Impact of creatine supplementation on kidney health: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 42507286 · doi:10.1007/s11255-026-05287-x
What was done
Researchers conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) across MEDLINE, Embase, Cochrane Library, and Google Scholar up to March 2025. They examined the impact of creatine supplementation versus placebo on kidney health parameters in healthy individuals and patients with chronic kidney disease. Outcomes pooled using random-effects models included serum creatinine, creatinine-based and Cr-EDTA-based GFR, serum urea, albuminuria, proteinuria, and urinary creatinine.
What was found
Across 26 RCTs involving 1,036 participants, creatine supplementation significantly increased serum creatinine levels (MD 0.14 mg/dL; 95% CI 0.05 to 0.22; P = .002; I2 = 93.9%) and reduced creatinine-based estimated GFR (MD -10.75 mL/min; 95% CI -17.48 to -4.02; P = .002; I2 = 0%). However, direct GFR measured by Cr-EDTA showed no significant change (MD 5.89 mL/min; 95% CI -0.30 to 12.08; P = .06; I2 = 6.3%). No significant overall differences were observed for serum urea, albuminuria, proteinuria, or urinary creatinine. In a hemodialysis subgroup, creatine significantly increased serum creatinine while significantly reducing serum urea.
Why it matters
Elevations in serum creatinine and drops in creatinine-based eGFR following creatine supplementation likely reflect benign altered creatinine metabolism rather than true renal impairment, as direct filtration measurements and renal injury markers remain unchanged.
Limits
Serum creatinine outcomes exhibited extremely high heterogeneity (I2 = 93.9%). The Cr-EDTA analysis approached statistical significance (P = .06) and may have been limited by small sample size. Dosing protocols, trial durations, and specific numerical results for several secondary outcomes are not reported in the abstract.
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