Emergency medicine pharmacotherapy compromises accuracy of plasma creatinine determination by enzyme-based methods: real-world clinical evidence and implications for clinical practice

Regina Demlova; Sarka Kozakova; Michal Rihacek; Dana Buckova; Katerina Horska; Ondrej Wiewiorka; Lubos Boucek; Iveta Selingerova; Martina Podborska; Alena Korberova; Alena Mikuskova; Jiri Starha; Miroslava Benovska; Martin Radina; Michal Richter; Lenka Zdrazilova Dubska; Dalibor Valik

doi:10.3389/fmed.2023.1236948

Emergency medicine pharmacotherapy compromises accuracy of plasma creatinine determination by enzyme-based methods: real-world clinical evidence and implications for clinical practice

Front Med (Lausanne). 2024 Jan 8:10:1236948. doi: 10.3389/fmed.2023.1236948. eCollection 2023.

Authors

Regina Demlova^#¹, Sarka Kozakova^#^{1

2}, Michal Rihacek^{3

4

5}, Dana Buckova^{4

5}, Katerina Horska^{6

7}, Ondrej Wiewiorka^{5

8}, Lubos Boucek⁸, Iveta Selingerova^{1

9}, Martina Podborska^{5

8}, Alena Korberova^{5

8}, Alena Mikuskova^{5

10}, Jiri Starha^{11

12}, Miroslava Benovska^{5

8}, Martin Radina^{13

14

15}, Michal Richter¹⁵, Lenka Zdrazilova Dubska^{1

5

8}, Dalibor Valik^{1

5

8

16}

Affiliations

¹ Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia.
² Department of Pharmacy, University Hospital Brno, Brno, Czechia.
³ Diagnostic and Therapeutic Centre, Emergency Services Department, University Hospital Brno, Masaryk University, Brno, Czechia.
⁴ Department of Laboratory Medicine, University Hospital Brno, Masaryk University, Brno, Czechia.
⁵ Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czechia.
⁶ Department of Pharmacy, Clinical Pharmacy Services Unit, University Hospital Brno, Brno, Czechia.
⁷ Department of Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Brno, Czechia.
⁸ Department of Laboratory Medicine, University Hospital Brno, Brno, Czechia.
⁹ Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czechia.
¹⁰ Department of Pediatric Hematology and Biochemistry, University Hospital Brno, Brno, Czechia.
¹¹ Department of Pediatrics, Pediatric Nephrology Unit, University Hospital Brno, Brno, Czechia.
¹² Faculty of Medicine, Masaryk University, Brno, Czechia.
¹³ Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University, Prague, Czechia.
¹⁴ General Teaching Hospital, Prague, Czechia.
¹⁵ Spadia Laboratories, Central Reference Lab, Division of Clinical Biochemistry, Ostrava, Czechia.
¹⁶ Department of Pediatric Oncology, University Hospital Brno, Brno, Czechia.

^# Contributed equally.

Abstract

Background: Assessment of kidney function in emergency settings is essential across all medical subspecialties. Daily assessment of patient creatinine results from emergency medical services showed that some deviated from expected values, implying drug-related interference.

Methods: Real-time clinical evaluation of an enzyme method (Roche CREP2) in comparison with the Jaffé gen. 2 method (Roche CREJ2) was performed. During the period of December 2022 and January 2023, we analyzed 8,498 patient samples, where 5,524 were heavily medicated STAT patient specimens, 500 were pediatric specimens, and 2,474 were from a distant general population in a different region using the same methods.

Results: In 109 out of 5,524 hospital specimens (1.97%, p < 0.001), the CREP2 value was apparently (25% or more) lower than CREJ2. Suspect interfering medication was found in a sample of 43 out of 46 reviewed patients where medication data were available. This phenomenon was not observed in the general population.

Conclusion: In a polymedicated urgent care hospital population, a creatinine enzyme method produces unreliable results, apparently due to multiple drug-related interferences.

Keywords: creatinine; cystatin C; eGFR; renal functions; urgent care medication.

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article. This study was supported by LRI CZECRIN (LM2018128), CZECRIN_4 PATIENTS (CZ.02.1.01/0.0/0.0/16_013/0001826), MHCZ-DRO (FNBr, 65269705), ERN PaedCan grant 101085543, and CREATIC grant agreement 101059788.