Variable creatinine levels in critical care patients: A concerning knowledge gap

Trushil Shah, Madhusudhanan Narasimhan, Mary Latha Rathinam, Karen Relle, Melanie Kim, Tharani Muthukumar, William Tharpe, Sonja Bartolome, Lenin Mahimainathan, Alagarraju Muthukumar

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

An accurate creatinine (Cr) estimate is pivotal for the assessment of renal function. Both patient-and practice-spawned factors palliate the test accuracy of serum creatinine (sCr) and can erratically represent actual kidney function. This study evaluated the caregivers’ awareness of enzymatic serum creatinine (E-sCr) assay interfering in dopamine/dobutamine (DD)-infused patient samples and the frequency of such interference in a critical care setting. We conducted an sCr awareness survey among UT Southwestern physicians, nurses, and pharmacists. We then performed a cross-sectional E-sCr comparison against the kinetic Jaffe method using the DD-infused patient samples collected from central venous catheters (CVC), peripherally inserted central catheter (PICC) lines, and the peripheral vein (PV). We retrospectively compared the longitudinal E-sCr results of the CVC/PICC draws with the corresponding blood urea nitrogen (BUN) levels. The survey results show a significant lack of awareness among caregivers about the negative interference of DD infusions on E-sCr. Cross-sectional E-sCr assessment relative to the Jaffe method displayed a negative interference in 12% of CVC/PICC line samples (7/57 DD-infused patients) compared to none in the PV draws. A longitudinal assessment of E-sCr, BUN, and potassium (K) levels from CVC/PICC line samples further confirmed a spurious decrease for E-sCr in about 12/50 (24%) patients who did not show a concurrent BUN or K decrease. The results suggest that a direct PV sampling accompanied by clinical laboratory-directed proactive discussion/activities can foster awareness among caregivers and eschew the false E-sCr estimates in DD-infused patients.

Original languageEnglish (US)
Article number1689
JournalJournal of Clinical Medicine
Volume10
Issue number8
DOIs
StatePublished - Apr 2 2021

Keywords

  • Awareness
  • Creatinine enzymatic assay
  • Dobutamine
  • Dopamine
  • Interference
  • Survey

ASJC Scopus subject areas

  • Medicine(all)

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