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Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap

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 seru...

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Autores principales: Shah, Trushil, Narasimhan, Madhusudhanan, Rathinam, Mary Latha, Relle, Karen, Kim, Melanie, Muthukumar, Tharani, Tharpe, William, Bartolome, Sonja, Mahimainathan, Lenin, Muthukumar, Alagarraju
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071156/
https://www.ncbi.nlm.nih.gov/pubmed/33920766
http://dx.doi.org/10.3390/jcm10081689
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author Shah, Trushil
Narasimhan, Madhusudhanan
Rathinam, Mary Latha
Relle, Karen
Kim, Melanie
Muthukumar, Tharani
Tharpe, William
Bartolome, Sonja
Mahimainathan, Lenin
Muthukumar, Alagarraju
author_facet Shah, Trushil
Narasimhan, Madhusudhanan
Rathinam, Mary Latha
Relle, Karen
Kim, Melanie
Muthukumar, Tharani
Tharpe, William
Bartolome, Sonja
Mahimainathan, Lenin
Muthukumar, Alagarraju
author_sort Shah, Trushil
collection PubMed
description 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.
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spelling pubmed-80711562021-04-26 Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap Shah, Trushil Narasimhan, Madhusudhanan Rathinam, Mary Latha Relle, Karen Kim, Melanie Muthukumar, Tharani Tharpe, William Bartolome, Sonja Mahimainathan, Lenin Muthukumar, Alagarraju J Clin Med Article 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. MDPI 2021-04-15 /pmc/articles/PMC8071156/ /pubmed/33920766 http://dx.doi.org/10.3390/jcm10081689 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Shah, Trushil
Narasimhan, Madhusudhanan
Rathinam, Mary Latha
Relle, Karen
Kim, Melanie
Muthukumar, Tharani
Tharpe, William
Bartolome, Sonja
Mahimainathan, Lenin
Muthukumar, Alagarraju
Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap
title Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap
title_full Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap
title_fullStr Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap
title_full_unstemmed Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap
title_short Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap
title_sort variable creatinine levels in critical care patients: a concerning knowledge gap
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071156/
https://www.ncbi.nlm.nih.gov/pubmed/33920766
http://dx.doi.org/10.3390/jcm10081689
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