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Hyperlactataemia and metabolic acidosis during haemofiltration using lactate-buffered fluids
A Davenport1, E J Will, A M Davison
1Department of Renal Medicine, St. James's University Hospital, Leeds, UK.
Nephron
|January 1, 1991
Summary
Exogenous lactate loads during haemofiltration can cause hyperlactataemia in patients with renal failure. This may worsen acid-base status, necessitating careful monitoring of arterial pH and potential substitution with bicarbonate solutions.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biochemistry
Background:
- Machine haemofiltration is used for renal failure.
- Lactate-based solutions are common in dialysis and haemofiltration.
- Understanding lactate metabolism in renal failure is crucial.
Purpose of the Study:
- To investigate the impact of exogenous lactate load during haemofiltration on acid-base balance in patients with acute and chronic renal failure.
- To determine if lactate accumulation affects acid-base status beyond ultrafiltrate losses.
- To assess the correlation between arterial lactate and hydrogen ion concentrations.
Main Methods:
- Administered exogenous lactate load during machine haemofiltration.
- Monitored acid-base status (arterial pH, bicarbonate, hydrogen ions) in patients with acute and chronic renal failure.
- Analyzed ultrafiltrate for lactate and bicarbonate losses.
- Correlated changes in arterial lactate with acid-base parameters.
Main Results:
- All patients developed hyperlactataemia after lactate load.
- Expected acid-base changes (increased bicarbonate, decreased hydrogen ions) occurred in <40% of acute renal failure treatments.
- Ultrafiltrate losses did not fully explain acid-base alterations.
- A positive correlation was found between increased arterial lactate and hydrogen ion concentrations (r=0.52, p<0.01).
Conclusions:
- Lactate accumulation during haemofiltration can worsen acid-base status in renal failure patients.
- This effect may be more pronounced in patients near their lactate utilization threshold, potentially impairing cardiac function.
- Continuous monitoring of arterial pH and preparedness to use bicarbonate solutions are recommended when using lactate-based haemofiltration solutions in critically ill patients.