Journal Article

Association between hemoglobin/red blood cell distribution width ratio and acute kidney injury in sepsis and heart failure patients

Rayane Alves Moreira, Remo Holanda M Furtado, João Marcos Santos da Rocha, Mateus Américo Galvão Santos, Petherson Mendonça Dos Santos, Lucas Andrade Pinheiro, Miguel Angelo Goes, Andreia Pardini, João Paulo Fonseca da Silva, Isabele Pardo, Daniela Harsanyi, Beatriz Mota Busnardo, Kirliane de Sousa Rodrigues Lacerda, Fernanda Gabas Miglioli, Maria Carolina Borges Pereira de Almeida, Yvve Priscila Gatto, Beatriz Moreira Silva, Bruno Bravim, Felipe Prieto Siqueira, Anna Carolina de Rizzo Cantoni Rosa, Rafael Santana de Oliveira

2026

Overview

IntroductionThe hemoglobin/red blood cell distribution width (Hb/RDW) ratio has emerged as a potential biomarker for acute kidney injury (AKI), particularly in patients with cardiovascular conditions. This study investigated the relationship between Hb/RDW ratio and AKI incidence in critically ill patients diagnosed with sepsis and heart failure (HF).MethodsA retrospective study was conducted with 119 critically ill patients with sepsis and 83 patients with HF, analyzed according to the presence or absence of kidney injury. Multivariable logistic regression identified independent predictors of AKI. Outcomes between higher and lower Hb/RDW groups were compared.ResultsPatients who developed AKI showed higher C-reactive protein levels, elevated RDW (15.7 ± 2.2 vs. 14.9 ± 1.8; p = 0.01), and higher SAPS 3 scores, along with markedly lower Hb concentrations and Hb/RDW ratios (75.1 ± 1.6 vs. 85.5 ± 1.9; p < 0.001). In multivariable analysis, serum urea (OR 1.016; 95% CI 1.005-1.027 per mg/dL), SAPS 3, and Hb/RDW ratio (OR 0.977; 95% CI 0.959-0.996) were independently associated with AKI. Patients with a lower Hb/RDW ratio had higher frequencies of AKI, kidney-replacement therapy, red-cell transfusion, and mortality. During a 7-year follow-up, progression to dialysis-dependent stage V chronic kidney disease (CKD-V) occurred in 10.8% of HF patients and 2.5% of sepsis patients, indicating that a lower Hb/RDW ratio was also associated with worse long-term renal outcomes.ConclusionThe Hb/RDW ratio is independently associated with AKI and may also reflect long-term kidney prognosis, representing a cost-effective and readily available ICU marker to identify patients at risk for both acute and chronic renal deterioration in sepsis or HF.

• Publisher: Public Library of Science (PLoS)