Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 29;36(4):704-712.
doi: 10.1093/ndt/gfaa277.

Association of lactate dehydrogenase with mortality in incident hemodialysis patients

Soh Young Ryu  1 , Carola-Ellen Kleine  1 , Jui-Ting Hsiung  1   2 , Christina Park  1 , Connie M Rhee  1   2 , Hamid Moradi  1   2 , Ramy Hanna  1 , Kamyar Kalantar-Zadeh  1   2 , Elani Streja  1   2
Affiliations

Association of lactate dehydrogenase with mortality in incident hemodialysis patients

Soh Young Ryu et al. Nephrol Dial Transplant. .

Abstract

Background: Lactate dehydrogenase (LDH) plays a role in the glucose metabolism of the human body. Higher LDH levels have been linked to mortality in various cancer types; however, the relationship between LDH and survival in incident hemodialysis (HD) patients has not yet been examined. We hypothesized that higher LDH level is associated with higher death risk in these patients.

Methods: We examined the association of baseline and time-varying serum LDH with all-cause, cardiovascular and infection-related mortality among 109 632 adult incident HD patients receiving care from a large dialysis organization in the USA during January 2007 to December 2011. Baseline and time-varying survival models were adjusted for demographic variables and available clinical and laboratory surrogates of malnutrition-inflammation complex syndrome.

Results: There was a linear association between baseline serum LDH levels and all-cause, cardiovascular and infection-related mortality in both baseline and time-varying models, except for time-varying infection-related mortality. Adjustment for markers of inflammation and malnutrition attenuated the association in all models. In fully adjusted models, baseline LDH levels ≥360 U/L were associated with the highest risk of all-cause mortality (hazard ratios = 1.19, 95% confidence interval 1.14-1.25). In time-varying models, LDH >280 U/L was associated with higher death risk in all three hierarchical models for all-cause and cardiovascular mortality.

Conclusions: Higher LDH level >280 U/L was incrementally associated with higher all-cause and cardiovascular mortality in incident dialysis patients, whereas LDH <240 U/L was associated with better survival. These findings suggest that the assessment of metabolic functions and monitoring for comorbidities may confer survival benefit to dialysis patients.

Keywords: all-cause mortality; end-stage renal disease; hemodialysis; lactate dehydrogenase.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Baseline all-cause (A), cardiovascular (B) and infection-related (C) mortality, and time-varying all-cause (D), cardiovascular (E) and infection-related (F) mortality HRs (and 95% CI error bars) by LDH levels across three levels of multivariable adjustment in 109 632 incident HD patients.
FIGURE 2
FIGURE 2
Subgroup analysis of all-cause mortality hazard ratios (and 95% CI error bars) of baseline (A) and time-varying (B) high LDH (LDH ≥250 U/L) versus low LDH (LDH <250 U/L) after adjustment for casemix + MICS variables. AST, aspartate aminotransferase; CBVD, cerebrovascular disease; COPD, chronic obstructive pulmonary disease; Hgb, hemoglobin; HIV, human immunodeficiency virus.
See this image and copyright information in PMC

References

    1. Jurisic V, Radenkovic S, Konjevic G.. The actual role of LDH as tumor marker, biochemical and clinical aspects. Adv Exp Med Biol 2015; 867: 115–124 - PubMed
    1. Rossello X, Hall AR, Bell RM. et al. Characterization of the Langendorff perfused isolated mouse heart model of global ischemia-reperfusion injury: Impact of ischemia and reperfusion length on infarct size and LDH release. J Cardiovasc Pharmacol Ther 2016; 21: 286–295 - PubMed
    1. Erez A, Shental O, Tchebiner JZ. et al. Diagnostic and prognostic value of very high serum lactate dehydrogenase in admitted medical patients. Isr Med Assoc J 2014; 16: 439–443 - PubMed
    1. Hernandez-Cardenas CM, Serna-Secundino H, Garcia-Olazaran JG. et al. Acute respiratory distress syndrome secondary to influenza A(H1N1)pdm09: Clinical characteristics and mortality predictors. Rev Invest Clin 2016; 68: 235–244 - PubMed
    1. Drent M, Cobben NA, Henderson RF. et al. Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation. Eur Respir J 1996; 9: 1736–1742 - PubMed

Publication types