High Creatinine Levels After Dialysis: Causes and Solutions

After dialysis, creatinine and liver enzyme levels remain elevated?

Hello Dr.
Wu: I started dialysis in March, and my most recent blood test report showed several values outside the reference range: creatinine was 8.0 before dialysis and 3.1 after; urea was 134 mg/dL before and 47 mg/dL after; sodium was 123 mmol/L; calcium was 2.58 mmol/L; and albumin was 3.1 g/dL.
Am I not dialyzing effectively enough, and what methods can I use to improve? Should I focus on dialysis solutions, diet, or exercise? Additionally, I recently fell and injured my right back, but the pain has persisted for two weeks, making it difficult to sleep.
I have had an X-ray, and there are no fractures.
Could this be due to excess body toxins making recovery more difficult? Thank you for your response!

Liang, 60~69 year old female. Ask Date: 2016/05/20

Dr. Wu Jiyu reply Internal Medicine

Hello, regarding your questions, I would like to respond in the following points:
1) The effectiveness of dialysis is commonly referred to by two key indicators: one is the Urea Reduction Ratio (URR, which should be >65%), and the other is Kt/V.
Based on the index you provided, a URR of 65% meets the standard.
Serum creatinine is just one of the indicators and has limited use in assessing dialysis efficiency; it is primarily used to evaluate residual kidney function.
For a more accurate calculation, you may inquire about the Kt/V index with your dialysis center.
However, since you started dialysis in March, the clearance rates should be evaluated in the first few months based on residual kidney function, rather than solely relying on blood test values.
I recommend discussing ways to improve this with your nephrologist, as adjustments to dialysis must consider the overall picture, including weight, lifestyle, fluid intake, diet, dialysis access, and the dialysis machine, among other parameters.
Your attending physician is best suited to address this issue.
2) Your albumin level is low, which typically indicates nutritional deficiency or chronic inflammation.
For patients undergoing hemodialysis, protein intake should generally be 1.2 times that of the average person (i.e., 1.2 grams per kilogram per day).
Increasing your intake of protein sources such as meat and eggs may help improve your nutritional status.
3) Dialysis patients often have compromised kidney function, which can lead to weaker immunity and slower recovery from physical exertion or wounds compared to the general population.
However, regular and effective dialysis can alleviate most symptoms of uremia.
If you continue to experience back pain, it may be advisable to consult a specialist to investigate other potential causes of the pain.

Reply Date: 2016/05/20

More Info

High creatinine levels after dialysis can be concerning, especially for patients who have recently started dialysis treatment. In your case, it appears that your creatinine levels have decreased from 8.0 mg/dL to 3.1 mg/dL after dialysis, which indicates that the dialysis is effectively removing waste products from your blood. However, the fact that your creatinine levels remain elevated suggests that your kidneys are still not functioning optimally.

Creatinine is a waste product produced from muscle metabolism and is typically filtered out of the blood by the kidneys. In patients with kidney failure, creatinine levels can rise significantly. Dialysis is a treatment that helps to remove excess waste products and fluids from the blood when the kidneys can no longer perform this function adequately.

Several factors can contribute to persistently high creatinine levels after dialysis:
1. Dialysis Efficiency: The effectiveness of your dialysis treatment can vary based on several factors, including the type of dialysis (hemodialysis or peritoneal dialysis), the duration of the treatment, and the dialyzer (filter) used. If you feel that your dialysis sessions are not adequately clearing waste products, it may be worth discussing with your nephrologist about adjusting the duration or frequency of your treatments.

2. Dietary Factors: Your diet plays a crucial role in managing creatinine levels. A diet high in protein can increase creatinine levels, as protein metabolism produces more waste. It may be beneficial to work with a renal dietitian to create a meal plan that is low in protein and rich in fruits and vegetables, while also managing sodium, potassium, and phosphorus intake.

3. Fluid Management: Proper fluid management is essential for dialysis patients. Overhydration can lead to increased blood pressure and strain on the heart, while dehydration can cause kidney damage. Monitoring your fluid intake and output is crucial, and your healthcare team can help you determine the appropriate fluid limits.

4. Medication Management: Certain medications can affect kidney function and creatinine levels. Ensure that your healthcare provider is aware of all medications you are taking, including over-the-counter drugs and supplements, as some may be nephrotoxic.

5. Underlying Conditions: Conditions such as diabetes and hypertension can exacerbate kidney issues. Managing these underlying conditions is critical for improving kidney health and reducing creatinine levels.

Regarding your recent fall and ongoing back pain, it is essential to consider that while your X-ray did not show any fractures, the pain could be due to soft tissue injury or muscle strain. Elevated creatinine levels can sometimes be associated with muscle breakdown (rhabdomyolysis), which can occur due to various factors, including dehydration or excessive physical activity. However, in your case, it is more likely that the pain is related to the fall rather than directly linked to your creatinine levels.

To address your back pain, consider the following:
- Rest and Ice: Allow your back to rest and apply ice to reduce inflammation.

- Pain Management: Over-the-counter pain relievers (if approved by your doctor) can help alleviate discomfort.

- Physical Therapy: A physical therapist can provide exercises to strengthen your back and improve flexibility, which may help with recovery.

- Follow-Up: If the pain persists or worsens, it is essential to follow up with your healthcare provider for further evaluation.

In summary, it is crucial to work closely with your healthcare team to optimize your dialysis treatment, manage your diet, and address any underlying health issues. Regular follow-ups and open communication with your nephrologist will help ensure that you receive the best care possible.

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