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Higher red blood cell distribution width to platelet count ratio is associated with increased cardiovascular events in peritoneal dialysis patients

Year: 2026

Type: article

Abstract: BACKGROUND: Red blood cell distribution width to platelet count ratio (RPR) has garnered increasing attention as a novel inflammation marker. However, its association with cardiovascular events (CVE) in end-stage renal disease patients undergoing peritoneal dialysis (PD) is largely unknown. METHOD: 1,222 PD patients, from 4 centers, were retrospectively recruited between January 1, 2012-December 31, 2017. Baseline data were collected ~ 3 months after starting PD treatment, and patients divided into 2 groups (low RPR [n = 710], high RPR [n = 512]), based on the optimal RPR cut-off of 0.084 identified by receiver operating characteristic curve analysis. The relationship between RPR with new CVE, cardiovascular disease mortality, and all-cause mortality was analyzed using restricted cubic spline (RCS) and Kaplan-Meier survival curve analyses. Associations between RPR and patient characteristics were identified using uni- and multi-variate Cox logistic regression analyses, adjusted for baseline patient characteristics, co-morbidities, and laboratory parameters. Competitive risk analysis was conducted to assess the effects of other follow-up endpoint events on CVEs. RESULTS: 77 new CVEs and 212 deaths occurred during the follow-up period. High RPR, versus low, had significantly higher rates of new CVEs under Kaplan-Meier analysis; this was still present even after adjusting for specific baseline characteristics, co-morbidities, and laboratory parameters under multivariate Cox regression analysis. RCS analysis also revealed that the relationship between RPR and CVE was non-linear, with RPR ~ 0.06-0.15 being associated with higher CVE risk. CONCLUSION: Higher RPR may serve as an independent prognostic marker for CVE risk in PD patients, providing a non-invasive, cost-effective marker for early CVE detection.

Source: BMC Nephrology

DOI: 10.1186/s12882-026-04925-x