Does a serum creatinine level increase from 2.8 to 3.1 milligrams per deciliter (mg/dL) at hospital discharge necessitate an emergency room (ER) visit due to impaired renal function?

From the Guidelines

A serum creatinine level increase from 2.8 to 3.1 mg/dL does not necessarily require an emergency room visit, but prompt medical evaluation is warranted. This increase represents a rise of 0.3 mg/dL, which, according to the criteria for diagnosing acute kidney injury (AKI), is a significant change 1. However, the decision to visit the emergency room should be based on the presence of severe symptoms such as severe nausea, vomiting, confusion, chest pain, or significant shortness of breath, rather than the creatinine level alone.

When evaluating the need for immediate medical attention, consider the following factors:

• The rate of change in creatinine levels: A rapid increase is more concerning than a gradual one.
• The presence of symptoms: Severe symptoms may indicate a need for urgent care.
• Baseline kidney function: Patients with pre-existing kidney disease may require more prompt evaluation.
• Overall health status: Patients with multiple comorbidities may be at higher risk for complications.

Given the information from the study published in 2022 in Clinical Gastroenterology and Hepatology 1, it is essential to contact a healthcare provider promptly to discuss the creatinine level increase. The provider may recommend repeating the blood test, reviewing medications that could affect kidney function, assessing hydration status, or adjusting the treatment plan.

Key considerations for healthcare providers include:

• Repeating the creatinine test to confirm the increase
• Reviewing medications such as NSAIDs, certain antibiotics, or blood pressure medications that can affect kidney function
• Assessing the patient's hydration status and providing guidance on fluid intake
• Adjusting the treatment plan as necessary to slow the progression of kidney disease

In the absence of severe symptoms, a prompt call to the nephrologist or primary care doctor is a more appropriate initial step than an emergency room visit, allowing for a thorough evaluation and guidance on the next steps in management.

From the Research

Impaired Renal Function and ER Visits

• A serum creatinine level increase from 2.8 to 3.1 milligrams per deciliter (mg/dL) at hospital discharge may indicate impaired renal function, but it does not necessarily require an emergency room (ER) visit 2, 3.
• According to the study by 2, a rise in serum creatinine of more than 0.3 mg/dL is defined as acute kidney injury (AKI) stage 1, which may not always necessitate an ER visit.
• The study by 3 recommends earlier referral to nephrologists for patients with elevated creatinine levels, but it does not specify that a small increase in serum creatinine level requires an ER visit.

Acute Kidney Injury and Serum Creatinine Levels

• Acute kidney injury (AKI) is characterized by an increase in serum creatinine level with or without reduced urine output 4.
• The spectrum of AKI ranges from mild to advanced, sometimes requiring renal replacement therapy 4.
• A study by 5 found that serum creatinine increases can be explained by renal transporter inhibitions, which may not always indicate impaired renal function.
• Another study by 6 found that patients who recovered from kidney function at discharge had longer survival times than those who did not recover, but it did not provide direct evidence on the necessity of ER visits for small increases in serum creatinine levels.

Management and Referral

• Management of acute kidney injury involves fluid resuscitation, avoidance of nephrotoxic medications and contrast media exposure, and correction of electrolyte imbalances 4.
• Renal replacement therapy (dialysis) is indicated for refractory hyperkalemia, volume overload, intractable acidosis, and other severe conditions 4.
• Earlier referral to nephrologists for patients with elevated creatinine levels is expected to lead to better health care outcomes and lower costs 3.