The effect of lactate-buffered solutions on the acid-base status of patients with renal failure

We investigated the effect of an exogenous lactate load given during intermittent machine haemofiltration to three groups of patients with renal failure: those with dialysis-dependent end-stage renal failure (6 patients) and those with either acute renal (8 patients) and/or acute hepatorenal failure (6 patients). As expected, the hepatorenal group exhibited the greatest degree of hyperlactataemia, and this was associated with the development of a metabolic acidosis. There were correlations between the maximum blood lactate measured during treatment and the increase in arterial hydrogen ion concentration (r = 0.76, P less than 0.001), and between the decrease in serum bicarbonate (r = 0.89, P less than 0.001) and the mean arterial blood pressure prior to treatment (r = -0.57, P = 0.003). This suggests that hyperlactataemia is not as benign as previously thought and that lactate-buffered fluids should be used with care in patients with hepatorenal failure and cardiovascular instability.