title: Effect of continuous venovenous hemofiltration with dialysis on lactate clearance in critically ill patients.
abstract: OBJECTIVE
  To evaluate the effect of continuous venovenous hemofiltration with dialysis on lactate elimination by critically ill patients.
  
  
  METHODS
  Prospective, clinical study.
  
  
  METHODS
  Surgical intensive care unit of a university hospital.
  
  
  METHODS
  Ten critically ill patients with acute renal failure and stable blood lactate concentrations.
  
  
  METHODS
  Two-stage investigation: a) measurement of lactate concentrations in samples of serum and ultradiafiltrate from patients receiving continuous venovenous hemofiltration with dialysis to calculate lactate clearance by the hemofilter; b) evaluation of total plasma lactate clearance by infusing sodium L-lactate (1 mmol/kg of body weight) over 15 mins.
  
  
  RESULTS
  Arterial lactate concentration was determined before, during, and after the infusion. Lactate elimination variables were calculated from the plasma curve using model-independent and model-dependent estimates (by software). At the end of the 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 median 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 cannot mask lactate overproduction, and its blood concentration remains a reliable marker of tissue oxygenation in patients receiving this renal replacement technique.
authors.affiliation: Département d'Anesthésie-Réanimation, Centre Hospitalo-Universitaire de Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Levraut
authors.forename: J P
authors.initials: JP
authors.lastname: Ciebiera
authors.forename: P
authors.initials: P
authors.lastname: Jambou
authors.forename: C
authors.initials: C
authors.lastname: Ichai
authors.forename: Y
authors.initials: Y
authors.lastname: Labib
authors.forename: D
authors.initials: D
authors.lastname: Grimaud
mesh_terms: D000140:Acidosis, Lactic / Q000378:metabolism*; D058186:Acute Kidney Injury / Q000378:metabolism / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D015314:Dialysis Solutions / Q000032:analysis; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D019344:Lactic Acid / Q000032:analysis / Q000378:metabolism*; D008297:Male
chemical_list: D015314:Dialysis Solutions; D019344:Lactic Acid