复合终点。
在中位随访3.1年（范围1.5 - 5.5年）期间，发生了165例CV事件（28.4%）和124例死亡（21.4%）。Cox回归显示，低ACI-高RDW组（调整后风险比[HR]，1.66；95%置信区间[CI]，1.04 - 2.66；p = 0.03）和高ACI-低RDW组（调整后HR，1.95；95% CI，1.21 - 3.14；p = 0.006）发生CV事件和死亡的风险高于低ACI-低RDW组。高ACI-高RDW组风险最大（调整后HR，2.23；95% CI，1.42 - 3.52；p = 0.001）。ACI与RDW之间的相互作用对CV事件和死亡率的影响具有统计学意义（p = 0.005）。
高RDW和VC相互作用会增加ESKD患者发生CV事件和死亡的风险。
