creatinine and clearance

[tyefly]

Well I have my first lab  after doing my first three weeks of D...   My clearance was 2.11 and I am just doing the 17 ga  at 250 for three hours three x week.....    but my creatinine was up to 4.1 now....   I was shocked that it went up... my bun in at 22 so that was lower.......  Everyone said that my clearance was really good...( maybe thats why I feel so good ) but why would be creatinine be so high....   its that supposed to be cleaned out..... or  Iam I making more cause I am running around alot more now that I feel good....  I am so busy now... maybe my muscles are working harder making more creatinine....  but then your kidneys are suppose to clean that out...right.....  why doesnt D do tht....  Is creatinine toxic.....

[tyefly]

     Thx for all the information..... IHD members once again came thru to give us new people the information that we seek....  I knew with so many people who have been on dialysis for so many years and Members of  IHD,  that the information would be plentifully.......  Once again.....  thx
   I have gain so much information here that it would be needless for me to ask anymore questions about Dialysis..... Mainly I should focus on how badly I feel or how badly I have been treated.....   

[Zach]

While the normal reference range for creatinine is 0.5 - 1.2mg/dL, those on hemodialysis (with little or no renal function) usually have a range between 9 to 11 mg/dL.  Mine runs about 9.8 mg/dL.

Those on hemodialysis who continue to have residual renal function will have a lower creatinine, (4.1) as you do.

Creatinine is the by-product of skeletal muscle.  So the more muscular one's body, the higher the creatinine.  And the blood levels tend to be the same month to month, unless there is a change in treatment time.

Also, the National Kidney Foundation (U.S.A.) states:

• The predialysis or stabilized serum creatinine and the creatinine index
reflect the sum of dietary intake of foods rich in creatine and creatinine (eg,
skeletal muscle) and endogenous (skeletal muscle) creatinine production
minus the urinary excretion, dialytic removal, and endogenous degradation
of creatinine.

• Individuals with low predialysis or stabilized serum creatinine (less than
approximately 10 mg/dL) should be evaluated for protein-energy malnutrition
and wasting of skeletal muscle.

• A low creatinine index and, in the absence of substantial endogenous
urinary creatinine clearance, a low serum creatinine concentration suggest
low dietary protein intake (DPI) and/or diminished skeletal muscle mass
and are associated with increased mortality rates.

http://www.kidney.org/professionals/kdoqi/pdf/KDOQI2000NutritionGL.pdf
(Page 24)

 

[kristina]

Is it possible that Creatinine increases
because the muscles, for some reason,
overproduce it?
And thereby if a kidney function is in the low order, say 10%,
the kidneys have not the capacity to clear the excess of Creatinine
and therefore it builds up, giving the impression that the kidneys
are deteriorating more rapidly then they are in reality?
Would that have a connection to the liver overproducing Creatin
which acts on the muscles to produce the byproduct Creatinine?
This came into my mind, but has it any basis in fact?
Thanks from Kristina.

[Zach]

Is it possible that Creatinine increases
because the muscles, for some reason,
overproduce it?

That knowledge is above my pay scale.   

[sico]

Wheres hemodoc when you need him?

[kristina]

Sorry to put this rather complicated question forward, but I mentioned this several years ago to a couple of nephs and I noticed they immediately became uncomfortable & fidgeted and that led me to wonder if they had been thinking about this question as well, or they knew something but could not speak because there is no scientific proof.

Of course, their visual discomfort may have been due to an uncomfortable seat but I did not quite think it was.

So, I am still wondering about this question.

[Zach]

Is it possible that Creatinine increases because the muscles, for some reason,overproduce it?

Creatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Approximately 2% of the body's creatine is converted to creatinine every day.

Because the muscle mass in the body is relatively constant from day to day, the creatinine level in the blood normally remains essentially unchanged on a daily basis.
http://www.medterms.com/script/main/art.asp?articlekey=12550

Theoretically, if one experiences muscle wasting, their creatinine would initially increase (more muscle waste produce.  But then the creatinine levels would drop due to much less skeletal muscle.

I'm not sure the liver has much to do with it.

And kidney deterioration is determined not only by creatinine levels, but by BUN levels, 24 hour urinalysis, etc.

[Hemodoc]

Dear Tyefly, I would be interested in the breakdown between your native function and how well you have been dialyzed. I suspect that they had you do a 24 hour urine clearance to get a 2.1 clearance.  In many ways this reflects more of your residual urine function than the actual machine clearance from dialysis especially using 17 ga at 250 blood flow.

I wanted to know how well the machine was doing so I quit doing my 24 hour urine clearances that they then add to your single pooled Kt/V.  Good dialysis as measured by urea clearance standards are 1.2 by Medicare and 1.4 by most large dialysis organizations.  Once again, for those that have residual renal function, pretty much all dialysis units are going to do a quarterly 24 hour urine to add to the single pooled Kt/V.

To get an idea of how well the machine is doing alone, you can go to the Davita web site to calculate your own Kt/V for your information and compare that with your incenter results.

http://www.davita.com/tools/ktvcalculator/

As far as the increased creatinine since starting dialysis, I am not sure that there is a simple answer for that, but it is likely a factor of improved protein nutrition since starting on dialysis and the ratio of muscle catabolism before and after starting.  I know you were having difficulty keeping food down while you were waiting for the start of dialysis.

The take home message is that you have done well for the first three weeks of sustained dialysis and you need to begin to build upon this success.  With your residual renal function, you have the option of going slow while your fistula continues to mature as long as your other labs are in the normal range for CO2 and other labs that show how your physiology is reacting to dialysis and overcoming the uremic syndrome.  Once again, research these issues on your own and then discuss them with your health care team that has all of the information before them.  You have really learned a lot in a short period of time.