When patients are diagnosed with acute or chronic kidney disease, this is one question I frequently encounter. Through this article, I am addressing the various questions and doubts regarding creatinine levels and how they change before and after dialysis.
Creatinine is a waste product of muscle metabolism in the body. The normal blood creatinine levels vary from 0.8-1.21mg/dl. The levels may vary based on age, gender, medical history, etc. Generally, men have a higher creatinine level than women because of the higher muscle mass.
Along with urea, the kidneys also filter creatinine and so, kidney disease can affect the urine and blood concentration of creatinine.
Creatinine levels for dialysis
While blood creatinine levels guide me in the treatment of kidney disease, the decision to start dialysis is not dictated only by creatinine levels.
Other factors include potassium levels, acid load on the body, fluid accumulation, blood urea level, progression of renal disease, etc. Overall patient condition is taken into account while starting dialysis. This means that a patient with a creatinine level of 3mg/dl may need dialysis while another with a level of 9mg/dl may not.
Generally, a serum creatinine level of more than 1.2mg/dl in females and more than 1.4mg/dl in males suggests early kidney damage. But again, these levels are subjective and are influenced by many other factors.
At what creatinine level is dialysis started in India?
The creatinine levels to start dialysis in India is similar to anywhere else in the world. As mentioned above, creatinine level is just one of the factors that guides the start of dialysis. It is influenced by various factors. The type of kidney disease, the age of patients, their gender, medical history, etc are also taken into account before dialysis is suggested. Consult your nephrologist for more details.
Highest creatinine levels before dialysis
I am somewhat reluctant to answer this question that patients often ask me. This is because if I say that the highest I have seen is a creatinine level of 29mg/dl before starting dialysis, every patient will believe he/she can wait till blood creatinine levels are 29mg/dl before he/she needs to start dialysis. This will harm the patients.
Most patients should start preparing for dialysis once creatinine level is above 4mg/dl. The exact creatinine level at which dialysis is needed can’t be predicted in each and every patient. It is always better to be prepared well in advance rather than try to second guess what one’s creatinine level is going to be in a few weeks/months down the line.
What will be the creatinine level after dialysis?
Through dialysis, the various waste products and metabolites are removed from the body. Therefore, dialysis is an effective way to reduce serum creatinine levels in patients. We generally observe that blood creatinine levels fall by 50-60 at the end of each session of dialysis.
What happens over the few days after dialysis to creatinine levels?
As you may have guessed, the serum level of creatinine goes up again after a few days of dialysis. Since creatinine is a metabolite of muscle breakdown and the normal wear and tear of muscles will go on throughout the life of an individual, creatinine will have to be removed again and again through dialysis.
In acute renal disease, as the kidney regains its normal function, it will effectively start removing urea and creatinine. Therefore, dialysis for creatinine removal may no longer be needed.
But in CKD, as the damage is more of the permanent kind, creatinine levels will keep on rising again and again and will need to be removed by dialysis. This means that patients suffering from CKD may need lifelong dialysis.
Can creatinine levels change quickly?
Creatinine is produced as a result of muscle cell breakdown in the body.
In acute kidney disease, creatinine levels can rapidly increase, indicating increasing damage to the kidney. In chronic cases, the levels do not fluctuate too much but it can vary from person to person.
Conclusion
Creatinine is a waste product, which is excreted through the kidney, and kidney disease can hamper the effective removal of creatinine. This will result in increased levels of creatinine in the blood.
Dialysis can provide aid in reducing this serum creatinine effectively. The duration of dialysis needed to ensure good health varies with the unique history of the patient but it is safe to say that patients with a chronic renal disease may need lifelong dialysis to function effectively.
I hope this article helped answer your queries.
Please clarify “ blood creatinine levels fall by 50-60 at the end of each session of dialysis.
If.creatinine is 3.7 before continuous dialysis and after 15 hrs why his creatinine would be higher and his urine level almost nonexistent?
Each patient is unique. This article is mainly about stable patients who are on regular dialysis. Does not apply to acutely ill patients.
Sir my mother has creatinine lavel 3.7 and urea 87. She have no history about kidney disease before. Sir my question is what is the treatment for this stage medicine or dialysis?
Varinderji, only creatinine levels do not give all the information that is needed. She needs to be on close follow-up with a nephrologist to plan the future course of action.
Sir my dad is in ICU , he was admitted with 500µmol/L creatinine and urea 30.5mmol/L .
He had his first ever hemodialysis . He is a diabetic type 2 for the past 12 years, never being on a insulin.
Two weeks ago his creatinine was 256µmol/L. After 8 days we did anothe test and it was up to 500µmol/L.
After the haemodialysis his creatine levels decreased to 133µmol/L and urea 9.8mmol/L.
Then 48h later his creatinine levels went up to 386µmol/L and urea 15.8mmol/L.
We are just wondering if this is normal ?
Its a bit confusing with the CRP (“C” reactive protein) from being normal levels on admitting to ICU to a week later increase to 59.4mg/l. Is there an infection still going on or this is also normal after the hemodialysis?
Patients in ICU can experience rapid fluctuations in many parameters. What you have described is a common scenario. There may be an infection but I can’t be 100% sure. Trust your team of doctors and hopefully he will come out quite well.
Three days before dialysis the creatinine level is 6 and after three days from the KFT report the creatinine level is 4.8mg/dl. Does this means creatinine level is decreasing.
Needs to be checked before dialysis only. If it is decreasing and urine output is increasing, then it can be a sign of improvement.
Very good explanation
Thank you!
Good article. My question is if BUN and Creatine read high but the BUN/Creatine Ratio read normal (12.9) why is dialysis needed? Fluid Restriction 40 oz. Sodium watched. No restrictions on potassium or phosphorus. No binders. Thank you.
The ratio isn’t of much use, the absolute values are important.
How much progress is being made on producing “artificial kidney”
which will not require taking anti rejections drugs
My impression is that we are some way away from a truly “artificial kidney.” The kidney is a marvel of nature and replacing it with a man made device that replaces ALL the functions won’t be that easy.
My creative started at 1.8 then 1.9then2.16 then 3.2…….I’m 76 and in general good health and I exercise and eat salt free… what number does creating level have to be before starting dialysis
Hello Ms. Greenfield. There is no specific creatinine level that dictates the need for starting dialysis. Depends also on your overall health, potassium levels, urine output to name a few factors.
hello Dr i have CKD my creatinine level changed from 2.3 to 3.2 within a month is this possible ?
It can happen. You need to consult a nephrologist to manage it correctly.
Good Afternoon Dr. Prashant Dheerendra,
Would you be able to give any insight to immune compromised patient that has a high Protein/Creatine Ratio of 639 mg/g?
That’s too broad a description Ms.Christy. Will advise you to consult a nephrologist for the next step, though the value isn’t alarmingly high.
I creatinine strated at 1.4 then 1.5 then 1.6 then 1.7 then after 3 years 1.98 or 2.01 I’m 38 years old general good health and I work every day 8 hours and eat salt sugar …..what number does creatinine level have to be before dialysis
There is no fixed value of creatinine at which dialysis will be needed. Will advise you to be on regular follow-up with a nephrologist so that dialysis can be delayed as much as possible.
Very helpful information.
Thanks!
Once the creatinine levels goes normal, kidney starts working normally
My last month creatinine was 9.9 and this month it’s 9 what is the probability of getting kidney works again or it just because dialysis it came down
If you were on dialysis, then that’s the likely reason for the small decrease in creatinine.
Good day, I would like to ask does dialysis helps yo lower your acid and creatinine level?
Yes, it does.
My husband’s creatinine is 9.9 and urea 176. He is having swelling in feet and nausea in morning time. He is not on dialysis. Now he is feeling pain in both sides (kidneys) as well as backache.
What should he do now?
May need to start dialysis. Please see a nephrologost.
Hi doc my createne are 12.3my potassium is btw 4-6wich advice can u give please
Creatinine is very high. Need to see a nephrologist soon.
My father Creatinine level 2.6 and urea level 155 after 2 dialysis. More dialysis required or not? My father age is 69 years. He have also blood pressure and bronchitis.
That decision can only be taken by the treating nephrologist.
My husband’s creatinine was 14 and urea was 166 before start dialysis sessions. Now he has started dialysis and 5 sessions are done, but his today’s investigations are showing 8.6 creatinine and 96 urea. I’m curious that after each session how much creatinine and urea got lower? And how much time it takes to get increased instantly?
Generally urea decreases by 60-70% after a dialysis session and rises to the previous level in 2-3 days.
Hello sir, my mother’s creatinine was 3.5mg/dl and within a period of 4 months it’s is 5mg/dl. BUN is 50.
No diabetic, Blood pressure medication since 15 years. Now BP is under control in the range of 130/80.
All other Electrolytes ( Potassium ,Chloride , Sodium are normal. Protein Albumin and Globulin normal. Urine output is there. Water intake is 1 litre per day. Salt ristricted diet.
Is Dialysis required now ?
Can be decided only after assessing the patient comprehensively. She definitely needs to see a nephrologist to chart the future course of action. All the best!
Sir
My father creatinine level is 8 . Do he need dialysis..he is taking medication.
We have to take many aspects into consideration other than creatinine to start dialysis : symptoms, potassium levels, acid load, etc. You need to discuss with your nephrologist and take a call. All the best!
Sir what are the charges per dialysis at your clinic
We offer different types of dialysis — high flux vs low flux, single use vs multiple use, etc. You can call on 9880487219 to know the details. Thank you.
Hi
I am ckd patient. My creatinine is 6.75 mg. But my sugar is 65 fasting and pp is 117. Pressure is 126/82. Phosphorus is 6.10. Potassium is 5.60. Sodium is 144. But i don’t have any symptoms for dialysis. Can you please give advice how to reduce my creatine? Thank you.
Lakshmi Pillai
Difficult to give specific advice without knowing much more about your history. I will advise that you consult a nephrologist nearby.
Very informative.thanks sir
Thank you sir!
My father is 83 years old and he has creatinine level 5.4, sodium 143, potassium 4.80, urea blood 83.5, urea nitrogen(BUN) 39, hemoglobin 6.9, HBSAG 0.470. My father is taking amlodipiine 5 for last 12 years. Does he require to go for dialysis now?
I can give a final opinion on the website. The results are very abnormal. He definitely needs to consult a nephrologist to plan the treatment.
I am ckd patient initial before dialysis critinine was about 16 now after frequent dialysis the current after dialysis of 72 hrs the critinine level is 8.5 what does this indicate either the effect of dialysis or any improvement in kidney function
Generally the effect of dialysis in patients with CKD. Regards.
Hey
My Dad is 71 years of age. He has diabetes since 15 years and has BP also. His diabetes is overall well managed. His HBA1C is usually around 6.5 or lower.
His creatine levels in April 3, 2023 was 2.4. His creatine level rose to 4.2 in May 15, 2023. But when he took a Covid antibody test 2 weeks later it was positive. (He had fever earlier, but we didn’t get PCR test done. But later we had doubts if it was Covid, that’s when we did antibody test) His creatine levels have been steady since for 1. 5 months. On June 23, 2023, his creatine levels was the same, ie 4.2. He took pneumococcal vaccine against pneumonia on June 28, 2023. When we tested on 3 July, 2023, his creatine levels became 5.2. Could this spike be because of the vaccine? Also his sodium, potassium, phosphorus & bicarbonate are in normal range. And he has no swelling at the moment (had in the past), no shortness of breath. His nephrologist advised him to prepare for dialysis. Is there anything else he can do to delay it?
Unlikely that the worsening is due to the vaccine. Preparing for dialysis is important in case he worsens in-spite of treatment. CKD is an unpredictable disease. On the other hand, good control of diabetes, BP, moderate diet will postpone dialysis as much as possible. Be in touch with your nephrologist regularly.
My husband is having 9.7 creatinine level after 17 session of dialysis, before start of dialysis it was 8.7. what does it means,,is dialysis not working for him ,what is the reason to increase in creatinine levels
How he is feeling overall is more important than lab values. Some fluctuations can be there which are natural. Please talk to your nephrologist.
Hye….my creatinine is 6.88 mg/dL . I am termed as CKD patient . What should I do now to prevent the level from increasing any further? I also have hypertension. Should I opt for dialysis now ?
The decision to start dialysis is complex and many things need to be considered. You must definitely see a nephrologist and start preparing for dialysis.
Sir my creatinine 9.16 , serum bun 31 , urea 66 after 2 hour of dialysis is this ok or not
We generally don’t check after two hours of dialysis. We check at the end of a four hour dialysis session.
Hi sir first of all thank you very much for information you share here. My mom creatinine was 2.5 after 15 days it increased to 18 doctor advised dialysis we have done on session creatinine decreased to 14 that’s mean kidney is working and what could be the reason that in 15 days it’s jump that high
Hi. There are many reasons for such a big jump. Will need a kidney biopsy to ascertain the exact cause if she is fit for the procedure.
My creatinine is 11.3, it fluctuates between 10 and 12. my sodium is 135, potassium is 5.9, phosphate 1s 6. i am ckd patient. with high proteinuria. I have small fluid retentionin belly. I am 44 years of age. I donot have nausea. my bp remains between 140/80 and 120/70. My urine output has slightly increased. do I need dialysis.
Hi. Creatinine of 11.3 is very high. You must definitely plan for the future regarding dialysis/kidney transplantation.
Sir my father creatinine level is 4.The dialysis process is must or not.and what treatment will be recommended to us
Hello Sethupathiji. Difficult to give advice just by knowing the creatinine level. He definitely needs to be on close follow-up with a nephrologist.
Sir my father’s age 75 years creatinine level is 1.6. Blood urea 35, Serum uric acid 7.8, for almost all 10 years. and the Right side kidney is size7.8×3.3cm and the left size kidney is 8.2×3.4 sir., please advise me on what precautions he should take.
Low salt diet, moderate protein diet, keeping BP under control and regular follow-up with a doctor and following the advice — this is the minimum that is needed. All the best to him!
Sir my father’s creatinine level is 1.6. and BUN 35 and kidney sizes are 7.5×3.3 and 8.3×3.5, please advise what precautions he should take for healthy living.
Sir I am ckd. Creatine 4.8. Urea 120. Protien leakage is there.What medicine to control protine leakage?
You need to see a doctor/nephrologist to plan the whole treatment. Reducing protein leakage is only a part of the treatment.
Thank you!
Sir I was diagnosed with ckd in 2015, my creatinine was 3.2
Was hospitalised for charcot joint am diabetic since 1993.
Am 56.year old diabetic
After discharge creatinine became 1.7
It slowly rose during 8 year but was stabilised at 2 till Feb 2023
But recent test in aug 2023 showed 2.9
Ure 56 hba1c 7.9
Kindly advise
Need to know much more details. Please consult in person or with a nephrologist nearby.
My sisters creatinine level is high as 3.24
My sister is suffering e beta thalassemia when her hemoglobin level is low then her creatinine lelvel is high.
Hb 7.35=creatinine 0.91
Hb 5.1=creatinine 1.49
Hb 5.5= creatinine 3.24
Pls suggest me what i do now
Unlikely that they are closely related. Need to consult a hematologist and nephrologist about the way forward. Best of luck!
My husband creatinine level increase suddenly 14. Then start dialysis after 10 dialysis his creatinine is still 9 This is ok doctor
It’s really good article but my question is still there. Creatinine levels of my mother is 8.3, which is really very high. But, it is static at this point since last 4 weeks. I am getting treatment from a homeo doctor.
What if we take a session of dialysis, will it reduce creatinine level to 1 or some other point and will it stay there or come back to 8.3 again.
Sir my brother have only 1 kidney
Age 22 years what should i do is there any requirement for dylasis
Creatinine level 3.4mg/dl
Urea 45mg/dl
Potassium 3.7
Left kidney size 11.0×5.3cm
Cortical thickness 1.4 cm
Right kidney is removed
my brother creatinine was 11.8 with bun 65, after five weeks of dialysis sessions (twice every week), his creatinine is 8 and bun is 90 after 4 hours of dialysis session. He is ckd patient. is it normal.
My sister creatinine was 11.8 upod admission. With renal diet and 3 dialysis before disharge, it goes down to 4.8. After 2 sessions, we extract blood before next session and it was 3.41. Is there any significant number of creatinine changes for this? Here are the other details
Age: 31
Sex: Female
UTI: Yes
Protein in Urine: None
My father is termed as CKD STAGE 5 patient. He has diabetes, hypertension since 5 years but they are under control.
Before dialysis his creatinine level was 5.8
Urea 140
After 3 dialysis session his creatinine was 1.8 and urea is 27
Should he continue more dialysis or remain in medication??
My brother is suffering with CKD and after some infections in body, the creatine levels are 16 mg/dl, and after 8 dialysis it decreased upto 2.5 mg/dl, it is decreased rapidly after dialysis sessions, is that good sign.