Last week I met an anxious patient in my clinic. He was a young guy having end stage kidney disease (ESKD or ESRD) on regular 3 times per week hemodialysis. He exclaimed, "Doc I'm scared. Inspite of 3 times a week dialysis my creatinine levels have gone up from 6mg/dl (3 months ago) to 11mg/dl now. Why are the toxins not leaving my body inspite of good regular dialysis!" I simply told him that the toxins were getting out and that having a high creatinine was indeed GOOD for health. Quite a paradox, isn't it ??
Well, creatinine is a HARMLESS protein that comes from MUSCLES. One thing we must remember that in a person with kidney disease dialysis starts ONLY when the kidneys are no longer functioning (less than 10-15% of normal, which is almost as if it is nil function), so there is absolutely no question of the kidney problem to get worse. When a person with ESRD is on at least 3 times (or more) a week hemodialysis toxins do get removed well, appetite improves and the person starts eating well. As diet improves, muscle mass improves and as muscle mass increases the generation of creatinine (from muscle) also increases. Hence, a higher creatinine in someone on adequate dialysis is a sign of GOOD HEALTH. Just the opposite, when creatinine is low in a person with ESRD on regular dialysis, it means that he is undernourished and is a BAD sign.