ArticlePediatric research2026
Serum and urinary D-lactate in pediatric intestinal failure: clinical associations and reference values.
Article in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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17 authors.
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Abstract
backgroundD-lactate, produced by intestinal microbiota or derived from the methylglyoxal pathway and diet, is converted by D-lactate dehydrogenase (LDHD) to pyruvate, with several known pathogenic variants of the gene. This study compared serum and urinary D-lactate concentrations across five patient groups and established reference values in healthy children.
methodsIn this cross-sectional study, 341 serum and urine samples from 129 pediatric patients were analyzed. The cohort comprised patients receiving home parenteral nutrition (PN, n = 19), after bowel adaptation (ADAPT, n = 28), with gastrostomy feeding (PEG, n = 13), other gastrointestinal disorders (GI, n = 14), and healthy controls (HC, n = 55). D-lactate was measured via enzymatic spectrophotometric assay. A genetic sub-analysis assessed pathogenic LDHD variants.
resultsMedian serum and urinary D-lactate concentrations in healthy controls were 28.5 μmol/L (IQR 25-34.25) and 400 μmol/L (IQR 193-722), respectively. Both serum (p < 0.001) and urine (p = 0.011) D-lactate concentrations were higher in the ADAPT group compared to healthy controls. No pathogenic LDHD variants were identified.
conclusionChildren after bowel adaptation have higher serum and urine D-lactate concentrations compared to healthy controls. Reference values for serum and urinary D-lactate were defined. IMPACT: This is the first study to provide reference values for serum and urinary D-lactate concentrations in healthy children (serum: 28.5 µmol/L (IQR: 25-34.25 µmol/L); urine: 400 µmol/L (IQR: 193-722 µmol/L)). Children after bowel adaptation exhibited higher D-lactate concentrations in both serum and urine compared to healthy controls. Higher serum and urinary D-lactate levels were associated with the presence of an intestinal anastomosis.
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