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Am J Kidney Dis. Author manuscript; available in PMC 2017 July 01. Published in final edited form as: Am J Kidney Dis. 2016 July ; 68(1): 110–121. doi:10.1053/j.ajkd.2015.11.020.
Red Cell Distribution Width and Mortality in Hemodialysis Patients Tania Vashistha, MD1, Elani Streja, MPH, PhD1, Miklos Z. Molnar, MD, PhD2, Connie M. Rhee, MD, MSc1, Hamid Moradi, MD1, Melissa Soohoo, MPH1, Csaba P. Kovesdy, MD2,3, and Kamyar Kalantar-Zadeh, MD, MPH, PhD1 1Harold
Author Manuscript
Simmons Center for Kidney Disease Research & Epidemiology, University of California Irvine, School of Medicine, Orange, CA 2Division
of Nephrology, University of Tennessee Health Science Center, Memphis, TN
3Nephrology
Section, Memphis Veterans Affairs Medical Center, Memphis, TN
Abstract BACKGROUND—Red cell distribution width (RDW) is an index of red blood cell volume variability that has historically been used as a marker of iron-deficiency anemia. More recently,
Author Manuscript
Correspondence: Kamyar Kalantar-Zadeh, MD, MPH, PhD, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, City Tower, Suite 400 - ZOT: 4088, Orange, California 92868-3217, Tel: (714) 456-5142, Fax: (714) 456-6034, [email protected]. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Author Manuscript
Financial Disclosure: The other authors declare that they have no other relevant financial interests. Contributions: Research idea and study design: TV, ES, MZM, CMR, HM, CPK, KK-Z; data acquisition: TV, ES, KK-Z ; data analysis/interpretation: TV, ES, MZM, CMR, HM, MS, CPK, KK-Z; statistical analysis: TV, ES, MZM, MS, KK-Z; supervision or mentorship: KK-Z. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. KK-Z takes responsibility that this study has been reported honestly, accurately, and transparently; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. Peer Review: Evaluated by 2 external peer reviewers, a Statistical Editor, a Co-Editor, and the Editor-in-Chief. Supplementary Material Table S1: Association of baseline RDW with all-cause mortality over 5 y. Table S2: Association of time-varying RDW with all-cause mortality over 5 y. Table S3: Association of time-varying RDW with all-cause mortality over 5 y in patients ever with vitamin B12 or folate measurement. Table S4: Baseline characteristics of cohort with complete data for baseline case-mix and MICS covariates vs those with complete data across all variables. Table S5: Association of time-varying RDW with all-cause mortality over 5 y in patients with hemoglobin ≥12 g/dL. Note: The supplementary material accompanying this article (doi:_______) is available at www.ajkd.org Supplementary Material Descriptive Text for Online Delivery Supplementary Table S1 (PDF). Association of baseline RDW with all-cause mortality over 5 y. Supplementary Table S2 (PDF). Association of time-varying RDW with all-cause mortality over 5 y. Supplementary Table S3 (PDF). Association of time-varying RDW with all-cause mortality over 5 y in patients ever with vitamin B12 or folate measurement. Supplementary Table S4 (PDF). Baseline characteristics of cohort with complete data for baseline case-mix and MICS covariates vs those with complete data across all variables. Supplementary Table S5 (PDF). Association of time-varying RDW with all-cause mortality over 5 y in patients with hemoglobin ≥12 g/dl.
Vashistha et al.
Page 2
Author Manuscript
studies have shown that elevated RDW is associated with higher mortality risk in the general population. However, there is lack of data demonstrating the association between RDW and mortality risk in hemodialysis (HD) patients. We hypothesized that higher RDW levels are associated with higher mortality in HD patients. STUDY DESIGN—Retrospective observational study using a large HD patient cohort. SETTING & PARTICIPANTS—109,675 adult maintenance HD patients treated in a large dialysis organization January 1, 2007–December 31, 2011. PREDICTOR—Baseline and time-varying RDW, grouped into 5 categories:
Am J Kidney Dis. Author manuscript; available in PMC 2017 July 01. Published in final edited form as: Am J Kidney Dis. 2016 July ; 68(1): 110–121. doi:10.1053/j.ajkd.2015.11.020.
Red Cell Distribution Width and Mortality in Hemodialysis Patients Tania Vashistha, MD1, Elani Streja, MPH, PhD1, Miklos Z. Molnar, MD, PhD2, Connie M. Rhee, MD, MSc1, Hamid Moradi, MD1, Melissa Soohoo, MPH1, Csaba P. Kovesdy, MD2,3, and Kamyar Kalantar-Zadeh, MD, MPH, PhD1 1Harold
Author Manuscript
Simmons Center for Kidney Disease Research & Epidemiology, University of California Irvine, School of Medicine, Orange, CA 2Division
of Nephrology, University of Tennessee Health Science Center, Memphis, TN
3Nephrology
Section, Memphis Veterans Affairs Medical Center, Memphis, TN
Abstract BACKGROUND—Red cell distribution width (RDW) is an index of red blood cell volume variability that has historically been used as a marker of iron-deficiency anemia. More recently,
Author Manuscript
Correspondence: Kamyar Kalantar-Zadeh, MD, MPH, PhD, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, City Tower, Suite 400 - ZOT: 4088, Orange, California 92868-3217, Tel: (714) 456-5142, Fax: (714) 456-6034, [email protected]. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Author Manuscript
Financial Disclosure: The other authors declare that they have no other relevant financial interests. Contributions: Research idea and study design: TV, ES, MZM, CMR, HM, CPK, KK-Z; data acquisition: TV, ES, KK-Z ; data analysis/interpretation: TV, ES, MZM, CMR, HM, MS, CPK, KK-Z; statistical analysis: TV, ES, MZM, MS, KK-Z; supervision or mentorship: KK-Z. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. KK-Z takes responsibility that this study has been reported honestly, accurately, and transparently; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. Peer Review: Evaluated by 2 external peer reviewers, a Statistical Editor, a Co-Editor, and the Editor-in-Chief. Supplementary Material Table S1: Association of baseline RDW with all-cause mortality over 5 y. Table S2: Association of time-varying RDW with all-cause mortality over 5 y. Table S3: Association of time-varying RDW with all-cause mortality over 5 y in patients ever with vitamin B12 or folate measurement. Table S4: Baseline characteristics of cohort with complete data for baseline case-mix and MICS covariates vs those with complete data across all variables. Table S5: Association of time-varying RDW with all-cause mortality over 5 y in patients with hemoglobin ≥12 g/dL. Note: The supplementary material accompanying this article (doi:_______) is available at www.ajkd.org Supplementary Material Descriptive Text for Online Delivery Supplementary Table S1 (PDF). Association of baseline RDW with all-cause mortality over 5 y. Supplementary Table S2 (PDF). Association of time-varying RDW with all-cause mortality over 5 y. Supplementary Table S3 (PDF). Association of time-varying RDW with all-cause mortality over 5 y in patients ever with vitamin B12 or folate measurement. Supplementary Table S4 (PDF). Baseline characteristics of cohort with complete data for baseline case-mix and MICS covariates vs those with complete data across all variables. Supplementary Table S5 (PDF). Association of time-varying RDW with all-cause mortality over 5 y in patients with hemoglobin ≥12 g/dl.
Vashistha et al.
Page 2
Author Manuscript
studies have shown that elevated RDW is associated with higher mortality risk in the general population. However, there is lack of data demonstrating the association between RDW and mortality risk in hemodialysis (HD) patients. We hypothesized that higher RDW levels are associated with higher mortality in HD patients. STUDY DESIGN—Retrospective observational study using a large HD patient cohort. SETTING & PARTICIPANTS—109,675 adult maintenance HD patients treated in a large dialysis organization January 1, 2007–December 31, 2011. PREDICTOR—Baseline and time-varying RDW, grouped into 5 categories:
