How to manage elevated creatinine levels?

From the Guidelines

Managing elevated creatinine levels requires a multifaceted approach that includes lifestyle modifications, medical interventions, and careful monitoring, with the goal of reducing morbidity, mortality, and improving quality of life. The most recent and highest quality study, 1, published in 2022, emphasizes the importance of addressing the underlying cause of elevated creatinine levels, such as diabetic kidney disease, and implementing evidence-based interventions to slow disease progression.

Key Interventions

• Increase water intake to 2-3 liters daily to help flush toxins through the kidneys
• Adopt a kidney-friendly diet by reducing protein intake (particularly animal protein) to 0.8 g/kg body weight daily, limiting sodium to less than 2,300 mg per day, and restricting potassium and phosphorus if levels are high
• Regular exercise, such as 30 minutes of moderate activity most days of the week, can improve overall kidney function
• Medications that may harm kidneys should be avoided, particularly NSAIDs like ibuprofen and naproxen
• Blood pressure control is essential, often using ACE inhibitors (like lisinopril 10-40 mg daily) or ARBs (such as losartan 25-100 mg daily) which provide kidney protection, as recommended by 1 and 1
• For diabetic patients, maintaining tight glucose control with a target HbA1c below 7% is crucial, as emphasized by 1

Medication Management

• ACE inhibitors and ARBs should not be discontinued for minor increases in serum creatinine (<30%), in the absence of volume depletion, as noted in 1
• Sodium-glucose cotransporter-2 inhibitors (SGLT2i) such as empagliflozin 10-25 mg daily may be prescribed for their kidney-protective effects, as suggested by 1

Monitoring and Follow-up

• Regular monitoring of creatinine levels and kidney function is necessary to assess treatment effectiveness, as recommended by 1 and 1
• Timely identification and treatment of acute kidney injury (AKI) is important, as AKI is associated with increased risks of progressive CKD and other poor health outcomes, as noted in 1 and 1

From the FDA Drug Label

Losartan is indicated for the treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (urinary albumin to creatinine ratio ≥300 mg/g) in patients with type 2 diabetes and a history of hypertension In this population, losartan reduces the rate of progression of nephropathy as measured by the occurrence of doubling of serum creatinine or end stage renal disease (need for dialysis or renal transplantation)

To manage elevated creatinine levels, losartan may be used in patients with diabetic nephropathy and elevated serum creatinine. The goal is to reduce the rate of progression of nephropathy. However, it is crucial to monitor renal function and serum potassium levels when using losartan, especially in patients with compromised renal function or those taking other medications that affect renal function or potassium levels 2.

• Key considerations:
  • Monitor renal function periodically
  • Monitor serum potassium levels in patients taking losartan with other drugs that raise serum potassium levels
  • Avoid combined use of RAS inhibitors unless absolutely necessary, and closely monitor blood pressure, renal function, and electrolytes if used concomitantly 2.

From the Research

Managing Elevated Creatinine Levels

Elevated creatinine levels can be a sign of underlying kidney disease or other health issues. To manage elevated creatinine levels, it is essential to understand the causes and take appropriate measures.

• Age, treatment for hypertension, and diabetes are correlates of elevated creatinine levels 3.
• Certain medications, such as angiotensin-converting enzyme (ACE) inhibitors, can cause a rise in serum creatinine levels, especially in patients with preexisting chronic renal insufficiency 4.
• Creatine supplements may also transitorily rise serum creatinine levels and mimic a kidney disease 5.

Treatment Options

Treatment options for managing elevated creatinine levels depend on the underlying cause.

• For patients with chronic renal insufficiency, ACE inhibitors can help slow the progression of renal disease, despite the initial rise in serum creatinine levels 4.
• In cases of primary Sjögren's syndrome-chronic interstitial nephritis, treatment with glucocorticoids may help reduce serum creatinine levels 6.
• Treatment of severe hypothyroidism can also lead to a significant reduction in serum creatinine levels in patients with chronic renal failure 7.

Monitoring and Prevention

Regular monitoring of serum creatinine levels and other kidney function tests is crucial for patients with elevated creatinine levels.

• Patients with chronic renal disease or those using potentially nephrotoxic medications should avoid using creatine supplements 5.
• Clinicians should consider screening for rheumatic immune system diseases, such as primary Sjögren's syndrome, in young patients with chronic renal failure 6.
• Hypothyroidism should be considered in screening procedures for patients with chronic renal failure presenting with recent accelerated aggravation of renal function 7.