This study suggests that predialysis level of serum lactate level is an important marker of mortality in MALA patients requiring renal replacement therapy (RRT) with a linear dose-response relationship.

To better evaluate the optimal prescription of RRT in MALA, it is recommended fostering an international consortium to support prospective research and large-scale standardized case collection.

A total of 253 unique cases were identified with cumulative mortality of 17.2%.

87 percent of patients had acute kidney injury (AKI).

Serum lactate level was significantly higher in non-survivors (median 22.5 mmol/L) than in survivors and so did the median blood metformin concentrations.

The survival advantage was not significantly different between the modalities of RRT.

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