Falsely Low Serum Creatinine in an AKI Patient on Dopamine Drip
- AKI: Important, Yet Underappreciated Causes
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical‚ Outcomes‚ and Trials
- Dao, Tram, University of California Davis Department of Internal Medicine, Sacramento, California, United States
- Young, Brian Y., University of California Davis Department of Internal Medicine, Sacramento, California, United States
Two common methods to measure creatinine concentration in the blood are the Jaffe and enzymatic method. Enzymatic creatinine assays have been reported to be affected by the presence of catecholamines. Specifically, dopamine and dobutamine infusions are known to cause falsely decreased creatinine levels due to interference with the peroxidase reaction.
We present a 68 year old male with a past medical history of CKD stage 3b (baseline creatinine 1.7 mg/dL), interstitial lung disease status-post double lung transplant, coronary artery disease, heart failure with mildly reduced ejection fraction, and restrictive pericarditis who was admitted for decompensated heart failure. The patient also had acute kidney injury (AKI), presumed from diuretic refractory cardiorenal syndrome, with consistently rising creatinine levels since hospital admission. On hospital day 16, the patient’s creatinine decreased from 4.55 mg/dL to 1.28 mg/dL in 24 hours without any renal replacement therapy or medical changes other than dopamine infusion was started the day prior. Serum creatinine over the next few days sporadically fluctuated from 1.81 mg/dL to 5.28 mg/dL. After discussion with nursing staff, we confirmed that labs were drawn using the same intravenous line being used for dopamine infusion. When the nurse obtained labs via a peripheral venous puncture on hospital day 18, the creatinine level was 5.15 mg/dL, most consistent with the patient’s AKI. The patient was started on dialysis soon after due to poor clearance and volume control.
It is important for healthcare providers to be aware of the artifactual effects that dobutamine and dopamine infusions have on serum creatinine levels. A recent survey shows a lack of this awareness among healthcare providers. This issue can be avoided by educating nursing staff to avoid drawing creatinine levels using the same infusion lines for dopamine or dobutamine. It is also noted that the Jaffe method is unaffected by the presence of catecholamines, though the majority of labs now employ the enzymatic method. Consideration could also be made to use cystatin C if readily available.