title: Relationship between red cell distribution width and microalbuminuria: a population-based study of multiethnic representative US adults.
abstract: BACKGROUND
  Microalbuminuria (MA), a renal marker of vascular injury, is an independent predictor of cardiovascular (CV) events. Red cell distribution width (RDW), an emerging CV risk predictor, has not been evaluated for its association with MA.
  
  
  METHODS
  We evaluated 8,499 participants of the National Health and Nutrition Examination Survey (NHANES) 1999-2006, where RDW was evaluated as a continuous variable and in quartiles (Q(1) ≤ 12.1, Q(2) 12.2-12.5, Q(3) 12.6-13 and Q(4) >13). Multivariate adjusted logistic regression analysis was performed to estimate the odds of having MA (n = 1,736; adjusted for traditional CV risk factors, race, BMI, estimated glomerular filtration rate, hemoglobin, mean corpuscular volume, high-sensitivity C-reactive protein and nutritional factors deficiencies of iron, folate and vitamin B(12)).
  
  
  RESULTS
  The prevalence of MA increased with increasing RDW (13.52% in Q(1) vs. 30.02% in Q(4), p < 0.001). The odds of having MA for those in Q(4) was 2.49 (95% CI: 1.95-3.18, p < 0.001) compared to those in Q(1) after the adjustments. No effect modification was observed by covariates on the association between RDW and MA.
  
  
  CONCLUSIONS
  Elevated RDW is independently associated with a higher risk of MA. An interaction between chronic inflammation, oxidative stress, neurohumoral overactivity and endothelial dysfunction may explain this association and the attendant elevated CV/renal risk.
authors.affiliation: Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, MI 48201, USA. lafonso@med.wayne.edu
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
authors.forename: Sandip K
authors.initials: SK
authors.lastname: Zalawadiya
authors.forename: Vikas
authors.initials: V
authors.lastname: Veeranna
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Niraj
authors.forename: Sony
authors.initials: S
authors.lastname: Jacob
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000097:blood* / Q000208:ethnology; D015415:Biomarkers; D015897:Comorbidity; D003404:Creatinine / Q000652:urine; D004730:Endothelium, Vascular / Q000503:physiopathology; D004909:Erythrocyte Indices; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate; D044882:Glucose Metabolism Disorders / Q000453:epidemiology; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D007249:Inflammation / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D050177:Overweight / Q000453:epidemiology; D018384:Oxidative Stress; D012306:Risk; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D003404:Creatinine