Tag Archives: creatinine

Impact of creatinine measurement methods on eGFR and GFR category assignment

Elena-Cristina Preda, Oana Oprea, Zsolt Albert Barabas, Ioana Paula Simion, Ana-Maria Fotache, Minodora Dobreanu

George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2026-0023

Background: Accurate measurement of serum creatinine (SCr) is critical in estimating glomerular filtration rate (eGFR) and classifying kidney function. This study evaluated the analytical differences between the enzymatic and Jaffe methods for SCr measurement and their impact on eGFR estimation using two widely applied equations: CKD-EPI and EKFC.
Methods: The study included 427 patients over 40 years old. SCr was measured using both enzymatic and Jaffe methods on the Alinity c platform. eGFR was calculated with the CKD-EPI (2009) and EKFC equations. Agreement between methods was assessed using Bland-Altman and Passing-Bablok regression. eGFR differences were analyzed using the Wilcoxon signed-rank test and multiple linear regression. Agreement in GFR category classification was evaluated using weighted kappa and Kendall’s tau.
Results: While the mean difference between methods was small, both systematic and proportional biases were statistically significant. eGFR values differed significantly between methods in both sexes (p < 0.01), regardless of the equation used. ΔeGFR was significantly associated with SCr values, but not with age. Although overall agreement in GFR categories was high (kappa > 0.91), method-dependent reclassification of patients was observed, which may influence CKD diagnosis and clinical decision-making.
Conclusions: Even minor analytical differences between enzymatic and Jaffe SCr measurements can lead to clinically relevant discrepancies in GFR categorization. These findings highlight the need for harmonization in laboratory methods to ensure consistent reporting and patient management.

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Acute Kidney Injury Following Rhabdomyolysis in Critically Ill Patients

Alvin Saverymuthu, Rufinah Teo, Jaafar Md Zain, Saw Kian Cheah, Aliza Mohamad Yusof, Raha Abdul Rahman

Department of Anaesthesiology & Intensive Care, Hospital Canselor Tuanku Muhriz, University Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia

DOI: 10.2478/jccm-2021-0025

Introduction: Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury.
Aim: To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients.
Methods: All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury.
Results: Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine kinase levels following hydration treatment was statistically significant in the non- kidney injury group (Z= -3.948, p<0.05) compared to the kidney injury group (Z= -0.623, p=0.534). Significantly, odds of developing acute kidney injury were 1.040 (p<0.001) for mean BW >50kg, 1.372(p<0.001) for SOFA Score >2, 5.333 (p<0.001) for sepsis and the multivariate regression analysis showed that SOFA scores >2 (p<0.001), BW >50kg (p=0.016) and sepsis (p<0.05) were independent risk factors. The overall mortality due to rhabdomyolysis was 15.4% (23/149), with significantly higher incidences of mortality in the kidney injury group (35.2%) vs the non- kidney injury (3.5%) [ p<0.001].
Conclusions: One-third of rhabdomyolysis patients developed acute kidney injury with a significantly high mortality rate. Sepsis was a prominent cause of acute kidney injury. Both sepsis and a SOFA score >2 were significant independent risk factors.

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