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. 2017 Feb 15;27(1):153–176. doi: 10.11613/BM.2017.019

Table 3. Sources of errors in GFR estimation using creatinine.

Source of error Example Actions
Non-controllable variations
Non-steady state AKI Laboratory professionals and clinicians should be aware of listed limitations.
For a better flow of information please consult the Appendix 2.
Factors affecting creatinine generation Race
Extremes in muscle mass (body building, anorexia)
Diet/nutrition (high protein diet, creatine supplements, creatine, vegetarians)
Muscle wasting diseases (muscular dystrophy, rhabdomyolysis)
Ingestion of cooked meat
Factors affecting tubular secretion of creatinine Decrease by drug-induced inhibition (cimetidine, fenofibrate)
Dialysis
Factors affecting extra-renal elimination of creatinine Decrease by gut creatininase by antibiotics
Increased by large volume losses of extracellular fluid
Higher GFR Higher measurement error at low serum creatinine concentrations
Partly-controllable variations
Interferences with creatinine assay Spectral interference (e.g. bilirubin, some drugs)
Chemical interference (e.g. glucose, ketones, bilirubin, some drugs)
Lipemia (serum delipidation with heparin and MgCl2 may cause falsely decreased creatinine concentration)
For obtaining an adequate blood sample laboratory professionals should implement the valid national recommendations for venous and capillary blood sampling (References: 11, 12)
For management of lipemic samples please consult a review by Nikolac et al. (Reference: 25)
Regarding analytical interferences, laboratory professionals should verify the data declared by the manufacturer and define their own acceptability criteria.
AKI - acute kidney injury. GFR - glomerular filtration rate.
(Reproduced with permission from KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int, Suppl 2013;3:1-150.)
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