Determinants of Red Cell Distribution Width (RDW) in Cardiorenal Patients: RDW is Not Related to Erythropoietin Resistance

作者：Emans Mireille E; van der Putten Karien; van Rooijen Karlijn L; Kraaijenhagen Rob J; Swinkels Dorine; van Solinge Wouter W; Cramer Maarten J; Doevendans Pieter A F M; Braam Branko; Gaillard Carlo A J M^*

来源：Journal of Cardiac Failure, 2011, 17(8): 626-633.

DOI：10.1016/j.cardfail.2011.04.009

• Anemia
• hepcidin
• iron metabolism

Background: Studies have shown that red cell distribution width (RDW) is related to outcome in chronic heart failure (CHF). The pathophysiological process is unknown. We studied the relationship between RDW and erythropoietin (EPO) resistance, and related factors such as erythropoietic activity, functional iron availability and hepcidin.
Methods and Results: In the Mechanisms of Erythropoietin Action in the Cardiorenal Syndrome (EPO-CARES) study, which investigates the role of EPO in 54 iron-supplemented anemic patients with CHF and chronic kidney disease (CKD) (n = 35 treated with 50 IU/kg/wk Epopoetin beta, n = 19 control), RDW was not associated with EPO resistance. We defined EPO resistance by EPO levels (r = 0.12, P = .42), the observed/predicted log EPO ratio (r = 0.12, P = .42), the increase in reticulocytes after 2 weeks of EPO treatment (r = 0.18, P = .31), and the increase of hemoglobin after 6 months of EPO treatment (r = 0.26, P = .35). However, RDW was negatively correlated with functional iron availability (reticulocyte hemoglobin content, r = 0.48, P < .001, and transferrin saturation, r = 0.39, P = .005) and positively with erythropoietic activity (soluble transferrin receptor, r = 0.48, P < .001, immature reticulocyte fraction, r = 0.36, P = .01) and positively with interleukin-6 (r = 0.48, P < .001). No correlation existed between hepcidin-25 and RDW.
Conclusions: EPO resistance was not associated with RDW. RDW was associated with functional iron availability, erythropoietic activity, and interleukin-6 in anemic patients with CHF and CKD. (J Cardiac Fail 2011;17:626-633)

• 出版日期2011-8