Lactate-albumin ratio helps predict mortality risk in CKD patients who are not undergoing CRRT: Study

A new study published in the journal of BMC Nephrology showed that for ICU patients with chronic kidney disease (CKD) who are not undergoing continuous renal replacement therapy (CRRT), the lactate-albumin ratio (LAR) is a substantial and independent predictor of mortality.

There has not been any prior research on the connection between the LAR and all-cause mortality in CKD. This study sought to investigate the relationship between LAR levels and all-cause mortality in patients with CKD without CRRT in the ICU.

Patients with chronic kidney disease who were admitted to the intensive care unit (ICU) and did not have a CRRT application in the medical information mart for intensive care IV (MIMIC-IV) database were chosen based on exclusion criteria after the initial test results were collected within 24 hours of the ICU admission. All-cause death rates at 30, 90, and 365 days were the main outcome. The association between LAR and death rates at 30, 90, and 365 days was examined using Cox proportional hazard models and restricted cubic splines (RCS).

A total of 987 patients were included in this study after the inclusion and exclusion criteria were applied. The LAR was statistically significant in both the univariate and multivariate Cox analyses. Also, it was separated into CKD 1-2, CKD 3-4, and CKD 5, or early, middle, and late stages, according to the CKD stage (Kidney Disease Improving Global Outcomes 2012 CKD guideline).

The middle stage mortality rate was the most important of all. Patients with CKD who did not get CRRT had death rates of 38.9%, 41.6%, and 41.8% after 30, 90, and 365 days, respectively. The 30-day, 90-day, and 365-day mortality rates increased by 30% (hazard ratio [HR] = 1.30, 95% confidence intervals [CI]: 1.18–1.43, P < 0.001), 32% (HR = 1.32, 95% CI: 1.20–1.45, P < 0.001), and 32% (HR = 1.32, 95% CI: 1.21–1.45, P < 0.001) in Model III.

The LAR ratio and death rates at 30, 90, and 365 days showed a positive, nonlinear connection, according to RCS. Overall, this study offers initial proof that LAR is a reliable and clinically significant predictive indicator for ICU patients with CKD who are not dependent on CRRT.

Source:

Xie, R., Xie, H., Li, L., Wen, R., Tan, X., Zhu, F., Li, P., & Qin, J. (2025). Relationship between lactate-albumin ratio and all-cause mortality in chronic kidney disease without continuous renal replacement therapy in the intensive care unit ward: a retrospective analysis of the MIMIC-IV database. BMC Nephrology, 26(1), 685. https://doi.org/10.1186/s12882-025-04588-0