• J Levraut, J P Ciebiera, P Jambou, C Ichai, Y Labib, and D Grimaud.
• Département d'Anesthésie-Réanimation, Centre Hospitalo-Universitaire de Nice, France.
• Crit. Care Med. 1997 Jan 1; 25 (1): 58-62.

ObjectiveTo evaluate the effect of continuous venovenous hemofiltration with dialysis on lactate elimination by critically ill patients.DesignProspective, clinical study.SettingSurgical intensive care unit of a university hospital.PatientsTen critically ill patients with acute renal failure and stable blood lactate concentrations.InterventionsTwo-stage investigation: a) measurement of lactate concentrations in samples of serum and ultradiafiltrate from patients receiving continuous venovenous hemofiltration with dialysis to calculate lactate clearance by the hemofilter; b) evaluation of total plasma lactate clearance by infusing sodium L-lactate (1 mmol/kg of body weight) over 15 mins.Measurements And Main ResultsArterial lactate concentration was determined before, during, and after the infusion. Lactate elimination variables were calculated from the plasma curve using model-independent and model-dependent estimates (by software). At the end of the infusion, median blood lactate concentration increased from 1.4 mmol/L (range 0.8 to 2.6) to 4.8 mmol/L (range 2.4 to 5.7) and returned to 1.6 mmol/L (range 0.9 to 3.4) 60 mins later. The median total plasma lactate clearance was 1379 mL/min (range 753.7 to 1880.7) and the median filter lactate clearance was 24.2 mL/min (range 7.1 to 35.6). Thus, filter lactate clearance accounted for < 3% of total lactate clearance.ConclusionsContinuous venovenous hemofiltration with dialysis cannot mask lactate overproduction, and its blood concentration remains a reliable marker of tissue oxygenation in patients receiving this renal replacement technique.

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