Increase in serum creatinine in a patient on continuous peritoneal dialysis: potential mechanisms and management.

Increase in serum creatinine in a patient on continuous peritoneal dialysis: potential mechanisms and management. Adv Perit Dial. 2012;28:32-6 Authors: Xu Z, Gabaldon D, Wiggins B, Rondon-Berrios H, VanderJagt DJ, Tzamaloukas AH Abstract A large elevation in serum creatinine (S(Cr)) on an unchanged peritoneal dialysis (PD) schedule is usually caused by a decrease in total creatinine clearance (C(Cr)), but may also reflect an increase in creatinine (Cr) production. A meticulously compliant 43-year-old man with lupus nephritis on automated nocturnal PD plus an additional daytime exchange developed a rise in S(Cr) to 16.73 mg/dL from 8.06 mg/dL after starting fenofibrate, while total C(Cr) decreased only to 61.5 L/1.73 m2 from 77.4 m2 weekly. Creatinine excretion was 16.4 mg/(kg x 24 h) pre-fenofibrate. It increased to a high of 26.2 mg/(kg x 24 h) during the period of fenofibrate intake and returned to 21.9 mg/ (kg x 24 h) 2 months after discontinuation of that drug. The patient's age, weight, height, body mass index, 24-h drain and urine volumes, total Kt/V urea, serum urea nitrogen, urea nitrogen excretion, and (for the pre-fenofibrate period) S(Cr), Cr excretion, estimated Cr production, and measured-to-predicted Cr excretion (using a formula developed in PD patients) were within the 95% confidence intervals (CIs) obtained in a control group of 24 other men on similar PD schedules. The patient's Cr excretion and production were abov...
Source: Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis - Category: Urology & Nephrology Tags: Adv Perit Dial Source Type: research