How does creatine supplementation affect individuals with microalbuminuria (presence of albumin in urine)?

From the Guidelines

Creatine supplementation should be approached with caution in individuals with microalbuminuria, and it is generally recommended to either avoid creatine supplements or use them only under close medical supervision. For those with this condition, characterized by small amounts of albumin protein in the urine, the typical creatine monohydrate dosing protocol of 20g/day loading phase followed by 3-5g/day maintenance may pose risks for these individuals. This caution stems from creatine's metabolism, which produces creatinine as a byproduct, as noted in various studies 1. Creatinine is filtered through the kidneys and can temporarily increase serum creatinine levels, potentially adding stress to already compromised kidneys. While creatine itself hasn't been definitively proven to cause kidney damage in healthy individuals, microalbuminuria indicates existing kidney stress or early dysfunction, as discussed in the context of chronic kidney disease management 1.

The presence of albumin in urine suggests that the kidney's filtration barrier is already compromised, and adding substances that increase kidney workload could potentially exacerbate this condition. Guidelines for managing chronic kidney disease emphasize the importance of monitoring and managing factors that could worsen kidney function, including the use of substances that might increase kidney workload 1. Anyone with microalbuminuria who is considering creatine supplementation should first consult with a nephrologist or healthcare provider for personalized guidance and regular kidney function monitoring if supplementation is pursued.

Key considerations include:

• The potential for creatine to increase serum creatinine levels, which could be problematic for individuals with pre-existing kidney issues 1.
• The importance of monitoring kidney function in individuals with microalbuminuria, especially if they choose to use creatine supplements 1.
• The need for personalized medical guidance for individuals with microalbuminuria who wish to use creatine supplements, given the potential risks and the variability in individual responses to creatine supplementation.

Given the potential risks and the emphasis on cautious management of kidney health in individuals with microalbuminuria, it is crucial to prioritize careful medical evaluation and monitoring over the potential benefits of creatine supplementation. This approach aligns with recommendations for the management of chronic kidney disease and the prevention of its progression, as outlined in clinical practice guidelines 1.

From the Research

Creatine Supplementation and Microalbuminuria

• Microalbuminuria is defined as the presence of albumin in the urine, typically in amounts between 30-300 mg/day 2.
• It is a marker of endothelial dysfunction and a risk factor for cardiovascular disease and kidney disease progression 2, 3.
• Creatine supplementation is commonly used by athletes to improve strength and muscle mass, but its effects on kidney function and microalbuminuria are not well understood.

Effects of Creatine Supplementation on Kidney Function

• Short-term and long-term creatine supplementation has been shown to have no significant effects on kidney function in healthy individuals 4, 5.
• However, it is recommended that individuals with pre-existing kidney disease or those at risk for kidney dysfunction avoid using creatine supplements 4.
• One study found that short-term high-dose creatine supplementation increased the production of methylamine and formaldehyde in the urine, but the clinical significance of this is unclear 4.

Relationship Between Creatine Supplementation and Microalbuminuria

• One study found no association between protein supplement use (including creatine) and the presence of microalbuminuria in gym members 6.
• Another study found that short-term creatine supplementation had no effect on albumin excretion rates in healthy men 5.
• However, the relationship between creatine supplementation and microalbuminuria in individuals with pre-existing kidney disease or those at risk for kidney dysfunction is not well understood and requires further study.

Biomarkers for Cardiovascular Risk

• Serum creatinine and albuminuria are both biomarkers for cardiovascular risk, but they provide different information 3.
• Albuminuria is a marker of endothelial dysfunction and is associated with increased risk for cardiovascular events, while serum creatinine is a marker of kidney function 3.
• Concomitant evaluation of both biomarkers is recommended to assess kidney function and cardiovascular risk thoroughly 3.