Increased Serum Lactate in Peritoneal Dialysis Patients Presenting with Intercurrent Illness

Area of Science:

• Nephrology
• Emergency Medicine
• Clinical Chemistry

Background:

• Lactate is a common buffer in peritoneal dialysis (PD) solutions.
• Previous studies indicate normal serum lactate in stable PD patients.
• The significance of elevated lactate in PD patients presenting to the emergency department (ED) is not well-established.

Purpose of the Study:

• To assess the prevalence of elevated serum lactate in PD patients presenting to the ED.
• To evaluate clinical factors associated with abnormal lactate values in this population.
• To determine if elevated lactate in PD patients has the same significance as in the general population.

Main Methods:

• Observational cohort study design.
• Assessed 172 patient visits in 89 PD patients to the ED.
• Measured initial venous blood lactate levels and analyzed associated clinical factors.

Main Results:

• Elevated lactate (> 2 mmol/L) was found in 29% of PD patient visits to the ED.
• Abnormal lactate correlated with hemodynamic compromise signs like ICU admission and tachycardia.
• In 50% of elevated lactate cases, no hemodynamic instability was present; bowel ischemia was rare.

Conclusions:

• Abnormal lactate values are frequent in PD patients in the ED, even without hemodynamic instability.
• Elevated lactate in sick PD patients may stem from transient lactate metabolism disruption due to intercurrent illness.
• This suggests elevated lactate may not always indicate tissue hypoperfusion or gut ischemia, potentially avoiding unnecessary investigations.