Association of Red Cell Distribution Width with Early Metabolic–Renal Alterations in Patients with Type 2 Diabetes Mellitus and Preserved Renal Filtration
DOI:
https://doi.org/10.70749/ijbr.v4i2.2933Keywords:
Type 2 diabetes mellitus; red cell distribution width; early renal dysfunction; metabolic-renal axis; estimated glomerular filtration rate; diabetic nephropathy; biomarkers; chronic kidney disease risk; glycemic control; inflammationAbstract
Background: Renal dysfunction in individuals with type 2 diabetes mellitus (T2DM) should be detected early to allow prevention of chronic kidney disease (CKD). Yet classic renal markers tend to identify kidney impairment once significant levels of functional deterioration have taken place. Red cell distribution width (RDW), which is a regularly reported value of the complete blood count, has been linked to inflammation, oxidative stress, and unfavorable metabolic and renal consequences. Nevertheless, it has not been clearly defined how RDW can be an early predictor of metabolic renal dysfunction in diabetic patients with intact renal filtration, despite these associations. The aim of the study was to assess the association between RDW and early metabolic renal abnormalities in the person with T2DM and normal estimated glomerular filtration rate (eGFR). Methods: The analytical study was cross-sectional, and 250 adults with type 2 diabetes mellitus were studied in a tertiary care diabetic clinic. Participants were all in good renal filtration (eGFR ≥60 mL/min/1.73 m 2) and had never been diagnosed with chronic kidney disease. Hematological indexes such as RDW and hemoglobin were measured with the help of an automated hematology analyzer. Serum creatinine, blood urea, fasting plasma glucose, and glycated hemoglobin (HbA1c) were used as a biochemical measure. Renal functioning was assessed based on the CKD-EPI formula to determine eGFR. Participants were divided into groups of normal renal status and early renal stress depending on borderline increases in creatinine and/or urea despite a normal eGFR. Statistical tests involved group comparisons, correlation analysis, logistic regression as well as receiver operating characteristic (ROC) analysis. Results: Individuals that had early renal stress had higher levels of RDW than those who had normal renal status (15.1 + 1.4% vs. 13.8 + 1.1% p = 0.001). RDW had positive relationships with serum creatinine, blood urea, fasting glucose, and HbA1c and negative correlation to eGFR. The multivariate logistic regression analysis determined that RDW was an independent predictive factor of early renal stress. The ROC analysis showed that diagnostic accuracy was moderate with AUC of 0.72 with an optimal cutoff of RDW being 14.5%. Conclusion: Higher RDW is linked to initial metabolic and renal defects of T2DM patients even in the conditions of preserved renal filtration. RDW can be used as a low-cost and easy-to-detect biomarker of early warning against metabolic-renal dysfunction in diabetic patients.
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