How to lower elevated creatinine levels?

Strategies to Lower Elevated Creatinine Levels

The most effective approach to lower elevated creatinine levels is to optimize blood pressure control, implement appropriate dietary modifications, and use medications like SGLT2 inhibitors in patients with chronic kidney disease, particularly those with diabetes.

Understanding Creatinine and Kidney Function

• Creatinine is a waste product from muscle metabolism that is filtered by the kidneys; elevated levels typically indicate impaired kidney function 1
• Elevated creatinine is a marker of reduced glomerular filtration rate (GFR), which is used to diagnose and monitor chronic kidney disease (CKD) 1
• Normal urinary albumin-to-creatinine ratio (UACR) is defined as <30 mg/g creatinine, while elevated levels indicate kidney damage 1

Blood Pressure Management

• Optimize blood pressure control to reduce the risk or slow the progression of chronic kidney disease, which will help lower creatinine levels 1
• Target blood pressure should be <130/80 mmHg for most patients with CKD 1
• Multiple antihypertensive medications (typically 3-4) may be needed to achieve target blood pressure in patients with CKD 1

Medication Strategies

• For patients with diabetes and CKD, use of a sodium-glucose cotransporter 2 (SGLT2) inhibitor is recommended if eGFR ≥20 mL/min/1.73 m² to reduce CKD progression 1
• ACE inhibitors or angiotensin receptor blockers (ARBs) are recommended for patients with elevated UACR (>30 mg/g creatinine) and/or reduced eGFR (<60 mL/min/1.73 m²) 1
• Do not discontinue renin-angiotensin system blockade for minor increases in serum creatinine (≤30%) in the absence of volume depletion 1
• For patients with CKD who have albuminuria and are at increased risk for cardiovascular events, consider a nonsteroidal mineralocorticoid receptor antagonist (finerenone) if eGFR ≥25 mL/min/1.73 m² 1

Dietary Modifications

• For people with non-dialysis-dependent stage 3 or higher CKD, dietary protein intake should be limited to 0.8 g/kg body weight per day 1
• For patients on dialysis, higher levels of dietary protein intake (1.0-1.2 g/kg/day) should be considered to prevent malnutrition 1
• Reduce dietary sodium intake to help control blood pressure and reduce proteinuria 1
• Consider plant-based food sources which contain less absorbable phosphorus and generate less acid 2

Glycemic Control for Diabetic Patients

• Optimize glucose control to reduce the risk or slow the progression of CKD in patients with diabetes 1
• For patients with type 2 diabetes and CKD, SGLT2 inhibitors have shown benefits in reducing CKD progression and cardiovascular events 1
• Glucagon-like peptide 1 receptor agonists may also be beneficial in reducing albuminuria progression in patients with CKD who are at increased risk for cardiovascular events 1

Lifestyle Modifications

• Smoking cessation is recommended as smoking can worsen kidney function and increase proteinuria 1
• Weight loss in overweight or obese individuals can help improve kidney function 1
• Regular exercise may help improve overall kidney function, though intense exercise within 24 hours may temporarily elevate UACR 1

Monitoring and Follow-up

• Monitor serum creatinine and potassium levels periodically when using ACE inhibitors, ARBs, or diuretics 1
• Assess urinary albumin (e.g., spot UACR) and eGFR at least annually in patients with type 1 diabetes with duration ≥5 years and in all patients with type 2 diabetes 1
• Patients with urinary albumin >300 mg/g creatinine and/or eGFR 30-60 mL/min/1.73 m² should be monitored twice annually 1

When to Refer to a Nephrologist

• Refer patients to a nephrologist if eGFR <30 mL/min/1.73 m² 1
• Promptly refer for uncertainty about the etiology of kidney disease, difficult management issues, or rapidly progressing kidney disease 1

Important Cautions

• Creatine supplements should be avoided in people with CKD or those using potentially nephrotoxic medications 3
• Temporary elevations in creatinine may occur with high-intensity exercise, fever, infection, congestive heart failure, or marked hyperglycemia 1
• Dietary changes alone may affect creatinine levels without actually changing kidney function - protein restriction can reduce creatinine excretion and may falsely suggest improved kidney function 4, 5