Effect of continuous venovenous hemofiltration with dialysis on lactate clearance in critically ill patients

Crit Care Med. 1997 Jan;25(1):58-62. doi: 10.1097/00003246-199701000-00013.


Objective: To evaluate the effect of continuous venovenous hemofiltration with dialysis on lactate elimination by critically ill patients.

Design: Prospective, clinical study.

Setting: Surgical intensive care unit of a university hospital.

Patients: Ten critically ill patients with acute renal failure and stable blood lactate concentrations.

Interventions: Two-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 results: Arterial 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.

Conclusions: Continuous 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acidosis, Lactic / metabolism*
  • Acute Kidney Injury / metabolism
  • Acute Kidney Injury / therapy
  • Adolescent
  • Adult
  • Aged
  • Critical Illness / therapy*
  • Dialysis Solutions / analysis
  • Female
  • Hemodiafiltration*
  • Humans
  • Lactic Acid / analysis
  • Lactic Acid / metabolism*
  • Male


  • Dialysis Solutions
  • Lactic Acid