Hirotaka Saito1, Kenichi Tanaka2,3, Tsuyoshi Iwasaki1, Akira Oda1, Shuhei Watanabe1, Eri Kobari1, Hiroshi Kimura1, Sakumi Kazama4, Michio Shimabukuro4,5, Koichi Asahi4,6, Tsuyoshi Watanabe4, Junichiro J Kazama1,4. 1. Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikariga-oka, Fukushima, 960-1295, Japan. 2. Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikariga-oka, Fukushima, 960-1295, Japan. kennichi@fmu.ac.jp. 3. Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan. kennichi@fmu.ac.jp. 4. Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan. 5. Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University, Fukushima, Japan. 6. Division of Nephrology and Hypertension, Iwate Medical University, Yahaba, Japan.
Abstract
BACKGROUND: Mean corpuscular volume (MCV) and red cell distribution width (RDW), as well hemoglobin, are reported to be associated with mortality in various populations. However, associations between such hematological parameters and adverse outcomes in patients with CKD have not been sufficiently elucidated. METHODS: A total of 1,320 participants enrolled in the Fukushima CKD Cohort Study were examined to investigate associations between hematological parameters of anemia (MCV and RDW) and adverse outcomes, such as ESKD, all-cause death, and cardiovascular events, in patients with non-dialysis-dependent CKD. Baseline hematological parameters were grouped as follows: hemoglobin into 3 categories (< 11.0 g/dL, 11.0 ≤ - < 13.0 g/dL [reference], and ≥ 13.0 g/dL); MCV into 5 categories (< 90 fL, ≥ 90 - < 94 fL [reference], ≥ 94 - < 98 fL, ≥ 98 - < 102 fL, and ≥ 102 fL); and RDW into 2 categories (< 13.6% [reference] vs ≥ 13.6%). RESULTS: During the median observational period of 4.7 years, 120 patients developed ESKD, 160 developed cardiovascular events, and 122 died. Hemoglobin < 11 g/dL (hazard ratio [HR] 1.56, 95% confidence interval [CI], 1.00-2.42), MCV < 90 fL (HR 2.01, 95% CI 1.14-3.54), and RDW ≥ 13.6% (HR 1.57, 95% CI 1.01-2.42) were significantly associated with higher risks of ESKD. Hemoglobin < 11 g/dL, MCV ≥ 98 fL, and RDW ≥ 13.6% were significantly associated with higher risks of all-cause death. No significant associations between hematological parameters and risk of cardiovascular events were confirmed. CONCLUSION: In patients with non-dialysis-dependent CKD, MCV, RDW, and hemoglobin were associated with increased risks of ESKD and all-cause mortality.
BACKGROUND: Mean corpuscular volume (MCV) and red cell distribution width (RDW), as well hemoglobin, are reported to be associated with mortality in various populations. However, associations between such hematological parameters and adverse outcomes in patients with CKD have not been sufficiently elucidated. METHODS: A total of 1,320 participants enrolled in the Fukushima CKD Cohort Study were examined to investigate associations between hematological parameters of anemia (MCV and RDW) and adverse outcomes, such as ESKD, all-cause death, and cardiovascular events, in patients with non-dialysis-dependent CKD. Baseline hematological parameters were grouped as follows: hemoglobin into 3 categories (< 11.0 g/dL, 11.0 ≤ - < 13.0 g/dL [reference], and ≥ 13.0 g/dL); MCV into 5 categories (< 90 fL, ≥ 90 - < 94 fL [reference], ≥ 94 - < 98 fL, ≥ 98 - < 102 fL, and ≥ 102 fL); and RDW into 2 categories (< 13.6% [reference] vs ≥ 13.6%). RESULTS: During the median observational period of 4.7 years, 120 patients developed ESKD, 160 developed cardiovascular events, and 122 died. Hemoglobin < 11 g/dL (hazard ratio [HR] 1.56, 95% confidence interval [CI], 1.00-2.42), MCV < 90 fL (HR 2.01, 95% CI 1.14-3.54), and RDW ≥ 13.6% (HR 1.57, 95% CI 1.01-2.42) were significantly associated with higher risks of ESKD. Hemoglobin < 11 g/dL, MCV ≥ 98 fL, and RDW ≥ 13.6% were significantly associated with higher risks of all-cause death. No significant associations between hematological parameters and risk of cardiovascular events were confirmed. CONCLUSION: In patients with non-dialysis-dependent CKD, MCV, RDW, and hemoglobin were associated with increased risks of ESKD and all-cause mortality.