title: Mean corpuscular volume is associated with endothelial dysfunction and predicts composite cardiovascular events in patients with chronic kidney disease.
abstract: OBJECTIVE
  Mean corpuscular volume (MCV) is a measure of size of red blood cells. Recently a few studies showed an association of macrocytosis with all-cause mortality. We aimed to assess the relationship of MCV with cardiovascular (CV) morbidity and mortality in patients with chronic kidney disease (CKD), and the effect of MCV on endothelial function.
  
  
  METHODS
  This is an observational cohort study with a prospectively maintained cohort of patients with stage 1-5 CKD. Estimated glomerular filtration rate (eGFR), flow mediated dilatation (FMD) and laboratory values were measured at baseline. Multivariate linear and Cox regression analyses were used to predict independent associations of FMD and composite CV events, respectively.
  
  
  RESULTS
  A total of 309 patients were included in the study. In contrast to anaemia MCV did not show a significant change among CKD groups. MCV was an independent predictor of FMD in addition to serum haemoglobin, CRP, diabetes, systolic blood pressure (SBP) and eGFR. Median MCV value was 85 fl. Kaplan-Meier analysis showed that at 38 months the survival rate was 97.6% in the group with MCV < 85 compared to 81.6% in the arm with MCV ≥ 85 (P < 0.001, log-rank test). Cox regression analysis showed MCV as a predictor of composite CV events independent of major confounding factors.
  
  
  CONCLUSIONS
  This is the first study in the literature showing an independent association of MCV and FMD. Our results also determined MCV as an independent predictor of composite CV events independent of anaemia, inflammation, diabetes and eGFR in patients with CKD.
authors.affiliation: Nephrology Clinic, Karaman State Hospital, Karaman, Turkey.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Solak
authors.forename: Mahmut Ilker
authors.initials: MI
authors.lastname: Yilmaz
authors.forename: Mutlu
authors.initials: M
authors.lastname: Saglam
authors.forename: Seref
authors.initials: S
authors.lastname: Demirbas
authors.forename: Samet
authors.initials: S
authors.lastname: Verim
authors.forename: Hilmi Umut
authors.initials: HU
authors.lastname: Unal
authors.forename: Abduzhappar
authors.initials: A
authors.lastname: Gaipov
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Oguz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kayrak
authors.forename: Kayser
authors.initials: K
authors.lastname: Caglar
authors.forename: Abdulgaffar
authors.initials: A
authors.lastname: Vural
authors.forename: Suleyman
authors.initials: S
authors.lastname: Turk
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kanbay
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D014664:Vasodilation
keywords: cardiovascular event; chronic kidney disease; flow mediated dilatation; mean corpuscular volume; prediction