Recently, I accidentally discovered that someone on Baidu Tieba was discussing whether calcium dobesilate can reduce creatinine, and their comments were jaw-dropping. A laboratory friend also consulted on a case of creatinine interference in the WeChat group, and it was confirmed that it was also caused by this drug. The interference of calcium dobesilate on enzymatic creatinine has caused confusion to many doctors, patients, and laboratory personnel. Therefore, it is considered necessary to explain this issue and popularize it.
Calcium dobesilate is a microvascular protectant. The English name is Doxium (imported drug: Daoshengming), and there are many domestic drug names: Doxium, Endomin, Dashmin, Libesi, Keyuan, Haochang, etc.
Functional Indications:
Microangiopathy; diabetic microangiopathy-retinopathy and glomerulosclerosis; varicose vein syndrome; hemorrhoid syndrome; adjuvant treatment of vein dissection and venous sclerosis.
Can calcium dobesilate really lower creatinine?
All calcium dobesilate drug instructions do not mention that it can reduce creatinine levels, and there are no actual reports in the literature that it can significantly improve kidney function. So why do many patients and even doctors think that this drug lowers creatinine and protects kidney function? Because the creatinine test values of patients taking calcium dobesilate did decrease! !
In fact, authoritative research has long proven (1.Clinical Chemistry, 1993, 39(2).) that this “reduction” is an “illusion”. The most likely reason is that calcium dobesilate interferes with the creatinine detection method. , causing the results to be negatively biased.
The methods used to measure creatinine in clinical laboratories mainly include the alkaline picric acid method and the enzymatic method. Currently, about 2/3 of domestic laboratories use the enzymatic method to measure creatinine. The Peking Union Medical College Hospital’s bioimmunization research team further confirmed through in vitro addition tests, oral administration by volunteers and other tests (2. Medicine (Baltimore) 2015; 94:e905.) that calcium dobesilate is effective in detecting creatinine using the sarcosine oxidase method. Negative interference is commonly found in mainstream enzymatic creatinine testing systems at home and abroad, and the negative deviation in results can be as high as more than 60%, especially for patients with poor renal function. The mechanism is that the structure of calcium dobesilate is very similar to the chromogen in the enzymatic creatinine reagent, and it can also interact with the hydrogen peroxide produced by the reaction, resulting in a false reduction in the results.
Patients with diabetes are most likely to suffer from secondary kidney damage and need to monitor serum creatinine; calcium dobesilate is often used to protect microvessels in patients with diabetes. The negative interference in creatinine testing caused by this drug is covertly affecting clinical judgment. “Elevated creatinine levels are not recognized, existing kidney damage is masked, and decisions about alternative treatments that may be needed are not made in a timely manner,” It also caused the false impression in the previous article that the patient believed that the creatinine level would soar after stopping the drug.
Interference of calcium dobesilate on other common biochemical indicators
In fact, the drug not only interferes with the enzymatic creatinine detection, but also interferes with the determination of uric acid, triglycerides, total cholesterol, free fatty acids, glycated albumin, etc., which are also based on the Trinder reaction (3. Laboratory Medicine, 31(11):936-940. 4.PLoS ONE 13(2):e0192440.).
Many patients with diabetes are complicated by dyslipidemia and hyperuricemia, and the use of calcium dobesilate can also lead to an underestimation of these important metabolic indicators. In particular, it should be noted that glycated albumin is currently used to evaluate short-term glycemic control. The negative interference of this drug with glycated albumin will cause an incorrect assessment of glycemic control in diabetic patients! So everyone must pay attention to it.
The application value of calcium dobesilate
Does that mean calcium dobesilate has no application value? No, this drug is a microvascular protective agent. It was used clinically for the prevention and treatment of diabetic retinopathy in the 1970s and was included in the European Pharmacopoeia in 1997. It was included in the British Pharmacopoeia in 1998 and entered the market in my country in June 2001. It can significantly reduce capillary permeability, blood viscosity and platelet high activity, and improve abnormal blood rheology and microcirculation status. Therefore, it is an effective microvascular protective agent for preventing and treating diabetic retinopathy. Therefore, it is impossible to deny its value just because of the interference it brings. It must be used clinically when it should be used.
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