J. Levraut et al., EFFECT OF CONTINUOUS VENOVENOUS HEMOFILTRATION WITH DIALYSIS ON LACTATE CLEARANCE IN CRITICALLY ILL PATIENTS, Critical care medicine, 25(1), 1997, pp. 58-62
Objective: To evaluate the effect of continuous venovenous hemofiltrat
ion with dialysis on lactate elimination by critically ill patients. D
esign: Prospective, clinical study, Setting: Surgical intensive care u
nit of a university hospital. Patients: Ten critically ill patients wi
th acute renal failure and stable blood lactate concentrations. Interv
entions: Two-stage investigation: a) measurement of lactate concentrat
ions in samples of serum and ultradiafiltrate from patients receiving
continuous venovenous hemofiltration with dialysis to calculate lactat
e clearance by the hemofilter; b) evaluation of total plasma lactate c
learance by infusing sodium L-lactate (1 mmol/kg of body weight) over
15 mins. Measurements and Main Results: Arterial lactate concentra tio
n was determined before, during, and after the infusion, Lactate elimi
nation variables were calculated from the plasma curve using model ind
ependent and model-dependent estimates (by software). At the end of th
e infusion, median blood lactate concentration increased from 1.4 mmol
/L (range 0.8 to 2.6) to 4.8 mmol/L (range 2.4 to 5.7) and returned to
1.6 mmol/L (range 0.9 to 3.4) 60 mins later. The median total plasma
lactate clearance was 1379 mL/min (range 753.7 to 1880.7) and the medi
an filter lactate clearance was 24.2 mL/min (range 7.1 to 35.6). Thus,
filter lactate clearance accounted for <3% Of total lactate clearance
. Conclusions: Continuous venovenous hemofiltration with dialysis cann
ot mask lactate overproduction, and its blood concentration remains a
reliable marker of tissue oxygenation in patients receiving this renal
replacement technique.