Higher serum lactate dehydrogenase (LDH) levels are associated with significantly worse renal and cardiovascular outcomes in patients with advanced chronic kidney disease (CKD) without diabetes, according to new findings from an analysis of the PREDICT trial.
Higher Enzyme Levels Tied to Renal Decline and Mortality Risk
While elevated LDH has previously been linked to poor prognosis in diabetic kidney disease, its role in non-diabetic CKD has remained unclear. This study aimed to address that gap by evaluating the relationship between LDH levels and clinical outcomes in a high-risk population with advanced CKD and renal anaemia.
The analysis included 444 patients aged 20–85 years, with a median age of 73 years and a mean estimated glomerular filtration rate (eGFR) of 13.5 mL/min/1.73 m². Participants were stratified into four groups based on serum LDH levels, ranging from lowest (Q1) to highest (Q4).
Over a median follow-up of approximately 18–21 months, nearly half of patients (46%) experienced renal composite outcomes, while 10% experienced a composite of cardiovascular events or death. Outcomes worsened significantly with increasing LDH levels.
Patients in the highest LDH quartile (Q4) had more than double the risk of adverse renal outcomes compared with those in the lowest quartile (adjusted hazard ratio [aHR] 2.07). Additionally, the risk of cardiovascular events or death was nearly three times higher in this group (aHR 2.77).
Findings Support LDH as a Simple Prognostic Biomarker
These findings suggest that LDH, a widely available and inexpensive biomarker, may provide valuable prognostic information in patients with advanced CKD without diabetes. Elevated LDH levels could reflect underlying tissue damage, hypoxia, or systemic inflammation, all of which may contribute to disease progression and poorer outcomes.
The authors highlight the potential clinical utility of LDH in risk stratification and monitoring, particularly in patients approaching end-stage kidney disease.
Further research is needed to determine whether incorporating LDH into routine clinical assessment can improve patient management and outcomes in this population.
Reference
Nakamura Y et al. Association between serum lactate dehydrogenase level and renal outcome in patients with advanced chronic kidney disease without diabetes mellitus. Clin Exp Nephrol. 2026; DOI: 10.1007/s10157-026-02855-4.
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