title: Severe lactic acidosis in critically ill patients with acute kidney injury treated with renal replacement therapy.
abstract: OBJECTIVE
  Severe lactic acidosis (SLA) is frequent in intensive care unit (ICU) patients with acute kidney injury (AKI) treated with renal replacement therapy (RRT). The aim of the study is to describe the epidemiology of SLA in this setting.
  
  
  METHODS
  An observational single-center cohort analysis was performed on AKI patients treated with RRT. At initiation of RRT, SLA patients (serum lactate concentration>5 mmol/L and pH<7.35) were compared with non-SLA patients.
  
  
  RESULTS
  Of the 454 patients dialyzed during the study period, 342 patients matched inclusion criteria (116 with and 226 patients without SLA). In SLA patients, lactate stabilized/decreased in 69.7% at 4 hours (P=.001) and in 81.8% during the period of 4 to 24 hours (P<.001) after initiation of RRT. Mortality during this 24-hour period was 31.0%. Intensive care unit mortality was 83.6% compared with 47.3% in non-SLA patients. Initial lactate concentration was not related to ICU mortality in SLA patients.
  
  
  CONCLUSIONS
  Severe lactic acidosis was frequent in AKI patients treated with RRT. Severe lactic acidosis patients were more severely ill and had higher mortality compared with patients without. During the first 24 hours of RRT, a correction of lactate concentration and acidosis was observed. In SLA patients, lactate concentration at initiation of RRT was not able to discriminate between survivors and nonsurvivors.
authors.affiliation: Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium; Department of Anaesthesia and Intensive Care Medicine, AZ Groeninge Hospital, Kortrijk, Belgium. Electronic address: wouter.decorte@azgroeninge.be.
authors.forename: Wouter
authors.initials: W
authors.lastname: De Corte
authors.affiliation: Department of Paediatric Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Vuylsteke
authors.affiliation: Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: De Waele
authors.affiliation: Renal Division, Ghent University Hospital, Ghent, Belgium.
authors.forename: Annemieke W
authors.initials: AW
authors.lastname: Dhondt
authors.affiliation: Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Decruyenaere
authors.affiliation: Renal Division, Ghent University Hospital, Ghent, Belgium.
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.affiliation: Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium; Research Foundation Flanders, Belgium.
authors.forename: Eric A J
authors.initials: EA
authors.lastname: Hoste
mesh_terms: D018806:APACHE; D000140:Acidosis, Lactic / Q000401:mortality*; D058186:Acute Kidney Injury / Q000097:blood / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D017582:Renal Replacement Therapy
chemical_list: D019344:Lactic Acid
keywords: Acute kidney injury; ICU mortality; Lactic acidosis; Renal replacement therapy; Serum lactate