The prognostic use of a lactate infusion in patients with severe hepatorenal failure

We have used machine hemofiltration (MHF) with lactate-buffered hemofiltration replacement solution in the management of four patients with severe hepatorenal failure. Hyperlactatemia developed in all four patients. However, consecutive treatments were associated with increasing blood lactate values postfiltration in the two patients who died and with a fall in the lactates in the two patients who survived. The survivors had lower postfiltration blood lactates 3.2 +/- 0.2 mmol/L (mean +/- SEM) compared to the nonsurvivors, 5.3 +/- 0.5 mmol/L (p less than 0.01). This suggests that the measurement of blood lactate following a lactate challenge may be of prognostic significance in patients with severe hepatorenal failure.