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

Journal of Clinical Medicine

卷:10

Trushil Shah¹  Sonja Bartolome¹  Madhusudhanan Narasimhan²  Lenin Mahimainathan²  Alagarraju Muthukumar²  Tharani Muthukumar³  MaryLatha Rathinam⁴  Melanie Kim⁴  Karen Relle⁴  William Tharpe⁴ 

[1] Department of Internal Medicine, Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;

[2] Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;

[3] School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX 75080, USA;

[4] William P. Clements Jr. University Hospital (CUH), University of Texas Southwestern Medical Center, Dallas, TX 75235, USA;

关键词: creatinine enzymatic assay;    interference;    dopamine;    dobutamine;    awareness;    survey;   

DOI  :  10.3390/jcm10081689

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown