Why did my father's creatinine increase after treatment?

Question

Hello doctor,

My dad, who is 56 years old, had a heart stroke, but he recovered from that condition; he was on medication such as Clopidogrel, Atorvastatin, Telmisartan, and Amlodipine, and many more. He was suffering from a lack of sleep, hence taking sleeping pills according to the doctor’s recommendation, but these sleeping pills made him very drowsy.

Unfortunately, the water was retained in his body. We visited a cardiologist, and after tests, he prescribed Valsartan, Torsemide, Dapagliflozin, Metolazone (used for some time and later stopped), Eplerenone, Rosuvastatin (used for some time and later stopped), Linagliptin, Calcium and Vitamin D3, Aspirin, Atorvastatin, and Ezetimibe, Rivaroxaban (started later), Levothyroxine, Clonazepam, and Nitrazepam for sleep.

The water retention caused him to weigh 90 kg, whereas he normally weighs 80 kg. After taking all the medicines, his weight is now 75 kg, and the water has been removed. There is no breathlessness issue; he can sleep while lying down, has light tiredness, walks a minimum of 400 steps, and his blood pressure fluctuates between 60 to 70/110. The creatinine was 1, then 1.4, then 1.9, but suddenly increased to 3.2. Urea went from 45 to 90+ and then to 145. Potassium is 4.1.

We took an ultrasound of the abdomen and pelvis, which showed the liver, bladder, etc., as normal, with a 1 cm cyst in the kidney tube on the right. The left kidney was marked as normal. We gave the report to the cardiologist, and he stopped Valsartan, Dapagliflozin, Eplerenone, Calcium and Vitamin D3, and Metolazone, and changed the medicines to Hydralazine, Isosorbide Mononitrate, while continuing Torsemide, Linagliptin, Aspirin, Atorvastatin, and Ezetimibe, Calcium Carbonate and Vitamin D3, and Rivaroxaban 10 mg.

Want to know whether this change of tablets will not cause further issues.
We have yet to check whether the ejection fraction has changed after taking these medicines.
Kindly help and guide.

His ejection fraction is 20. He was a smoker and drinker but stopped suddenly, and all these happened. We checked the ejection fraction before we started taking all the medicines, and it was 20%.

An electrocardiogram showed abnormalities, but we were told that it had improved compared to the previous one. He has no cholesterol, no diabetes, and no history of thyroid disease. Creatinine was only 1 but has now increased.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your father’s situation is a complex balance between his heart and kidneys. With an ejection fraction of 20% (severe heart weakness), the fluid retention episode was likely due to worsening heart failure, and it is a good sign that his weight came down from 198.4 lb to 165.3 lb, the swelling reduced, and he can sleep flat without breathlessness.

The main concern now is the rise in creatinine from 1 to 3.2 and urea to 145, which can happen due to over-diuresis (too much fluid removal), low blood pressure, dehydration, or some heart medicines affecting kidney function.

The cardiologist’s decision to stop Valsartan, Dapagliflozin, Eplerenone, and others after seeing the kidney reports is a common approach to protect kidney function, and it should not automatically worsen his heart if he is monitored closely. He should have repeated kidney function tests, electrolytes, blood pressure, and weight monitoring after this change.

Since his potassium is normal and he has no breathlessness or swelling now, those are positive signs, but the kidney numbers need close follow-up. A repeat echocardiogram after stabilization will help show whether his ejection fraction has improved with treatment. It would also be useful to review with the cardiologist the reason for Rivaroxaban and whether its dose is appropriate with his current kidney function.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.