Acute Changes in Serum Creatinine Are Not a Meaningful Metric in Randomized Controlled Trials and Clinical Care

Acute changes in serum creatinine are labeled clinically as acute kidney injury (AKI). However, not all acute changes in serum creatinine are deleterious and need to be acted upon.

Intravenous fluids in response to AKI should be judiciously administered, and volume overload should be avoided. Since congestion is the driver of poor outcomes in patients with acute decompensated heart failure and must be managed, AKI that occurs at the expense of decongestion does not confer increased risk. We still do not have evidence of therapies that reduce AKI which will translate into any meaningful improvements in clinical outcomes. Finally, particularly in the setting of application of therapies designed to reduce cardiorenal risk, acute changes in serum creatinine are often in the opposite direction of the ultimate clinical outcomes, both renal and nonrenal.

Given the complexities and the nuance of acute changes in serum creatinine, it has ruled itself as an unreliable surrogate for randomized controlled trials and often hinders appropriate care in the clinical setting.