Abstract: Objective To study the effect of red blood cell distribution width (RDW) on anemia and prognosis in maintenance hemodialysis (MHD) patients. Methods A total of 252 end stage renal disease (ESRD) cases (18 years of age or older) treated with MHD in the Blood Purification Center of Xuanwu Hospital for more than 3 months were enrolled in this study. Medical history, laboratory parameters including blood routine and renal function tests, and recombinant human erythropoietin (rHuEPO) dosage were recruited. They were followed up, and the end-point of this study was the all-cause death. According to renal anemia diagnosis and treatment of Chinese expert consensus recommendations, the standard of hemoglobin level is greater than or equal to 110g/L. Patients with standard hemoglobin level were divided into RDW normal group and RDW elevated group based on the normal RDW limit of 15.0%. General situation, the amount of rHuEPO used, and the recombinant human erythropoietin/hemoglobin (rHuEPO/Hb) ratio were analyzed between the two groups. COX regression analysis was carried out for the risk factors of all-cause death in MHD patients. Results In patients with standard hemoglobin level, rHuEPO dosage and rHuEPO/Hb ratio were higher in RDW elevated group than in RDW normal group (t=7.279, P＜0.001 for rHuEPO dosage; t=5.762, P＜0.001 for rHuEPO/Hb ratio). Multivariate COX regression demonstrated that RDW was the risk factors while Hb and ALB were the protection factors for all- cause death in MHD patients (RR=1.752, 95% CI 1.320～2.325, P＜0.001 for RDW; RR=0.951, 95% CI 0.934～0.968, P＜0.001 for Hb; RR=0.900, 95% CI 0.850～0.954, P＜0.001 for ALB). Conclusions Patients with elevated RDW were less responsive to rHuEPO than those with normal RDW. Higher RDW was the risk factors while Hb and ALB were the protective factors for all-cause death.

Key words: Red blood cell distribution width, Maintenance hemodialysis, Renal anemia, Recombinant human erythropoietin