Elevation of serum creatinine in a renal transplant patient following oral creatine supplementation
Open accessAbstract
We report the case of a renal transplant recipient presenting with elevated serum creatinine levels whilst taking oral creatine ethyl ester (CEE), but not creatine monohydrate (CM). Standard investigations for allograft dysfunction, including Doppler ultrasound and renal biopsy, were normal. Serum creatinine normalized following cessation of the supplement. CM is poorly absorbed and does not affect creatinine. In contrast, CEE is converted and absorbed as creatinine, elevating serum levels. In such cases, creatinine is not a valid surrogate for glomerular filtration rate (GFR). Alternate methods of GFR measurement should be considered and a rigorous clinical and drug history taken.
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The clinically significant increase in creatinine levels observed with CEE should raise concerns about potential safety of CEE.
“the clinically significant increase in creatinine levels observed should raise some concerns about potential safety of CEE as has reported two case studies [195,196].”
From Bioavailability, Efficacy, Safety, and Regulatory Status of Creatine and Related Compounds: A Critical Review (2022) · cites this paper as [195]
The Case Report documents a substantial rise in serum creatinine after the patient switched to CEE. But the Abstract and Discussion explain that CEE can elevate measured creatinine without impairing kidney function; investigations found no allograft damage. The paper supports concern about interpreting the test result, not a conclusion that the rise indicates a safety risk from CEE. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEarly reports, animal studies, and clinical reliance on serum creatinine are the main sources of concerns about creatine and kidney function.
“Early reports are the main source of these concerns [5–10], animal studies [11], and the clinical reliance on serum creatinine.”
From Effect of creatine supplementation on kidney function: a systematic review and meta-analysis (2025) · cites this paper as [6]
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Cites
Analysis of the efficacy, safety, and regulatory status of novel forms of creatine
Jäger, R., Purpura, M., Shao, A., Inoue, T., & Kreider, R. B. (2011) · Amino Acids · doi:10.1007/s00726-011-0874-6 · Cited by 181 · see citing works
Spillane, M., Schoch, R., Cooke, M., Harvey, T., Greenwood, M., Kreider, R., & Willoughby, D. S. (2009) · Journal of the International Society of Sports Nutrition · doi:10.1186/1550-2783-6-6 · Cited by 95 · see citing works
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Research works printed but not linked: 3
- [2]Groeneveld GJ, Beijer C, Veldink JH et al Few adverse effects of long-term creatine supplementation in a placebo-controlled trial. Int J Sports Med 2005; 26: 307– 313 15795816
- [3]Koshy KM, Griswold E, Schneeberger EE. Interstitial nephritis in a patient taking creatine. N Engl J Med 1999; 340: 814– 815 10075534
- [5]Delanaye P, Ebert N, Melsom T et al Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 1: how to measure glomerular filtration rate with iohexol? Clin Kidney J 2016; 9: 682– 699 27679715 PMC5036902
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Kreider, R. B., Jäger, R., & Purpura, M. (2022) · Nutrients · doi:10.3390/nu14051035 · Cited by 103 · see citing works
Fazio, C., Elder, C. L., & Harris, M. M. (2022) · Journal of Strength & Conditioning Research · doi:10.1519/jsc.0000000000003873 · Cited by 20 · see citing works
Effect of creatine supplementation on kidney function: a systematic review and meta-analysis
Naeini, E. K., Eskandari, M., Mortazavi, M., Gholaminejad, A., & Karevan, N. (2025) · BMC Nephrology · doi:10.1186/s12882-025-04558-6 · Cited by 17 · see citing works
“Beyond its ergogenic advantages, increasing data indicate that creatine may have therapeutic effects in several clinical settings, including rheumatic illnesses [5, 6], and neurodegenerative disorders [7, 8], highlighting its broader applicability beyond the athletic population.”
- Authors
- Law, J. P., Di Gerlando, S., Pankhurst, T., & Kamesh, L.
- Affiliations
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Corresponding author
- Law, Jonathan Philip
- Venue
- Clinical Kidney Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-10-16
- Volume
- 12
- Issue
- 4
- Pages
- 600-601
- ISSN
- 2048-8505 (ISSN-L)
- 2048-8513
- PMC
- PMC6671525
- OpenAlex
- W2895959468
- Cited by
- 6
- References
- 2
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 1 · 2021: 2
- FWCI
- 0.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical Kidney Journal (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Keywords
- creatine monohydrate, creatinine elevation, kidney transplantation, creatine supplementation, glomerular filtration rate, drug-induced nephrotoxicity
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