Intended for healthcare professionals

Rapid response to:

Practice Lesson of the Week

Protein and creatine supplements and misdiagnosis of kidney disease

BMJ 2010; 340 doi: (Published 08 January 2010) Cite this as: BMJ 2010;340:b5027

Rapid Response:

Creatine Supplementation: safe and not just for athletes

The case presented by Willis et al. [1] on the misdiagnosis of kidney
highlights a potential difficulty with the use of creatine, at least in
subset of patients with HIV infection on anti retro-viral drugs.

In the past the safety profile of creatine has been questioned
particularly with
respect to heat illness although a meta-analysis has largely disproved
claims [2] and recent research suggests that it may in fact aid
performance in
hot climates[3].

Creatine cannot only be considered a useful ergogenic aid to athletic
individuals, as it is increasingly finding therapeutic uses, particularly
patients with neuro-degenerative conditions [4]. Encouragingly creatine
appears safe in these patient groups, as demonstrated by a 2 year follow
study of patients with Parkinson's disease which showed creatine to be
tolerated with no detrimental effects on renal function despite a slight
rise in
serum creatinine [5].

The message that creatine is safe despite changes in creatinine may
develop increasing relevance as its' use beyond the athletic arena becomes more prominent.


1) Willis J, Jones R, Nwokolo N, Levy J. Protein and creatine supplements
misdiagnosis of chronic kidney disease. BMJ 2010; 340:b5027

2) Lopez RM, Casa DJ, McDermott BP, Ganio MS, Armstrong LE, Maresh CM.
Doescreatine supplementation hinder exercise heat tolerance or hydration
status? A systematic review with meta-analyses. J Athl Train. 2009 Mar-

3) Dalbo VJ, Roberts MD, Stout JR, Kerksick CM. Putting to rest the myth
creatine supplementation leading to muscle cramps and dehydration. Br J
Sports Med. 2008 Jul;42(7):567-73..

4) Adhihetty PJ, Beal MF. Creatine and its potential therapeutic value for
targeting cellular energy impairment in neurodegenerative diseases.
Neuromolecular Med. 2008;10(4):275-90. Epub 2008 Nov 13.

5) Bender A, Samtleben W, Elstner M, Klopstock T. Long-term creatine
supplementation is safe in aged patients with Parkinson disease. Nutr Res. 2008. Mar;28(3):172-8.

Competing interests:
None declared

Competing interests: No competing interests

28 January 2010
Adrian Peall
Rheumatology Registrar
Royal Glamorgan Hospital, Llantrisant