Despite being one of the most extensively researched supplements in the industry, with over 500 peer-reviewed studies supporting its efficacy and safety, creatine still has persistent myths and misconceptions surrounding it. As highlighted in a recent press release from the International Society of Sports Nutrition (ISSN), creatine is "safe, provides lifelong benefits, and should not be restricted" - yet confusion about this essential supplement persists. This article draws on many of these studies, with a particular focus on ISSN peer-reviewed articles that address common questions and misconceptions, as well as reviews comparing various forms of Powder creatine.
Can Creatine Damage the Kidneys and Cause Renal Dysfunction?
The concern that creatine supplementation can cause kidney damage or renal dysfunction remains one of the most persistent and pernicious misconceptions in the sports nutrition field.
This misconception can cause many people to forgo the use of a safe and effective supplement out of unfounded fear.
This widespread fear may stem from two main reasons:
- Confusion about creatine metabolism: Creatine and its metabolite, creatinine, are filtered by the kidneys and excreted in the urine. Since elevated blood creatinine is a marker for renal dysfunction, some people mistakenly believe that creatine supplementation may stress or damage the kidneys.
- A 1998 case study: Perhaps the most influential source of this myth was a case report published in The Lancet involving a young man with kidney disease who experienced a marked deterioration in kidney function while taking creatine. Despite significant limitations, this case report garnered widespread attention and helped solidify the myth of kidney damage in popular consciousness.
Figure A shows the chemical process by which creatine naturally degrades to creatinine through cyclization, with the loss of a water molecule.
Figure B shows the stability of creatine over time at different pH levels, showing that creatine remains stable at neutral pH but degrades more rapidly in an acidic environment.
This chemical reaction helps explain why the claims of kidney damage are unfounded-creatinine formation is a natural metabolic process that has nothing to do with kidney function.
What many people don't realize is that this case study was seriously flawed. The patient had been suffering from kidney disease for 8 years and was being treated with a potentially nephrotoxic drug (cyclosporine). The authors also overlooked the fact that creatine supplementation naturally increases blood creatinine without affecting actual kidney function.
What the Science Shows
In response to concerns about kidney health, several well-designed studies have specifically examined the effects of creatine on kidney function:
- Short-term studies: Multiple studies have found that creatine-loading regimens (up to 20g/day) do not adversely affect kidney function.
- Long-term studies: Studies have examined the effects of creatine supplementation for months to years, and results have consistently shown that creatine supplementation has no harmful effects on kidney function in healthy individuals.
- Clinical populations: Even studies of patients with type 2 diabetes (a population at higher risk for kidney problems) have not found adverse effects of creatine supplementation on kidney function.
The scientific consensus from multiple systematic reviews and meta-analyses is clear: creatine supplementation at recommended doses does not adversely affect kidney function in people with healthy kidneys.
This comprehensive table summarizes eight controlled studies that have examined the effects of creatine on hydration and thermoregulation in different populations and exercise conditions. Consistent results across study protocols indicate that creatine does not impair hydration or increase heat stress. Several studies have demonstrated beneficial effects, providing strong evidence against the idea that creatine causes dehydration or cramping.
After nearly three decades of research, including numerous randomized controlled trials specifically looking at kidney function, the body of evidence suggests that creatine supplementation, when used in the recommended dosage regimen, does not impair kidney function in healthy individuals.
If anything, this myth represents a case study in how a flawed case report can generate persistent misconceptions that contradict the weight of scientific evidence.
Just because the metabolite of creatine is creatinine, and creatinine is used as a kidney function biomarker, does not mean there is a link between creatine use and kidney function.
As with any supplement, people with kidney disease should consult a physician before starting creatine supplementation. However, for healthy individuals, the body of current scientific research does not support concerns that creatine use can damage the kidneys.
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