From the Guidelines
A creatinine level of 9 mg/dL indicates severe kidney dysfunction requiring immediate medical attention, and the patient should be urgently evaluated by a nephrologist for likely acute kidney injury or end-stage renal disease. This condition necessitates prompt assessment for life-threatening complications such as hyperkalemia, metabolic acidosis, and fluid overload, as highlighted in the study by 1.
Immediate Interventions
Immediate interventions should include:
- Laboratory tests: complete metabolic panel, urinalysis, and ultrasound of the kidneys to assess the extent of kidney damage and potential causes.
- Discontinuation of nephrotoxic medications: NSAIDs, certain antibiotics, and contrast agents that can further impair kidney function, as noted in 1.
- Adjustment of medication dosages: for drugs cleared by the kidneys, based on estimated glomerular filtration rate, to prevent accumulation of toxic levels, as discussed in 1.
Potential Causes and Management
Potential causes to investigate include:
- Dehydration
- Obstruction
- Medication toxicity
- Glomerulonephritis
- Progression of underlying chronic kidney disease Management should also involve strict fluid management, dietary restrictions (low potassium, low phosphorus), and close monitoring of electrolytes, as these measures are crucial in preventing further complications and managing the condition effectively, as suggested by 1 and 1.
Renal Replacement Therapy
The patient may require renal replacement therapy (dialysis) depending on clinical status and the presence of uremic symptoms. The decision for dialysis initiation should be based on clinical judgment, considering the patient's overall condition, symptoms, and quality of life, rather than solely on the level of kidney function, as emphasized by the study 1.
Outcome Prioritization
The primary goal is to prioritize morbidity, mortality, and quality of life outcomes. Therefore, management strategies should focus on preventing life-threatening complications, managing symptoms, and improving the patient's quality of life, even if it means considering renal replacement therapy or other interventions to support kidney function, as guided by the principles outlined in 1, 1, and 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient with Elevated Creatinine Levels
- A patient with a creatinine level of 9 indicates severe kidney dysfunction, which may require immediate medical attention 2, 3.
- The management of such patients involves identifying and treating reversible causes of renal failure, slowing the rate of decline associated with progressive renal insufficiency, and managing coexisting conditions associated with chronic renal failure 2.
- Earlier referral to a nephrologist is expected to lead to better health care outcomes and lower costs for both the patient and the health care system 2.
Acute Kidney Injury (AKI)
- AKI is characterized by an abrupt decrease in renal function or the onset of frank renal failure, and can be caused by systemic illness or toxic exposure 3.
- The severity of AKI is determined by the degree of serum creatinine increase or decrease in urine output, and emergent referral to a nephrology subspecialist is recommended for patients with stage 2 or 3 AKI 3.
- Treatment of AKI includes control of the underlying cause, achievement and maintenance of euvolemia, nutritional optimization, blood glucose control, and pharmacotherapy 3.
Chronic Kidney Disease (CKD) and Anemia
- CKD is a worldwide health problem, and anemia is a common symptom, especially in stages 3 and 4 4, 5, 6.
- Erythropoietin is a key player in red blood cell production, and a deficit in erythropoietin synthesis is the main cause of normochromic normocytic anemia in patients with progressive CKD 5, 6.
- Recombinant human erythropoietin (rHuEPO) has revolutionized the treatment of anemia of chronic renal failure, and has been shown to increase survival, decrease hospitalizations, and improve quality of life for renal patients 6.