The Relationship between Red Cell Distribution Width with Erythropoietin Resistance in Iron Replete Hemodialysis Patients

Background: Recently, erythropoietin resistance (ER) has been shown to be related with cardiovascular and overall mortality in hemodialysis (HD) patients. Red blood cell distribution width (RDW) has also shown to be associated with cardiovascular and all cause mortality in general population. Thus in the current study we tested the hypothesis that RDW and erythropoietin resistance as determined by erythropoiesis stimulating agents (ESA) hyporesponsiveness index (EHRI) may be related with each other in iron replete HD patients. Methods: Study participants underwent medical history taking, physical examination, calculation of dialysis adequacy and biochemical analysis. EHRI was calculated as the weekly dose of EPO divided by per kilogram of body weight divided by the hemoglobin level. Results: Two separate analyses were performed. In the first analysis performed in 94 HD patients; the stepwise linear regression analysis revealed that being female (P=0.031), HD duration (P=0.021), presence of diabetes mellitus (P=0.008), RDW(P=0.023), and predialysis sodium (P=0.05) were independently related with logarithmically converted EHRI. We made second analysis after 4 months. The second analysis revealed that when compared to first EHRI, the EHRI was increased in 40, unchanged in one and decreased in 40 patients The second stepwise regression analysis also showed that the independent relationship with RDW and EHRI was persisted (beta=0.050, CI: 0.022-0.078, P=0.001). Conclusion: Red blood cell distribution width was independently related with EHRI in iron replete HD patients. (C) 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.