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Background and Aims Elevation in red cell distribution width (RDW), a marker of size variance in red blood cells, recently has been reported to predict future cardiovascular event. RDW elevation has also been reported to be associated with faster CKD progression. It is not known whether the elevation of RDW is merely a sequela of, or truly a predictor of, the decline in kidney function. Method A hospital-wide study with all the laboratory data for a period of 4 years and 2 months was conducted. All the adult patients in whom an eGFR slope was obtained over 731 days or more with haemoglobin (Hb) measurements of at least twice over 731 days or more were included. Hb and RDW values were classified according to the timing of measurement: first-year measurements during the period vs last-year values. The effects of Hb and RDW on the annual decline in eGFR (mL/min/1.73m2/year) were analyzed. Statistical analysis was performed with R 3.6.0 on Ubuntu. Results A total of 4,611 patients (M:F = 2124:2487, age 18-105 (median 68) years) were included. The first-month Hb and RDW were 7.5 − 20.2 (median 13.6) g/dL and 10.5 − 34.6 (median 12.6). eGFR was 3.4 − 195 (median 69.3) mL/min/1.73m2. Patients with the highest tertile in the first-year RDW had significantly faster decline in eGFR than the rest (-1.74 vs -1.51, P=0.04), while patients with the highest tertile in the last-year RDW had virtually identical eGFR decline compared with the rest. Patients with higher RDW (&amp;gt;=median) and lower Hb (&amp;lt; median) had significantly faster decline in eGFR than the rest (-1.84±4.11 vs -1.47±2.95, P =0.002). Conclusion Anemic patients with elevated RDW are likely to have faster CKD progression in the future.

MO450ANEMIC PATIENTS WITH ELEVATED RED CELL DISTRIBUTION WIDTH (RDW) ARE LIKELY TO HAVE FASTER FUTURE CKD PROGRESSION