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

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Summary

Caregivers lack awareness of how dopamine/dobutamine infusions interfere with enzymatic serum creatinine (E-sCr) tests. This interference leads to inaccurate kidney function estimates in critical care patients, particularly with central line draws.

Keywords:
awarenesscreatinine enzymatic assaydobutaminedopamineinterferencesurvey

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Area of Science:

  • Clinical Chemistry
  • Nephrology
  • Critical Care Medicine

Background:

  • Accurate serum creatinine (sCr) estimation is crucial for assessing renal function.
  • Patient and practice factors can compromise sCr test accuracy, leading to misrepresentation of kidney function.
  • Enzymatic sCr (E-sCr) assays are susceptible to interference from certain medications.

Purpose of the Study:

  • To evaluate healthcare providers' awareness of interference between dopamine/dobutamine (DD) infusions and E-sCr assays.
  • To determine the frequency of this interference in critically ill patients.
  • To compare E-sCr results from different blood sampling methods in DD-infused patients.

Main Methods:

  • A survey assessed awareness among physicians, nurses, and pharmacists regarding DD infusion interference with E-sCr.
  • Cross-sectional comparison of E-sCr against the kinetic Jaffe method using samples from central venous catheters (CVC), peripherally inserted central catheter (PICC) lines, and peripheral veins (PV).
  • Retrospective longitudinal analysis of E-sCr, blood urea nitrogen (BUN), and potassium (K) levels from CVC/PICC samples.

Main Results:

  • Survey revealed significant lack of caregiver awareness regarding DD interference with E-sCr.
  • Negative interference in E-sCr was observed in 12% of CVC/PICC line samples from DD-infused patients, but not in PV samples.
  • Longitudinal analysis indicated spurious E-sCr decreases in 24% of CVC/PICC samples without concurrent BUN or K changes.

Conclusions:

  • Dopamine/dobutamine infusions negatively interfere with enzymatic serum creatinine assays, particularly with central venous catheter or PICC line draws.
  • This interference can lead to falsely low creatinine estimates, potentially misrepresenting actual kidney function.
  • Peripheral vein sampling and enhanced communication between clinical laboratories and caregivers can mitigate these false estimates.