Association Between Red Blood Cell Distribution Width And Survival Rate Of Maintenance Dialysis Patients

Objective:To Studying the relationship between red blood cell distribution width mortality in maintenance hemodialysis(MHD)and Continuous ambulatory peritoneal dialysis(CAPD)patientsMethods:This study selected 331 adult patients who were diagnosed as end-stage renal disease(ESRD),in the Department of Nephrology of the second affiliated Hospital of Kunming Medical University from January 1,2015 to October 31,2016 and were treated with MHD or CAPD for 3 months or more.In a retrospective cohort study,all dialysis patients were followed up to other medical centers,kidney transplantation,death,loss of follow-up or follow-up for 2 years to the end of the study(October 31,2018).Collect demographic data of patients,including gender,age,blood pressure,height,weight,primary kidney disease,year of dialysis,complications(diabetes,hypertension,cardio-cerebrovascular disease,tumor,liver disease,lung disease,hematological disease,acquired immunodeficiency syndrome)history;Laboratory biochemical indicators:White blood cell count(WBC),hemoglobin(HB),RDW,carbon dioxide(CO2),serum creatinine(CREA),blood urea(BUN),serum uric acid(UA),albumin(ALB),serum calcium(Ca2+),serum phosphorus(P3+),parathyroid hormone(iPTH),C-reactive protein(CRP),total cholesterol(TC),triglyceride(TG),B-type natriuretic peptide precursor assay(PRO-BNP),folate(FOLW),Vitamin B12(ViTB12)and other indicators.Taking all-cause death as the end-point event of survival rate,the follow-up period was from October 31.2016 to the occurrence of the end-point event,and the specific cause and time of death were recorded.For patients who did not have end-point events or survived,the deadline for follow-up is October 31,2018.According to the median value of RDW,all dialysis patients were divided into high RDW group and low RDW group,the clinical data of the two groups were compared,the correlation between influencing factors and RDW was analyzed,the survival rate was analyzed by Kaplan-Meier method,the survival rate was calculated and the survival curve was drawn,the correlation between RDW and clinical outcome(all-cause death)was evaluated by COX regression analysis,and the independent risk factors of all-cause death were analyzed.ROC analysis was used to compare the predictive value of RDW for all-cause death in MHD,CAPD and all dialysis patients,and finally to compare the difference of 2-year survival rate under different dialysis methods.Results:1.A total of 331 patients were included in this study.The median survival time of all dialysis patients was 19(12.0)months,the median follow-up time of MIID patients was 16(11.0)months,and the median follow-up time of CAPD patients was 22(20.0)months.The median follow-up time of all dialysis patients was 19(12.0)months,the median survival time of CAPD patients was 16(11.0)months,and the median survival time of all dialysis patients was 16(11.0)months,and the median survival time of CAPD patients was 22(20.0)months.The main diseases that lead patients to enter the ESRD stage are chronic glomerulonephritis(200,60.4%),diabetic nephropathy(59,17.8%),hypertension(38,11.5%),polycystic kidney(12,3.6%),obstructive kidney disease(8,2.4%)and other diseases(14,4,3%).2.The median RDW was 14.3%(13.5%score 15.2%).The dialysis patients were divided into high RDW group and low RDW group,including high RDW(RDW>14.3%)group and low RDW(RDW?14.3%)group.The proportion of MHD in the high RDW group was significantly higher than that in the low RDW group,while the proportion of CAPD in the high RDW group was lower than that in the low RDW group.In terms of blood biochemical indexes,the white blood cell count,C-reactive protein and folic acid in the high RDW group were higher than those in the low RDW group,while the hemoglobin,hematocrit and total cholesterol in the low RDW group were lower than those in the low RDW group.There was no significant difference in other laboratory indexes between the two groups(all P>0.05).In terms of complications,the proportion of hypertension in the high RDW group was lower than that in the low RDW group,and there was no significant difference in other complications.3.Spearman correlation analysis showed that RDW was positively correlated with white blood cell count,urea and folic acid,and negatively correlated with hemoglobin,hematocrit,average concentration of hemoglobin,creatine kinase,total cholesterol and survival time.There was no significant correlation between RDW and MCV,ferritin,vitamin B12,iPTH,serum calcium and phosphorus.4.At the end of follow-up,54(1 6.3%)of the 331 dialysis patients died,22(6.6%)were transferred to other centers,6(1.8%)were transferred from CAPD to MHD and from MHD to CAPD,4 cases(1.2%)were lost,and 0 cases(0.0%)were transplanted.The specific causes of death were as follows:32 cases died of cardiovascular events,15 cases died of infection,4 cases died of cerebrovascular accident.2 cases cled of malignant tumor,1 case died of gastrointestinal bleeding.The percentage of all-cause death and infection death in the high RDW group was significantly higher than that in the low RDW group.Kaplan-Meier survival curve showed that the survival rate of all-cause death in high RDW group was higher than that in low RDW group in all dialysis patients,MHD patients and CAPD patients.There was no significant difference in survival rate between patients with MHD and CAPD(P>0.05).5.Univariate and multivariate Cox regression analysis showed that RDW w as an independent risk factor for all-cause death in dialysis patients(HR=1.311,95%CI:1.1061.555).Conclusions:1.The main primary disease leading to end-stage renal disease is chronic glomerulonephritis;Death and transfer to other medical centers are the main reasons for the termination of follow-up.2.There is no significant difference in 2-year survival rate between MHD and CAPD patients.We should make the best choice according to the actual situation of patients in clinical work.3.RDW is an independent risk factor for all-cause death in maintenance dialysis patients and can be used as one of the valuable indicators to predict the risk of death in patients.4.As a routine blood test item at present,RDW has the advantages of simple,rapid and cheap.For chronic dialysis patients,,it is convenient and effective to evaluate the prognosis of patients and intervene as soon as possible to improve the dialysis effect and quality of life of patients.