Serum Lactate Levels in CAPD Patients with Liver Cirrhosis

Lee, Hyeon Suk; Kang, Jae Young; Yang, Won Seok; Kim, Soon Bae; Lee, Sang Koo; Park, Jung Sik; Kang, Duk Hee; Yoon, Kyun Il

Abstract

Lactate is the most commonly used buffer in CAPD. The buffering effect of lactate is accomplished by its complete metabolism in liver and kidney. In patients with hepatic disease the rate of metabolism may be lower with a consequent increase in plasma lactate levels. Plasma lactate levels, however, have not been measured in CAPD patients. This study was performed to evaluate the plasma lactate levels and acid-base status in CAPD patients with liver cirrhosis. The concentrations of arterial L-lactate, pH, bicarbonate and venous total CO2 were measured in 6 CAPD patients with LC, 36 CAPD patients without liver disease and 17 LC patients. All CAPD patients used commercially available dialysate containing 40mmol/L lactate(D,L-racemic solution). Arterial lactate levels were 4.19mmol/L in CAPD patients with LC, 1.43mmol/L in CAPD patients and 1.94mmol/L in LC patients(p<0.05). Arterial pH were not different among subgroups. Arterial bicarbonate concentrations were 20.5meq/L in CAPD patients with LC, 24.2meq/L in CAPD patients and 24.4meq/L in LC patients. Venous total CO2 levels were 21.4, 24.7 and 23.4meq/L, respectively. Anion gap were 13.1, 9.4 and 8.1, respectively. From our results and possible toxicity of elevated lactate levels, lactate-containing PD solutions should be used carefully to treat CAPD patients with LC.