Abstract
OBJECTIVE: To investigate the correlation between red blood cell distribution width to albumin ratio (RAR) and cardiovascular events (CVEs) in maintenance hemodialysis (MHD) patients. METHODS: Clinical data were retrospectively collected from MHD patients in Tongren Hospital, Shanghai Jiao Tong University School of Medicine from January 1, 2017 to May 31, 2024. The prognostic endpoints in this study were CVEs. Kaplan-Meier survival curve, Cox regression model, restricted cubic spline analyses and subgroup analysis were used to analyze the independent relationship between RAR and CVEs. RESULTS: A total of 237 MHD patients were included. The median follow-up was 22 (6, 45) months, and CVEs occurred in 100 patients (100/237, 42.2%). The population was divided into Tertile1, 2, and 3 according to the tertiles of baseline RAR levels. Kaplan-Meier survival curve showed a significant difference in the cumulative survival free of CVEs among the tertiles (p=0.0096). Multivariate Cox regression model showed that RAR was an independent risk factor for CVEs in MHD patients (HR=1.336, 95% CI 1.090, 1.638, p=0.005). Compared with Tertile 1 (RAR<3.75), Tertile 3 (RAR≥4.46) was associated with an increased risk of CVEs (HR=1.909, 95% CI 1.074, 3.394, p=0.028). The adjusted restricted cubic spline analysis indicated that the relationship of RAR with CVEs was linear (p for nonlinearity = 0.402). In the subgroup analysis, an interaction effect of RAR and gender was observed. CONCLUSION: Elevated RAR is an independent risk factor for CVEs in MHD patients, and RAR may be helpful for early detection of CVEs risk in MHD patients, although sex differences should be taken in account.