title: Red cell distribution width is an independent factor for left ventricular diastolic dysfunction in patients with chronic kidney disease.
abstract: BACKGROUND
  The increased value of the red cell distribution width (RDW) was reported to indicate poor prognosis in patients with chronic heart failure. We evaluated the value of the RDW in the diagnosis of left ventricular diastolic dysfunction (LVDD) in patients without diastolic heart failure among the chronic kidney disease (CKD) population.
  
  
  METHODS
  The study group consisted of 73 ambulatory patients with CKD, stages 2-5. Standard echocardiography and tissue Doppler imaging (TDI) were performed, and the level of RDW was determined. Patients were divided into four groups according to the results of peak early diastolic velocity of mitral annulus (EmLV) and the stage of CKD: group with early stage CKD (eGFR > 30 ml/min/1.73 m(2)) without LVDD (EmLV ≥ 8 cm/s), early stage CKD with LVDD (EmLV < 8 cm/s), group with advanced stage CKD (eGFR ≤ 30 ml/min/1.73 m(2)) without LVDD, and group with advanced stage CKD with LVDD.
  
  
  RESULTS
  Patients with advanced stage CKD with LVDD were characterized by higher RDW levels than patients with advanced stage CKD without LVDD and with early stage CKD groups with and without LVDD [14.5 (13.8-19.5) % vs. 13.7 (11.4-15,4) %, p = 0.049, vs. 13.8(13.1-14.9) %, p = 0.031, vs. 13.7(12.1-16.2) %, p = 0.0007], respectively. The area under the receiver operating characteristic (ROC) curve of RDW level for the detection of LVDD was 0.649, 95 % confidence interval (CI) 0.528-0.758, p = 0.021, whereas ROC derived RDW value of >13.5 % was characterized by a sensitivity of 83.3 % and specificity of 45.2 % for predicting LVDD. The only independent factor of LVDD was RDW level >13.5 % with odds ratio (OR) = 3.92 (95 % CI 1.05-14.56), p = 0.037.
  
  
  CONCLUSIONS
  RDW can be used as an additional factor for the diagnosis of LVDD in patients with advanced stage of CKD.
authors.affiliation: Department of Internal Diseases, Gastroenterology and Hepatology, University Clinical Hospital in Olsztyn, ul. Warszawska 30, 10-082, Olsztyn, Poland, lgol@op.pl.
authors.forename: Leszek
authors.initials: L
authors.lastname: Gromadziński
authors.forename: Beata
authors.initials: B
authors.lastname: Januszko-Giergielewicz
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003971:Diastole; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000150:complications