EPO and metabolic syndrome: Furthermore, increased RDW mirrors a profound deregulation of erythrocyte homeostasis involving both impaired erythropoiesis and abnormal red blood cell survival, which may be attributed to a variety of underlying metabolic abnormalities, such as shortening of telomere length, oxidative stress, inflammation, poor nutritional status, dyslipidemia (Lippi et al., 2013), hypertension, erythrocyte fragmentation, and alteration of erythropoietin function.