Creatinine levels and need for dialysis

Nurses General Nursing

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Specializes in Vascular, Neurosurgery, Urology.

Just out of curiosity, how high does a Cr level need to be before you have seen MD's start pt's on dialysis?

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Specializes in Nephrology, Cardiology, ER, ICU.

Its not just the serum creatinine - its a number of factors:

1. What is the 24 hour creatinine clearance?

2. Why is pt in renal failure?

3. Chronic or acute?

4. How does pt look? Acutely or chronically ill?

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Had a pt this past week with a Cr of 52 and no urine output for about 24 hours. Lots of 3+ pitting edema. Dialysis catheter was inserted. She became hypoxic and ventilated. At sometime the docs decided she was dry. Infused about a liter, then tapped her and pulled 1.5 L out her R lung. Over the weekend she was on dopamine, and whadya know, started to pee. No dialysis started and her Cr was dropping nicely.

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Specializes in Cardiology.

I definitely agree with traumaRUs's reply - there are a number of factors that go into deciding if a patient needs dialysis. In my unit, we recently started new dialysis on someone whose Crt was only 2.9, but they were not making urine, fluid overloaded, and not responding to IV diuretics and were becoming clinically unstable.

http://nursinginfluence.com

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Specializes in ICU, ER, EP,.

For us, I don't care what a chronic or acute creatine level is...... period. Is their electrolyes stable? Are they on a vent due to volume overload and you need to pull fluid?

The point is, forget the number, look at your patient, are they stable? Can you get a high K down with insulin and glucose and calcium? If not and they are in CHF and not oxygenating well drop a line, and pull off the fluid and fix the K.

I never jerk at a number, if I can't get my patient's electrolytes stable, or oxygenated them then we dialyze stat, you can always pull that line later. It is never about a creatinine level.

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