The relationship of lactate and lactate clirens with hospitality duration and 28-day mortality in patients who are diagnosed of acute kidney injury in the emergency department and have been treated with hemodialiysis

INTRODUCTION: Acute kidney injury (AKI) can be defined as impaired kidney's filtration and excretory function within days / weeks. From asymptomatic changes in laboratory parameters, by affecting the circulating volume; Various clinical presentations resulting in acid / base and electrolyte imbalance resulting in high mortality and morbidity may be encountered. Diagnosis of AKI is often made in emergency departments; AKI should be included among the pre-diagnoses in a wide range of symptoms, from anorexia, nausea, vomiting, which can be considered as a mild discomfort, or loss of consciousness caused by uremic encephalopathy, which may be the reason for admission to the hospital. MATERIALS AND METHODS: In our study, the data of 600 patients who applied to the emergency department between 10.10.2019-10.06.2020 and who received a dialysis decision were analyzed prospectively. 115 patients who met the inclusion criteria were included in the study. Patients' age, gender, chronic diseases, laboratory findings (WBC, Hgb, Plt, urea, creatinine Na, K, pH, HCO3, lactate, BE), hospitalization days, AKI type and 28-day mortality status were recorded. RESULTS: In our study, in which 115 patients were evaluated, the mean age was 73 ± 14. There was no significant difference in the age distribution of the patients who were evaluated among survivors and non survivors. In our study, 64 patients (55.66%) survived in their 28-day follow-up; 51 patients (44.34%) were non survivors. When biochemical parameters are evaluated according to the presence of 28 days of mortality and survival status; neutrophil 1-2, neutrophil lymphocyte ratio 1-2, urea 1-2, creatine 1-2, white blood cell, pH 1-2, lactate 1-2, HCO3 2, BE 2, K 2 values, a statistically significant difference was found in their blood before and after hemodialysis. In our study, when ROC analysis of the lactate values of patients with mortality in 28 days was performed, it was predicted that the lactate value would not have a mortality rate of 80.4% within 28 days at values below 1.215 lactate level and a mortality of 40.6% at ≥1,215 levels. CONCLUSION: AKI is an important cause of mortality and morbidity for patients admitted to the emergency department. In the literature we scanned during our study, there have been very few studies on the effect of lactate and lactate clearance on mortality in AKI, which has been performed in the emergency v department. Lactate has been shown to be particularly effective in mortality in our study. However, we think that there is a need to work with more patient groups for lactate clearance. KEYWORDS: Acute kidney injury, emergency department, emergency hemodialysis, lactate clearancy, mortality