Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.
Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA.
Nephrol Dial Transplant. 2021 Mar 29;36(4):704-712. doi: 10.1093/ndt/gfaa277.
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.
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.
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.
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.
乳酸脱氢酶（LDH）在人体的葡萄糖代谢中发挥作用。较高的 LDH 水平与各种癌症类型的死亡率有关；然而，LDH 与新发生血液透析（HD）患者的生存之间的关系尚未被研究。我们假设较高的 LDH 水平与这些患者的死亡风险增加有关。
我们检查了美国一家大型透析机构在 2007 年 1 月至 2011 年 12 月期间接受治疗的 109632 名成年新发生 HD 患者的基线和时变血清 LDH 与全因、心血管和感染相关死亡率之间的关联。基线和时变生存模型调整了人口统计学变量和可用的营养不良-炎症综合征的临床和实验室替代指标。
在基线和时变模型中，除了时变感染相关死亡率外，基线血清 LDH 水平与全因、心血管和感染相关死亡率之间存在线性关联。在所有模型中，对炎症和营养不良标志物的调整均减弱了这种关联。在完全调整的模型中，基线 LDH 水平≥360 U/L 与全因死亡率的最高风险相关（危险比=1.19，95%置信区间 1.14-1.25）。在时变模型中，LDH>280 U/L 与全因和心血管死亡率的所有三个层次模型中的死亡风险增加相关。
较高的 LDH 水平>280 U/L 与新发生透析患者的全因和心血管死亡率的增加相关，而 LDH<240 U/L 与更好的生存相关。这些发现表明，代谢功能的评估和合并症的监测可能为透析患者带来生存获益。
