What is the effect of creatinine supplementation on heart failure?

From the Guidelines

Creatinine supplementation is not recommended for heart failure patients due to concerns about increased creatinine levels, which could complicate kidney function monitoring. The primary concern with creatinine supplementation in heart failure patients is the potential for worsening renal function, as indicated by increased creatinine levels 1. According to the European Society of Cardiology guidelines, an increase in creatinine of up to 50% above baseline is acceptable, but higher increases may require adjustment of medications or specialist advice 1.

Key Considerations

• Patients with kidney disease should avoid creatine due to concerns about increased creatinine levels, which could complicate kidney function monitoring.
• Creatine supplementation may benefit heart failure patients by improving muscle strength and exercise capacity, though it should be used cautiously.
• Patients should stay well-hydrated while taking creatine and consult their cardiologist before starting supplementation, especially if they're taking medications like diuretics that affect fluid balance.

Monitoring and Precautions

• Blood chemistry should be monitored frequently and serially until potassium and creatinine have plateaued 1.
• If potassium rises to >5.5 mmol/L or creatinine increases by >100% or to >310 μmol/L (3.5 mg/dL)/eGFR <20 mL/min/1.73 m2, the ACE inhibitor (or ARB) should be stopped and specialist advice sought 1.
• The safety of an ARB in patients developing angioedema with an ACE inhibitor is uncertain, and renin inhibitors are not recommended in heart failure 1.

Alternative Approaches

• The addition of a combination of hydralazine and a nitrate is reasonable for patients with reduced LVEF who are already taking an ACEI and beta-blocker for symptomatic HF and who have persistent symptoms 1.
• Compassionate end-of-life care/hospice, extraordinary measures, heart transplant, chronic inotropes, permanent mechanical support, and experimental surgery or drugs may be considered in certain cases 1.

From the Research

Effects of Creatinine Supplementation on Heart Failure

• Creatine supplementation may be useful in heart failure, as it increases creatine content in the heart and improves muscle strength and endurance in patients with heart failure 2, 3, 4.
• The decrease in creatine level in heart failure anticipates the reduction in adenosine triphosphate, and the degree of myocardial phosphocreatine/adenosine triphosphate ratio reduction correlates with disease severity, contractile dysfunction, and myocardial structural remodelling 5.
• Creatine supplementation has been shown to increase skeletal muscle creatine phosphate and muscle performance in patients with chronic heart failure, without changing ejection fraction 4.
• The potential benefits of creatine supplementation in heart failure may be due to its ability to increase energy-rich phosphagens, improve muscle strength and endurance, and exhibit antioxidant and anti-inflammatory effects 2, 6.

Mechanisms of Action

• Creatine supplementation increases creatine content in the heart, which can improve energy metabolism and contractility reserve of the myocardium 2.
• The creatine kinase system plays a major role in cardiac energy metabolism, and creatine supplementation may help to correct the energy deficit in heart failure 5.
• Creatine may also exhibit non-energy related properties, such as antioxidant and anti-inflammatory effects, which could contribute to its potential benefits in heart failure 6.

Clinical Implications

• Creatine supplementation may be a useful adjunctive therapy for patients with heart failure, particularly those with decreased muscle strength and endurance 3, 4.
• Further studies are needed to fully elucidate the effects of creatine supplementation on heart failure and to determine its potential as a therapeutic agent 2, 5.