Abstract: Objective  To explore the correlation between red blood cell distribution width to albumin ratio (RAR) and all-cause mortality in maintenance hemodialysis (MHD) patients.  Methods  A total of 100 MHD patients who met the inclusion criteria were recruited, and 24 patients died and 76 survived at the study endpoint. Their baseline clinical data and laboratory indicators were collected and compared between the death group and the survival group.  The correlation between RAR and all-cause mortality in the MHD patients was analyzed.  Results  Patients in the death group were older than those in the survival group (Z=        -4.086, P＜0.001). The proportion of patients with diabetes, neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), RAR and C-reactive protein (CRP) were higher in the death group than in the survival group (χ²/Z=5.099, -2.215, -2.163, -2.797 and -2.680 respectively; P=0.024, 0.027, 0.031, 0.005 and 0.007 respectively). Serum HDL-C was lower in the death group than in the survival group (Z=-2.741, P=0.006). Multivariate Cox regression analysis suggested that age (HR=1.073, 95% CI:1.030～1.118, P=0.001), diabetes (HR=8.197, 95% CI:2.911～23.082, P＜0.001), RAR (HR=33.179, 95% CI:1.588～693.181, P=0.024) and CRP (HR=1.178, 95% CI:1.059～1.310, P=0.002) were the risk factors for all-cause mortality. The overall survival rate was lower in the patients with higher RAR than in those with lower RAR (χ2=20.341, P＜0.001). ROC curves using RAR, CRP and combination of RAR and CRP to predict all-cause mortality in MHD patients showed that the area under curves were 0.690 (95% CI:0.582～0.798, P=0.005), 0.682 (95% CI:0.560～0.804, P=0.007) and 0.738 (95% CI:0.633～0.843, P＜0.001) respectively.   Conclusion  RAR is correlated with all-cause mortality in MHD patients. The combination of RAR and CRP will have better predictive value for all-cause mortality in MHD patients.

Key words: Hemodialysis, Red blood cell distribution width to albumin ratio, All-cause mortality