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Creatinine is a metabolic by-product of muscle metabolism, and normally appears in urine in relatively constant quantities over a 24 hour period with normal liquid intake. Therefore, urine creatinine can be used as an indicator of urine water content or as a marker identifying a specimen as urine. Greater than normal intake of water will increase the urine water content (lowering the creatinine level) consequently diluting the amount of drug in urine. Conversely, a limited intake of water can lead to an abnormally concentrated urine specimen (as occurs with dehydration) resulting in elevated creatinine levels.
Taken together, the prevalence of false-positive urine samples for buprenorphine with the CEDIA assay was 1.1%, the sensitivity was 100%, the specificity was 98.0%, and the PPV was 0.957. In these 25 samples, the lowest creatinine concentration was 3.9 mg/dL, the highest 50.4 mg/dL, and pH was between 5.4 and 7.6.