Abstract: Objective  To explore the relationship between peripheral red blood cell distribution width (RDW), microRNA-133a, and heart failure in maintenance hemodialysis (MHD) patients.  Method   A total of 80 MHD patients admitted to The First Hospital of Qinhuangdao from December 2020 to December 2021 were recruited and divided into a heart failure group (n=23) and a non-heart failure group (n=57) according to the presence or absence of heart failure. End-stage renal disease (ESRD) patients not on dialysis were recruited as the ESRD control group, and 40 healthy people with normal physical examinations during the same period were recruited as the healthy control group. Their RDW was measured. miR-133a content in peripheral blood was measured by real-time quantitative PCR. The relationship between RDW, miR-133a level and heart failure in MHD patients was then evaluated.  Result   Peripheral blood RDW was higher in heart failure group than in non-heart failure group (t=11.896, P＜0.001), ESRD control group (t=12.010, P＜0.001), and healthy control group (t=3.570, P＜0.001); the difference between the four groups was statistically significant (F=61.144, P＜0.05). Serum miR-133a was lower in heart failure group than in non-heart failure group (t=8.321, P＜0.001), ESRD control group (t=8.321, P＜0.001), and healthy control group (t=10.395, P＜0.001); the difference between the four groups was statistically significant (F=73.835, P＜0.05). Stroke volume (SV) and left ventricular ejection fraction (LVEF) were lower in heart failure group than in non-heart failure group (t=12.335, 14.044, P＜0.001), ESRD control group (t=17.609, 17.782, P＜0.001), and healthy control group (t=19.195, 20.149, P＜0.001); the differences between the four groups were statistically significant (F=120.238, 161.756, P＜0.05). Left ventricular mass index (LVMI) was higher in heart failure group than in non-heart failure group (t=5.46550, P＜0.001), ESRD control group (t=17.515, P＜0.001), and healthy control group  (t=18.124, P＜0.001); the difference between the four groups was statistically significant (F=274.669, P＜0.05). Pearson correlation analysis showed that peripheral RDW was negatively correlated with SV and LVEF (r=-0.357, -0.422, P＜0.001), and positively correlated with LVMI (r=0.458, P＜0.001); serum miR-133a was positively correlated with SV and LVEF (r=0.412, 0.437, P＜0.001), and negatively correlated with LVMI (r=-0.416, P＜0.001). ROC curve showed that combined detection of peripheral blood RDW and miR-133a had an area under the curve of 0.83 for predicting heart failure in MHD patients, with a sensitivity and specificity of 82.49% and 68.37%.  Conclusion   Peripheral RDW and serum miR-133a are closely related to the heart function in MHD patients, and have a better value for predicting heart failure in MHD patients.

Key words: Red blood cell distribution width, microRNA-133a, Hemodialysis, Heart failure