Review says creatine may be safe in kidney disease

Key Takeaways

• This paper is a narrative review, not a new clinical trial in kidney disease patients.
• Its main message is that creatine-related kidney safety concerns may be overstated, especially when based only on serum creatinine changes.
• The review suggests creatine could help problems common in CKD, including sarcopenia, frailty and possibly neurocognitive decline.
• The evidence for direct benefit in CKD patients is still limited, so this is not a blanket recommendation for self-supplementing with kidney disease.
• For healthy people, the broader creatine literature still supports monohydrate as the best-studied form at standard doses.
• Anyone with impaired kidney function should discuss creatine with their nephrologist before starting it.

What the review actually found

The new paper in Nephrology, Dialysis, Transplantation makes a careful but important point: creatine should not automatically be viewed as harmful in people with kidney disease, and it may eventually prove useful in chronic kidney disease (CKD) care because of effects that go beyond gym performance.

Specifically, the authors argue that creatine’s known roles in cellular energy metabolism, muscle function and exercise capacity may matter in CKD, where sarcopenia, frailty and reduced physical function are common. The review also highlights emerging interest in possible effects on inflammation, oxidative stress, neuroprotection and gut-barrier function.

That is the news value here. For years, public discussion around creatine and kidneys has often been dominated by a simple fear: if creatine can raise blood creatinine, maybe it must be damaging the kidneys. This review pushes back on that assumption and suggests the issue is more nuanced. A rise in serum creatinine can reflect creatine metabolism rather than new kidney injury, which means standard lab interpretation can get tricky.

Still, readers should keep the conclusion in proportion. This is not a finding that creatine is now proven safe and beneficial for everyone with CKD. It is a case that the supplement deserves a more evidence-based, less reflexively fearful appraisal in nephrology. For general readers, that means two things: creatine’s kidney risk is often oversimplified, and people with known kidney disease still need individual medical guidance rather than social-media advice.

This was a narrative review, not a new trial

The biggest limitation is also the key to interpreting the paper properly: this was a narrative review. That means the authors synthesised mechanistic, experimental and clinical evidence across several topics rather than reporting a new randomised controlled trial.

Narrative reviews can be very useful, especially when a topic is broad and clinically important. They help connect dots between kidney physiology, muscle wasting, inflammation, cognition and practical concerns around supplement safety. But they sit lower on the evidence hierarchy than a well-conducted systematic review or meta-analysis, and far below a large, well-controlled clinical trial in CKD patients.

That matters because the review’s most interesting claims are still largely forward-looking. The abstract describes creatine as a promising nutritional strategy for CKD management, but promising is not the same as proven. The paper does not establish a standard creatine protocol for CKD, quantify a clear treatment benefit, or show that long-term supplementation improves hard renal outcomes such as disease progression, dialysis needs or hospitalisation.

There is another practical limitation: kidney disease is not one condition. CKD ranges from mild impairment to advanced disease, dialysis and transplant settings, each with different risks, medications and nutrition issues. So even if creatine proves helpful in one subgroup, that does not automatically generalise to all patients.

The bottom line on design is simple: treat this as a serious review that challenges old assumptions and identifies a research opportunity, not as a definitive clinical green light.

Why creatine and kidney safety are so often confused

The review lands on a genuinely important issue in sports nutrition and nephrology: creatine can complicate kidney lab interpretation without necessarily harming the kidneys.

Creatine is converted in the body to creatinine, and serum creatinine is one of the standard blood markers used to estimate kidney function. That creates an obvious problem. If someone starts taking creatine and their creatinine level rises, it may look concerning at first glance. But that change does not automatically mean the kidneys have been damaged. It may simply reflect increased creatine turnover or altered assay interpretation.

This distinction has been discussed for years in the broader literature. Position stands and reviews such as Kreider et al. (2017), ISSN Position Stand: Safety and Efficacy of Creatine — JISSN and Antonio et al. (2021), Common questions and misconceptions about creatine supplementation — JISSN have noted that creatine monohydrate is generally well studied and has not been shown to impair kidney function in healthy people when used at recommended doses.

That broader context is helpful, but it does not eliminate caution in CKD. In healthy users, a lab blip may be mostly interpretive noise. In people with established renal disease, clinicians need more careful monitoring and sometimes different markers or a fuller clinical picture. For readers trying to make sense of the headline, the right takeaway is not “creatine cannot affect kidney tests.” It is “changes in creatinine are not the same thing as proof of kidney damage.”

What this means if you have kidney disease or take creatine

For most readers, the practical message splits into two groups.

If you are healthy and using creatine for training: this review does not really change current best practice. The best-supported option remains creatine monohydrate. A common maintenance intake is 3-5 g/day, and a typical loading approach is about 20 g/day split into four doses for 5-7 days, followed by maintenance. If you want help estimating a routine, a creatine dosage calculator can simplify the basics, and our creatine guides cover the evidence in more detail.

If you have CKD, reduced kidney function, a kidney transplant, or are on nephrology follow-up: do not treat this paper as permission to start supplementing on your own. The review is hypothesis-generating and clinically interesting, but it is not a substitute for personalised care. Your stage of disease, medications, protein intake, hydration status and lab-monitoring plan all matter.

Product choice matters too. If creatine is considered, monohydrate is still the logical first option because it is the most studied form. Flashier forms have less evidence and may add cost without adding confidence. Our best creatine rankings, creatine brand reviews and creatine product catalog focus on transparent formulations and third-party credibility, which is especially important for anyone with a medical condition.

How this fits the broader creatine evidence base

In the wider literature, creatine monohydrate is one of the most studied supplements in sports nutrition. In healthy adults, the evidence strongly supports its ability to raise intramuscular phosphocreatine stores and improve performance in high-intensity exercise, with a well-established safety profile at recommended intakes.

The newer and more interesting question is whether those same energy-buffering and cell-protective effects can help clinical populations. That is where this review sits. It points to CKD as a condition in which muscle loss, fatigue, frailty and sometimes cognitive issues are common, making creatine biologically plausible as an adjunct nutrition strategy.

But biologically plausible is not the same as clinically settled. The paper’s mention of neuroprotection, inflammation, oxidative stress and gut physiology reflects active areas of research, not mature consensus. The gut-microbiota angle, in particular, is intriguing, yet still early for practice-changing conclusions.

This is why the review matters most as a reframing exercise. It suggests nephrology may need to move beyond an outdated fear that creatine is inherently nephrotoxic, and toward a more precise question: in which kidney-disease populations, at what doses, with what monitoring, could creatine produce net benefit?

That is a better scientific question than the old blanket warning. It is also more useful for patients and clinicians. The broader evidence says creatine is not the villain it is often made out to be. This review asks whether, in some renal settings, it could even become helpful.

Bottom line for readers

The fairest summary is this: the new review argues that creatine in kidney disease deserves less fear and more research. It suggests potential upside for problems that matter in CKD, especially muscle wasting and frailty, while challenging the simplistic idea that creatine-related changes in creatinine automatically mean kidney harm.

What it does not do is prove that creatine should now be routinely recommended to CKD patients. There is a meaningful gap between “promising nutritional strategy” and “standard of care.” Until stronger trials arrive, that gap should be respected.

• Healthy users: the existing evidence on creatine monohydrate remains broadly reassuring.
• People with kidney disease: this paper is encouraging, but not a self-prescribing guide.
• Clinicians and researchers: the review supports better-designed trials and more sophisticated interpretation of renal biomarkers.

If you are considering creatine and have any kidney diagnosis, ask your nephrologist or physician first and discuss how kidney function will be monitored. For everyone else, the big takeaway is narrower but still useful: creatine’s reputation for kidney danger is more controversial, and more context-dependent, than many people think.

Creatine and kidney disease: what this review changes

• 3-5 g/day Common creatine maintenance dose — Mainstream sports-nutrition guidance for healthy users, not a CKD prescription.
• ~20 g/day Typical loading amount — Usually split into 4 doses daily for 5-7 days in healthy adults.
• 5-7 days Standard loading phase length — Best-established approach for saturating stores quickly.
• 1 review Type of new evidence here — This paper is a narrative review, not a new randomised clinical trial.

Frequently Asked Questions

Sources & Further Reading

• Kreider et al. (2017), ISSN Position Stand: Safety and Efficacy of Creatine — JISSN
• Antonio et al. (2021), Common questions and misconceptions about creatine supplementation — JISSN