Improving risk stratification in male haemodialysis patients using LRG

Leucine-rich alpha-2-glycoprotein  (LRG or also used as a synonym LRG1) is a matricellular protein that has been recognized for its role in inflammation, fibrosis, and cardiovascular disease (1).

In renal disease, inflammation and vascular complications are key drivers of progression and poor outcomes. For patients with end-stage renal disease undergoing maintenance hemodialysis, traditional risk factors do not fully explain the high rates of cardiovascular mortality (2, 3). This has driven the search for new biomarkers, like LRG1, that may reflect the underlying pathology.

Improving risk stratification in male haemodialysis patients using LRG.

In a recent study, researchers have explored the link between serum LRG levels and all-cause mortality in patients receiving long-term haemodialysis (2).

Elevated leucine-rich alpha-2 glycoprotein levels and mortality risk in end-stage renal disease: evidence for gender differences.  Xiong J et al., Clin Kidney J. 2026.

Key findings:

• In a 5-year prospective cohort of 313 stable HD patients, LRG serum levels were linked to increased mortality risk in male, but not female, patients.
• The findings suggest that LRG may have potential as a sex-specific biomarker for risk stratification in end-stage renal disease.

 

Leucine-rich alpha-2-glycoprotein (LRG or also used as a synonym LRG1)  was successfully measured in serum samples with Biomedica´s LRG ELISA 

Human LRG (syn. LRG1) ELISA (cat. no. BI-LRG)

-TRUSTED –   Full validation package 

-CONVENIENT – Ready-to- use reagents and controls included – protocol booklet

-RELIABLE – Reference values available

 

 

Elevated leucine-rich alpha-2 glycoprotein levels and mortality risk in end-stage renal disease: evidence for gender differences. Xiong J et al., Clin Kidney J. 2026.

Abstract

Background: Leucine-rich α-2 glycoprotein (LRG) is an inflammation-related serum protein implicated in cardiovascular pathology. Its prognostic role in patients with end-stage renal disease (ESRD) remains unclear. We investigated the association between serum LRG levels and all-cause mortality in maintenance haemodialysis patients, with a focus on sex-specific effects.

Methods: In this prospective cohort study, 313 stable haemodialysis patients (206 males, 107 females) were enrolled and followed for 5 years. Baseline serum LRG concentrations were quantified by ELISA. Receiver operating characteristic (ROC) analysis identified an optimal mortality risk cut-off (45.5 µg/ml). Survival analyses used Kaplan-Meier curves and multivariable Cox regression models adjusted for demographic, clinical, and laboratory covariates. Analyses were stratified by sex.

Results: During follow-up, 103 deaths occurred (78 males, 25 females). Higher LRG levels were significantly associated with increased mortality risk in males (log-rank P < .001), but not females (P = .17). In adjusted Cox models, male patients with LRG >45.5 µg/ml had a ∼2-fold higher mortality risk [hazard ratio (HR) = 2.07; 95% confidence interval (CI) 1.32-3.23] compared to those below the cut-off. The association remained robust after further adjustment for C-reactive protein, albumin, dialysis vintage, and comorbidities. No significant association was observed in females (HR = 1.24; 95% CI = 0.65-2.34). ROC analysis yielded an AUC of 0.604 for LRG in predicting mortality.

Conclusions: Elevated serum LRG independently predicts all-cause mortality in male, but not female, haemodialysis patients. These findings highlight the potential of LRG as a sex-specific biomarker for risk stratification in ESRD and underscore the need for mechanistic studies on sex differences in LRG-related pathways.

 

Literature

1. LRG1: an emerging player in disease pathogenesis. Camilli C, Hoeh AE, De Rossi G, Moss SE, Greenwood J. J Biomed Sci. 2022 Jan 21;29(1):6. doi: 10.1186/s12929-022-00790-6. PMID: 35062948; PMCID: PMC8781713.
2. LRG1 Contributes to the Pathogenesis of Multiple Kidney Diseases: A Comprehensive Review. Chen C, Zhang J, Yu T, Feng H, Liao J, Jia Y. Kidney Dis (Basel). 2024 Apr 3;10(3):237-248. doi: 10.1159/000538443. PMID: 38799248; PMCID: PMC11126829.
3. Elevated leucine-rich alpha-2 glycoprotein levels and mortality risk in end-stage renal disease: evidence for gender differences. Xiong J, Li X, Liu Y, Hocher JG, Reichetzeder C, Elitok S, Horvathova K, Krämer BK, Tepel M, Hocher B. Clin Kidney J. 2026 Feb 12;19(4):sfag043. doi: 10.1093/ckj/sfag043. PMID: 42017030; PMCID: PMC13092969.