Introduction:
The interaction between heart failure, renal insufficiency and anemia has been termed as cardiorenal anemia (CRA) syndrome. Red cell distribution width (RDW) hasn’t been clarified of the prognostic impacts in acute heart failure (HF) with cardiorenal anemia syndrome.
Hypothesis:
RDW remained its prognostic predictive power in patient with cardiorenal anemia syndrome
Methods:
A total of 978 patients (age 75±14 years, 70% men) hospitalized for AHF were enrolled. National Death Registry was linked for the clinical outcomes of all-cause mortality. We collected data of past medical history, biochemistry profiles, and echocardiographic on admission.
Results:
Among the study population, 419 (43%) subjects had cardiorenal anemia syndrome. Across the tertiles of RDW distribution, high RDW was associated with lower left ventricular ejection fraction (LVEF) and hemoglobin levels, and higher serum creatinine levels. During a median follow-up duration of 31 months, 472 subjects (43%) died. The post-discharge mortality increased along with the tertiles of RDW(Figure). After accounting for age, gender, co-morbidities, hemoglobin, renal function, and sodium level, RDW remained an independent predictor of mortality (HR and 95% CI for 1% increase of RDW: 1.11; 1.07-1.15). With further adjustment of NT-proBNP, RDW still was an independent prognostic factor. With adjustments for age, sex and hemoglobin in subgroup analysis, RDW was associated with mortality in patients with chronic kidney disease stage I/II (1.09; 1.03-1.15), III (1.12; 1.06-1.19), and IV/V (1.07; 1.00-1.14). Furthermore, in patients with CRA syndrome, RDW was still related to mortality (1.07; 1.02-1.12).
Conclusions:
Elevated RDW is independently associated with mortality in patients hospitalized for acute HF, despite anemia status, renal function, or CRA syndrome status. Giving RDW an easily accessible marker, the study results may support RDW to improve the risk stratification of acute HF.
Red cell distribution width reflects the early stage residual renal function in peritoneal dialysis patients
