Cardiovascular

Ratio of Red Blood Cell Distribution Width to Albumin Level and Mortality Outcomes in Population with Chronic Kidney Disease.

Lei K, An X, et al. • Kidney & blood pressure research • 2026

Cohort PubMed 42957989 DOI 10.1159/kbr/adjag012
TL;DR

Increased RAR (red blood cell distribution width to albumin ratio) was robustly associated with elevated risks for all-cause, CVD, and cancer mortality in a NHANES 1999-2018 cohort of 3,965 US adults with CKD.

Key Findings

Results

Higher RAR was independently associated with higher all-cause mortality in people with CKD.

  • Cohort of 3,965 CKD patients from NHANES 1999-2018, linked to the National Death Index.
  • 1,163 fatal events occurred during follow-up.
  • Multivariable Cox regression: HR 1.81, 95% CI 1.60-2.06, p < 0.001.
Results

Higher RAR was independently associated with higher cardiovascular disease mortality.

  • Multivariable Cox regression: HR 1.89, 95% CI 1.59-2.26, p < 0.001.
  • Analysis was in the 3,965-person CKD cohort from NHANES 1999-2018.
Results

Higher RAR was independently associated with higher cancer mortality.

  • Multivariable Cox regression: HR 1.76, 95% CI 1.46-2.11, p < 0.001.
Results

The dose-response relationship of RAR with all-cause and CVD mortality was non-linear, whereas that with cancer mortality was linear.

  • Restricted cubic spline analysis was used to assess dose-response relationships and thresholds.
  • All-cause mortality: p for non-linear < 0.001.
  • CVD mortality: p for non-linear < 0.001.
  • Cancer mortality: p for non-linear = 0.113, indicating a linear relationship.
Results

Age, gender, urine albumin-to-creatinine ratio, and poverty income ratio potentially interacted with the association between RAR and mortality.

  • Subgroup analyses were performed to identify potential interactive factors.
  • Interacting factors identified: age, gender, urine albumin-to-creatinine ratio, and poverty income ratio.
Conclusions

RAR, which combines inflammation and nutrition information, is proposed as a reliable prognostic marker in CKD, but validation and mechanistic work are still needed.

  • RAR combines red blood cell distribution width and albumin level.
  • The authors call for future clinical trials to validate the findings and determine the underlying mechanisms.

What This Means

This study looked at whether a simple blood-test ratio could help predict who among people with chronic kidney disease (CKD) is at higher risk of dying. The ratio, called RAR, divides red blood cell distribution width (how much red blood cells vary in size, linked to inflammation) by albumin (a blood protein linked to nutrition and inflammation). Researchers used US national survey data from 1999-2018 on 3,965 adults with CKD and tracked deaths through a national registry. About 1,163 died during follow-up. People with higher RAR had a substantially higher risk of dying from any cause, from cardiovascular disease, and from cancer, even after accounting for other factors. The hazard ratios were around 1.8 to 1.9 for each outcome. The relationship with all-cause and heart-related death was not a straight line, while for cancer death it was. Age, gender, kidney protein leakage in urine, and income level may change how strongly RAR is linked to risk. This research suggests RAR, calculated from routine blood tests, might be a useful marker of prognosis in people with CKD. However, this is an observational study, so it cannot show that RAR causes death or that changing it would improve survival. The authors note that further clinical trials are needed to confirm the findings and to understand the mechanisms.

Have a question about this study?

Presence or severity of Hashimoto's thyroiditis does not influence basal calcitonin levels: observations from CROHT biobank.
Journal of endocrinological investigation • 2022

HT patients of all disease stages preserve Ct production as healthy individuals and there is no need for Ct measurements...
Approach to the Patient: Safety of Growth Hormone Replacement in Children and Adolescents.
The Journal of clinical endocrinology and metabolism • 2022

rhGH therapy has been used for more than 3 decades and data are largely reassuring, yet we still have much to learn abou...
Extended Absorption of Liothyronine from Poly-Zinc-Liothyronine: Results from a Phase 1, Double-Blind, Randomized, and Controlled Study in Humans.
Thyroid : official journal of the American Thyroid Association • 2022

PZL possesses the necessary properties to achieve a much improved T3 pharmacokinetic profile, with ~30% lower Cmax that...
Lipoprotein subtypes after testosterone therapy in transmasculine adolescents.
Journal of clinical lipidology • 2022

Testosterone appears to be a major contributor to differences in lipoprotein profiles, a surrogate for cardiovascular di...
Long-term testosterone undecanoate treatment in the elderly testosterone deficient male: An observational cohort study.
Andrology • 2022

Long-acting testosterone undecanoate treatment in elderly testosterone-deficient patients required more frequent dose ad...
Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism.
Clinical endocrinology • 2022

The Society for Endocrinology commissioned a multidisciplinary guideline to provide all care providers with a comprehens...

Citation

Lei K, An X, Chen A, Lin L, Su B, Li Y. (2026). Ratio of Red Blood Cell Distribution Width to Albumin Level and Mortality Outcomes in Population with Chronic Kidney Disease.. Kidney &amp; blood pressure research. https://doi.org/10.1159/kbr/adjag012