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A study of interferences in routine methods for creatinine measurement
1Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
Summary
Acetoacetate and bilirubin significantly interfere with common serum creatinine measurement methods, causing substantial errors. Despite documented issues, current laboratory practices show little change, impacting accurate creatinine testing.
Area of Science:
- Clinical Chemistry
- Analytical Chemistry
- Biochemistry
Background:
- Serum creatinine measurement is crucial for assessing kidney function.
- Routine creatinine assays are susceptible to interference from various substances.
- Acetoacetate and bilirubin are known potential interferents in creatinine assays.
Purpose of the Study:
- To evaluate the impact of acetoacetate and bilirubin on commonly used serum creatinine measurement methods.
- To assess the extent of interference in routine clinical laboratory settings.
Main Methods:
- A survey was conducted via the Irish External Quality Assessment Scheme.
- Samples were spiked with acetoacetate (10 mmol/l) and high concentrations of bilirubin.
- Interference was assessed across different routine creatinine assay methods, including Jaffé-based techniques.
Main Results:
- Acetoacetate caused significant errors in creatinine measurement, ranging from -28% to +22%.
- Jaffé methods, particularly those without a delay between reagent addition and measurement, showed the greatest errors.
- High bilirubin concentrations led to apparent creatinine results from zero to 280 µmol/l.
Conclusions:
- Acetoacetate and bilirubin pose a considerable risk of interference in routine serum creatinine testing.
- Current laboratory methods appear inadequately protected against these well-documented interferences.
- Clinical laboratories need to be aware of and mitigate these interferences for accurate kidney function assessment.