대한신장학회

논문분류	춘계학술대회 초록집
제목	Differential Prognostic Roles of Red Cell Distribution Width and Neutrophil-to-Lymphocyte Ratio for Dialysis Initiation and Mortality in Non-Dialysis Chronic Kidney Disease
저자	Yunkyeong Hwang
출판정보	2026; 2026(1):
키워드	Chronic kidney disease , Red cell distribution width, Neutrophil-to-lymphocyte ratio, Risk stratification
초록	Objectives: Risk stratification in patients with non-dialysis chronic kidney disease (CKD) remains challenging. Blood-based inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) have been associated with CKD progression, while red cell distribution width (RDW) has emerged as a broader prognostic marker. However, their differential roles in predicting renal outcomes and mortality have not been fully clarified. Methods: We conducted a retrospective cohort study of adult patients with non-dialysis CKD. Baseline RDW and NLR were assessed using routine complete blood count data. Optimal cut-off values were derived from receiver operating characteristic analysis based on 3-year dialysis-free survival. The primary outcomes were dialysis initiation and all-cause mortality. Associations were evaluated using Kaplan–Meier analysis and multivariable Cox proportional hazards models adjusted for demographic factors, comorbidities, kidney function, anemia, and laboratory parameters. Results: A total of 2,692 patients were included. During follow-up, 451 patients initiated dialysis and 239 patients died. Elevated RDW was independently associated with both dialysis initiation (adjusted hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.18–1.81) and all-cause mortality (HR 1.70, 95% CI 1.25–2.31). In contrast, higher NLR was significantly associated with an increased risk of dialysis initiation (HR 1.56, 95% CI 1.26–1.94) but was not independently associated with mortality after multivariable adjustment. RDW-stratified analyses demonstrated that the association between NLR and dialysis risk was preserved regardless of RDW level, whereas no significant interaction between RDW and NLR was observed for mortality. Conclusion: In patients with non-dialysis CKD, RDW predicts both dialysis initiation and mortality, whereas NLR predicts dialysis initiation only. These findings suggest that RDW reflects broader systemic vulnerability, while NLR primarily captures inflammatory activity related to renal disease progression.
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