When to worry about creatinine levels — a simple answer

“Doctor when should I worry about creatinine levels?” – seeing patients in our dialysis center in Bangalore makes it one of the commonest questions that I am asked.

Like to most questions in life the most correct answer is “it depends.” But since that answer is unlikely to be of much help in real life I will answer it in a little more detail.

But before that: a few basic facts about creatinine. Creatinine is a waste product that is removed from the body by the kidneys through urine. Muscles are the most important source of creatinine. Also, it is removed from the body only by the kidneys. Hence it is a good marker of kidney function because the levels of creatinine in blood begin to rise when the functioning of the kidneys is decreased.

The normal level in the blood in people in good health is 0.6-1.4 mg/dl. The test is often called as “serum creatinine” test in medical terms. For the understanding of the common man serum creatinine means nothing but blood creatinine test. The normal levels vary slightly from lab to lab and are generally lower in women compared to men.

To be honest, I wouldn’t advocate that people should worry excessively about their creatinine values. Some worry/anxiety may be ok as it will lead one to take proper care. But excessive worry is counter productive as it hinders proper treatment of the kidney condition and takes one away from good health.

So coming  back to our question of when to worry about creatinine levels.

Here are the situations when one needs to “worry” about creatinine levels:

1.    You don’t know your creatinine levels at all

2.    When creatinine values are very high and dialysis is needed

3.    When creatinine levels are above normal for a long time

4.    When creatinine values are increasing rapidly

You don’t know your creatinine levels at all

This is probably the situation that worries me the most. Of course the patient hasn’t done the test and hence is unaware of her creatinine values.Most likely she is not aware that there is anything wrong. So, this is a situation in which the patient is not worried but the doctor is.

 Kidney failure is asymptomatic(a word that the COVID-19 pandemic has made very famous) even upto its advanced stages. So, unless one is aware of one’s blood creatinine report, kidney failure may not be diagnosed till it is very advanced.

Does that mean that every healthy person needs to get the blood test for creatinine regularly?

The answer to that is “NO.” But there are a few well known risk factors for kidney failure. People harbouring any of them should definitely test their creatinine levels periodically.

What are these risk factors that need regular creatinine testing?

The most important ones are :

1.    Diabetes: even if it has been diagnosed recently

2.    High blood pressure

3.    Obesity

4.    Smoking

5.    Family history of kidney failure

6.    Heart disease

So anyone with with the above risk factors should definitely check her creatinine levels regularly. How frequently? Generally once a year should be enough. People with multiple risk factors or with already elevated blood creatinine will need more frequent testing. 

It has happened so many times that I have suggested creatinine testing for someone with these risk factors and absolutely no symptoms and they turned out to have high creatinine levels. 

When creatinine levels are very high and dialysis is needed

Higher the creatinine lesser the kidney function. Creatinine level by itself doesn’t decide when dialysis will be needed. So, someone with a creatinine level of 4.0 mg/dl may need dialysis and another person with 8 mg/dl may not. However, in a given patient the likelihood of dialysis increases as creatinine levels increase.

As a general rule I advise my patients to start thinking about dialysis once creatinine levels are above 4 mg/dl. Of course, it is only a rule of thumb and many patients will not need dialysis till the creatinine is much higher. But it is always good to prepare in advance and 4.0 is the level at which this communication/preparation should start.

When creatinine levels are above normal for a long time

A creatinine level above normal for more than 3 months means chronic kidney disease(CKD) is present. This is a disease which progresses over months, years and even decades.

Hence regular follow-up with a kidney specialist (nephrologist) is needed, at least once in three months. Unfortunately, in the early stages because creatinine levels are not dramatically abnormal, CKD gets neglected until it’s too late.

Avoid doing this and take maximum care in the early stages because this can slow the progression in the long run.

When creatinine levels are increasing rapidly

Creatinine levels can be normal or slightly abnormal for a long time and then start increasing rapidly.

The main question to answer in such a scenario is whether the damage is reversible or not? In both the situations some very critical decisions regarding treatment have to be taken. In such a situation very detailed investigation including urine and blood tests, ultrasound scanning, kidney biopsy, etc may be needed.

Dialysis may also be needed at least temporarily. Hence it is important to see a nephrologist when creatinine levels start to rise rapidly.

So, there you have it. Four situations when one has to take proper care of one’s kidney health based on blood creatinine test.

Also blood creatinine levels tell more about your kidney function than ultrasound scan which may be reported as “bilateral renal parenchymal disease” but gives very little information about kidney function.

Some numbers : 

  • 15% of Indians(that’s almost 20 crore people!) have chronic kidney disease. Unfortunately, a vast majority are unaware of it. The easiest way to diagnose early is to be aware of the risk factors mentioned above and test regularly. 
  • 2 lakh Indians develop kidney failure requiring dialysis every year. Again, most of them are recognised too late. The above measure of periodic testing will help in recognizing the people with severe kidney failure early. They can then prepare properly for dialysis. 

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