Elevated Serum Lactate Linked to Mortality in Hemodialysis Patients: Study
Researchers have discovered in new research that elevated serum lactate levels at the initiation of hemodialysis in patients with end-stage kidney disease were associated with increased all-cause mortality and a higher likelihood of coexisting ischemic heart disease. However, the findings are based on a retrospective observational study and do not establish causation. Prospective studies are needed to confirm these associations and determine the clinical significance of serum lactate as a potential prognostic marker. The study was published in BMJ Nephrology by Emiko O. and colleagues.
In order to establish a connection between serum lactate concentration at the time of hemodialysis and mortality rates, researchers studied clinical data of patients receiving hemodialysis treatment in Nagasaki Harbor Medical Center during the period from 2016 through 2023, including a long-term follow-up till 2024. The sample size was 261 adult patients (mean age, 72.0 ± 11.7 years; 65.6% male).
Lactate concentrations were examined among hemodialysis initiators; median value of baseline lactate was 9 mg/dL (interquartile range 7–12 mg/dL). Patients were divided into two groups according to quartile of serum lactate: a high-lactate group (≥ 12 mg/dL), and a non-high-lactate group (< 12 mg/dL). Cox proportional hazards model was built for the assessment of overall mortality and factors affecting baseline lactate concentration.
Key findings:
- Quantitative associations were identified in the analysis of 261 end-stage kidney disease patients during the longitudinal follow-up period.
- In multivariate Cox regression models, after full adjustment, an increase in baseline serum lactate levels by 1 mg/dL was independently associated with an increased risk of death from all causes by 9% (hazard ratio [HR]: 1.09; 95% CI: 1.04-1.13).
- The presence of ischemic heart disease at the onset of hemodialysis was significantly positively correlated with baseline serum lactate levels (p < 0.01).
Based on the data from observational cohort studies, higher levels of serum lactate concentration at the onset of hemodialysis significantly increase all-cause mortality and are associated with ischemic heart disease in individuals with end-stage renal disease. The findings indicate that serum lactate acts as a useful prognostic indicator in patients with end-stage renal failure.
Reference:
Otsuka, E., Kitamura, M., Yamashita, H. et al. Association of serum lactate levels measured immediately before hemodialysis initiation with all-cause mortality in patients with end-stage kidney disease. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-05369-z
