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Kidney Week

Abstract: FR-PO027

Initial Lactate Level and Lactate Clearance on Renal Outcomes in Critically Ill Patients with Sepsis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Jung, Jihoon, Chung-Ang university hospital, Seoul, Korea (the Republic of)
  • Moon, Ji in, Chungang university, Seoul, Korea (the Republic of)
  • Hwang, Jin Ho, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
  • Kim, Su Hyun, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
  • Shin, Jungho, Chung-Ang University College of Medicine, Seoul, Korea (the Republic of)
Background

Lactate level and lactate clearance have been implicated as predictors of mortality in patients with sepsis. However, their roles for renal outcomes remain uncertain. In this study, we investigated the impacts of initial lactate level and lactate clearance on renal outcomes in critically ill patients with sepsis.

Methods

We retrospectively reviewed a total of 151 adult patients with sepsis who met the Sepsis-3 definition. Serum lactate levels were measured at initial and 24 hours from the intensive care unit admission. Among patients with initial lactate level ≥2 mmol/L, the lactate clearance was calculated as (initial lactate−24-hour lactate)/initial lactate × 100, then, they were divided as those with lactate clearance <20% and ≥20%. Acute kidney injury (AKI) was defined using the KDIGO guideline.

Results

AKI occurred in 52 (68.4%) patients with initial lactate level <2 mmol/L and 69 (92.0%) in those with initial lactate level ≥2 mmol/L (P<0.001). In addition, patients with initial lactate level ≥2 mmol/L had higher probabilities of renal replacement therapy than those with its level <2 mmol/L, independent of age, sex and the sequential organ failure assessment (SOFA) score (OR 2.9, 95% CI 1.1–7.3, P=0.025). However, the lactate clearance was not related with AKI occurrence and renal replacement therapy use (P=1.000 and 0.293). The lactate clearance <20% was associated with 28-day mortality, independent of age, sex and the SOFA score (HR 3.8, 95% CI 1.5–9.7, P=0.005), but Initial lactate level was not (P=0.164). Among 116 survivors, estimated glomerular filtration rate (eGFR) at discharge were assessed, and we found that the eGFR did not differ according to initial lactate level and lactate clearance in multivariate linear regression analyses (P=0.954 and 0.203).

Conclusion

In critically ill patients with sepsis, initial lactate level can predict the AKI occurrence and renal replacement therapy need, however, lactate clearance cannot. In addition, renal function recovery may be associated with neither initial lactate level nor lactate clearance.