BICARBONATE-BASED HEMOFILTRATION IN THE MANAGEMENT OF ACUTE-RENAL-FAILURE WITH LACTIC-ACIDOSIS

Continuous haemofiltration with lactate-based replacement fluid is wid ely used for the treatment of acute renal failure (ARF). In the presen ce of lactic acidosis, such treatment exacerbates rather than improves the clinical state. Continuous haemofiltration using a locally-prepar ed bicarbonate-based replacement fluid was performed in 200 patients o ver 7 years. All the patients had ARF with concomitant lactic acidosis , or demonstrated lactate intolerance after starting haemofiltration w ith lactate-based replacement fluids. In every case it was possible to correct the acidosis without inducing either extracellular volume exp ansion or hypernatraemia. In 89 patients (45%), the lactic acidosis re solved while being treated with bicarbonate-based haemofiltration. Fif ty-seven patients (28.5%) survived. Significant differences at present ation in the group who survived, compared with those who died, were se en in age (50.8 vs. 57.1), mean arterial pressure (68.5 vs. 60.0 mmHg) and APACHE II score (32.1 vs. 38.9). Neither the severity of the pres enting acidosis nor the arterial blood lactate appeared to predict out come. Patients who developed ARF and lactic acidosis after cardiac sur gery had a low survival rate. The combination of ARF and lactic acidos is that cannot safely be treated by haemofiltration using lactate-base d replacement fluids can be managed with bicarbonate-based haemofiltra tion.