ACC CardiaCast Cr Too High (Almost No Such Thing)
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Dec 18, 2025 Prateeti Khazanie, MD, MPH, is a renowned cardiologist specializing in heart failure and cardio-renal interactions. In this discussion, she emphasizes that rising creatinine levels should not delay heart failure treatment. Khazanie explains why it’s crucial to distinguish between functional and structural kidney injuries and shares effective decongestion strategies using high-dose diuretics. She also highlights the safe use of SGLT2 inhibitors and discusses when it's necessary to involve nephrology for better patient outcomes.
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Creatinine Often Reflects Hemodynamics
- Rising creatinine in heart failure usually reflects hemodynamic changes, not intrinsic kidney injury.
- Creatinine is a lagging marker and often increases because the failing heart reduces renal perfusion and causes venous congestion.
Don't Delay HF Treatment For Mild Cr Rise
- Do not delay diuresis or heart-failure therapy solely for a modest creatinine rise without signs of true kidney injury.
- Prioritize relieving congestion because untreated congestion links to worse outcomes including death and dialysis.
Aggressive, Monitored Diuresis For Congestion
- Use loop diuretics as first-line decongestive therapy and give higher doses if needed in CKD.
- Prefer IV diuresis and combine with thiazide-type agents for synergy while monitoring labs closely.