Objective: Peritoneal dialysis (PD) patients, who are more likely to have a poor prognosis for new cardiovascular events (CVE), are the focus of our research. We aim to investigate whether the hemoglobin-to-red cell distribution width (HRR) ratio is associated with a higher risk of new-onset CVE in PD patients. This research could potentially lead to new strategies for predicting and preventing new-onset CVE in PD patients.

Methods:1474 patients from November 1, 2005, to December 31, 2016, were divided into high and low HRR groups using restricted cubic spline (RCS). Various statistical methods were utilized to study the impact of HRR changes on new-onset CVE in PD patients, including Kaplan-Meier cumulative incidence curves, multivariate COX regression, competitive risk analysis, and forest plots to analyze subgroup interactions.

Results: During the follow-up period, 104 new-onset CVEs were recorded. Restricted cubic spline showed a nonlinear relationship between HRR and new-onset CVE. A multifactorial COX regression analysis model showed reduced HRR as an independent risk factor for new-onset CVE (HR, 1.737; 95%CI 1.119-2.695, p=0.014). Kaplan-Meier analysis showed a significant difference in survival between the two groups of patients (P=0.002). The competing risks model found that after excluding endpoint events, there was still a significant difference in new-onset CVE (p=0.0009) between the different HRR groups. In subgroup analyses, there were no significant differences between groups.

Conclusions: Low hemoglobin to red cell distribution width ratio (HRR) is associated with a higher risk of new-onset CVE in PD patients.