title: Renal function is independently associated with red cell distribution width in kidney transplant recipients: a potential new auxiliary parameter for the clinical evaluation of patients with chronic kidney disease.
abstract: Red cell distribution width (RDW), a measure of heterogeneity in the size of circulating erythrocytes, reportedly predicts mortality. Similarly to RDW, impaired renal function is also associated with inflammation and protein-energy wasting. This study assessed if renal function is associated with RDW independent of relevant confounders in stable kidney transplant recipients. We examined the association between RDW and estimated glomerular filtration rate (eGFR) in a cohort of 723 prevalent kidney transplanted recipients who were not receiving erythropoietin-stimulating agents. Associations were examined in regression models adjusted for age, sex, comorbidity, blood haemoglobin, iron indices, markers of nutritional status and inflammation, markers of bone and mineral metabolism and the use of immune suppressants. Lower eGFR was significantly associated with higher RDW (r = -0·382, P < 0·001). This association remained highly significant even after multivariate adjustments where 10 ml/min decrease in the eGFR was significantly associated with an increase of the RDW values (B10 ml/min decrease  =  0·078; 95% confidence interval: 0·044-0·111). The results were consistent in subgroups of patients with different levels of haemoglobin, chronic kidney disease status and various markers of inflammation and iron status. Lower eGFR is associated with higher RDW, independent of comorbidity, iron deficiency, inflammation and nutritional status in kidney transplant recipients.
authors.affiliation: Institute of Pathophysiology, Semmelweis University, Budapest, Hungary.|Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, CA, USA.
authors.forename: Akos
authors.initials: A
authors.lastname: Ujszaszi
authors.affiliation: Institute of Pathophysiology, Semmelweis University, Budapest, Hungary.|Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, CA, USA.|Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Czira
authors.affiliation: Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.|Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Marta
authors.initials: M
authors.lastname: Novak
authors.affiliation: Institute of Pathophysiology, Semmelweis University, Budapest, Hungary.|Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.|Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D004909:Erythrocyte Indices / Q000502:physiology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D018836:Inflammation Mediators