Comparison of RDW-SD and RDW -CV in Chronic Kidney Disease Patients Before and After Hemodialysis

Authors

  • Dzaki Ahmad Fahrezi Amus Departemen Patologi Klinik, Fakultas Kedokteran, Universitas Tadulako, Palu, 94119, Indonesia
  • Haerani Harun Program Studi Kedokteran, Fakultas Kedokteran, Universitas Tadulako, Palu, 94119, Indonesia
  • Jeremy Tanan Departemen Patologi Klinik, Fakultas Kedokteran, Universitas Tadulako, Palu, 94119, Indonesia
  • Rahma Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran, Universitas Tadulako, Palu, 94119, Indonesia
  • Nur Syamsi Departemen Farmakologi, Fakultas Kedokteran, Universitas Tadulako, Palu, 94119, Indonesia
  • Christin Rony Nayoan Departemen Farmakologi, Fakultas Kedokteran, Universitas Tadulako, Palu, 94119, Indonesia

DOI:

https://doi.org/10.29103/averrous.v12i1.26722

Keywords:

Chronic Kidney Disease, hemodialysis, RDW-CV, RDW-SD

Abstract

Red Cell Distribution Width (RDW) is a prognostic biomarker in chronic kidney disease (CKD), reported as RDW-SD (absolute) and RDW-CV (relative). This study directly compares changes in RDW-SD versus RDW-CV before and after a single hemodialysis (HD) session. This pre-post observational study involved 30 adult CKD patients undergoing routine HD. Blood samples were taken pre-HD and one hour post-HD. RDW-SD, RDW-CV, and other hematological parameters were analyzed using a hematology analyzer (Wilcoxon test). Median RDW-SD was 44.40 fL pre-HD vs. 43.80 fL post-HD (p=0.186); median RDW-CV was 14.35% pre-HD vs. 14.30% post-HD (p=0.052). Neither showed significant acute changes, although hemoglobin and leukocytes increased while platelets decreased. A single HD session does not significantly alter RDW-SD or RDW-CV, confirming both parameters reflect chronic disease status rather than acute procedural effects. Clinical implications: These preliminary findings suggest that RDW-SD and RDW-CV may be considered potential long-term prognostic markers, although this requires confirmation in larger studies.

References

[1] K. Kalantar-Zadeh, T. H. Jafar, D. Nitsch, B. L. Neuen, and V. Perkovic, “Chronic Kidney Disease,” Lancet, vol. 398, no. 10302, pp. 786–802, Aug. 2021, doi: 10.1016/S0140-6736(21)00519-5.

[2] D. D. W. Kim, M. Lee, K. J. Lee, Y. H. Lee, S. J. Shin, and H. E. Yoon, “The Combined Clinical Impact of Red Blood Cell Distribution Width and Vascular Calcification on Cardiovascular Events and Mortality in Patients With Endstage Kidney Disease,” Kidney Res. Clin. Pract., vol. 41, no. 3, pp. 351–362, 2022, doi: 10.23876/j.krcp.21.078.

[3] S. Roumeliotis et al., “Red Blood Cell Distribution Width is Associated with Deterioration of Renal Function and Cardiovascular Morbidity and Mortality in Patients with Diabetic Kidney Disease,” Life, vol. 10, no. 11, p. 301, 2020, doi: 10.3390/life10110301.

[4] A. Agarwal and F. Anjum, Hemodialysis. StatPearls [Internet]: StatPearls Publishing, 2026. [Online]. Available: https://www.ncbi.nlm.nih.gov/books/NBK563296/

[5] A. K. Bello et al., “Epidemiology of Haemodialysis Outcomes,” Nat. Rev. Nephrol., vol. 18, no. 6, pp. 378–395, 2022, doi: 10.1038/s41581-022-00542-7.

[6] S. Lulumanin dan D. S. Fahrurodzi, “Analisis Determinan Penyakit Gagal Ginjal Kronis di Indonesia Berdasarkan Data Survei Kesehatan Indonesia Tahun 2023,” Infokes J. Ilm. Rekam Medis dan Inform. Kesehat., vol. 15, no. 2, pp. 86–94, Aug. 2025, doi: 10.47701/kz1ava25.

[7] M. Rezal, “Hubungan Adekuasi Hemodialisis Dengan Kualitas Hidup Pasien Gagal Ginjal Kronis Di Rumah Sakit Anutapura Palu,” J. Innov. Creat., vol. 6, no. 1, pp. 2866–2873, 2026, doi: 10.31004/joecy.v6i1.7195.

[8] H. Widiani, “Penyakit Ginjal Kronik Stadium V Akibat Nefrolitiasis,” Intisari Sains Medis, vol. 11, no. 1, pp. 160–164, 2020, doi: 10.15562/ism.v11i1.680.

[9] J. Zhang, X. Lu, J. Feng, S. Wang, and H. Li, “Prognostic Value of Red Cell Distribution Width and Mean Corpuscular Volume on Mortality in Hemodialysis Patients,” Semin. Dial., vol. 36, no. 1, pp. 18–23, 2023, doi: 10.1111/sdi. 13109.

[10] S. Roumeliotis et al., “Association of Red Blood Cell Distribution Width and Neutrophil-to-Lymphocyte Ratio with Calcification and Cardiovascular Markers in Chronic Kidney Disease,” Metabolites, vol. 13, no. 2, p. 303, Feb. 2023, doi: 10.3390/metabo13020303.

[11] S. Sarkar, S. Kannan, P. Khanna, and A. K. Singh, “Role of Red Blood Cell Distribution Width, as a Prognostic Indicator in COVID‐19: A Systematic Review and Meta‐Analysis,” Rev. Med. Virol., vol. 32, no. 2, p. e2264, 2022, doi: 10.1002/rmv. 2264.

[12] J. Feng et al., “Association Between RDW-SD and Prognosis Across Glycemic Status in Patients with Dilated Cardiomyopathy,” BMJ Open Diabetes Res. Care, vol. 12, no. 6, p. e004478, 2024, doi: 10.1136/bmjdrc-2024-004478.

[13] K. Miyataka et al., “Red Blood Cell Distribution Width is Associated with Renal Tubular Injury in Individuals with Type 2 Diabetes,” J. Diabetes Investig., vol. 16, no. 12, pp. 2191–2200, Dec. 2025, doi: 10.1111/jdi. 70149.

[14] W. Jian, X. Shen, Z. Zheng, Z. Wu, Y. Shi, and J. Liu, “Association Between Red Blood Cell Distribution Width and Coronary Calcification in Patients Referred for Invasive Coronary Angiography,” Angiology, vol. 76, no. 7, pp. 690–698, Aug. 2025, doi: 10.1177/00033197241238509.

[15] N. Nakamura, H. Tsunemine, R. Ikunari, Y. Tanaka, and N. Arima, “Red Blood Cell Distribution Width is A Useful Biomarker to Predict Bleeding and Thrombosis Risks in Patients with Immune Thrombocytopenic Purpura,” eJHaem, vol. 5, no. 3, pp. 431–439, Jun. 2024, doi: 10.1002/jha2.897.

[16] R. M. Alhamawi et al., “The Impact of Hemodialysis on Humoral and Cellular Immunity in Patients with Renal Failure,” J. Clin. Med., vol. 14, no. 18, p. 6533, 2025, doi: 10.3390/jcm14186533.

[17] A.Anitha, P.Sudhakar, and S.Ramapriya, “A Study of Red Blood Cell Indices among Covid 19 Individuals in Tertiary Care Triage Centre,” Int. J. Physiol., vol. 9, no. 4, pp. 1–8, 2021, doi: 10.37506/ijop.v9i4.3085.

[18] X. Deng, X. Gong, Y. Huang, J. Zhou, and S. Ren, “Eryptosis in Renal Anemia: Mechanisms, Clinical Implications, and Therapeutic Targeting,” Front. Pharmacol., vol. 16, pp. 1–18, 2025, doi: 10.3389/fphar.2025.1718803.

[19] O. Dziadkowiec, “Statistical Methods for Pre-Post Intervention Design,” J. Obstet. Gynecol. Neonatal Nurs., vol. 53, no. 1, pp. 9–13, Jan. 2024, doi: 10.1016/j.jogn.2023.11.010.

[20] K. D. Yoo et al., “Red Blood Cell Distribution Width as a Predictor of Mortality Among Patients Regularly Visiting The Nephrology Outpatient Clinic,” Sci. Rep., vol. 11, no. 1, p. 24310, 2021, doi: 10.1038/s41598-021-03530-2.

[21] B. Janssen et al., “Dialyzer Characteristics are Associated with Differential Effects on Intradialytic Microvascular Tissue Perfusion,” Ann. Med. Surg., vol. 88, no. 2, pp. 1369–1382, 2026, doi: 10.1097/MS9.0000000000004738.

[22] Fahima Albeshti and Ayah AL-Hanish, “Hematological Changes in Pre- and Post-Dialysis in Patients Undergoing Hemodialysis: A Comparative Study at Zawia Hospital,” AlQalam J. Med. Appl. Sci., vol. 7, no. 4, pp. 1174–1179, 2024, doi: 10.54361/ajmas. 247438.

[23] S. M. Hutasuhut, A. T. Nasution, and M. Feldy Gazaly Nasution, “Correlation between Red Cell Distribution Width (RDW) with Kidney Function and Hematologic Parameters in Patients Undergoing Regular Hemodialysis,” J. Endocrinol. Trop. Med. Infect. Dis., vol. 2, no. 4, pp. 171–176, 2020, doi: 10.32734/jetromi.v2i4.4732.

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Published

2026-05-20