CREATINE MONOHYDRATE SUPPLEMENTATION IN ATHLETIC POPULATIONS: IMPLICATIONS FOR PHYSICAL PERFORMANCE, COGNITIVE RESILIENCE, AND RENAL SAFETY — A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5329Keywords:
Creatine Monohydrate; Athletic Performance; Cognition; Sleep Deprivation; Renal Safety; Narrative ReviewAbstract
Background: Creatine monohydrate is one of the most studied ergogenic supplements in sports nutrition. Beyond its established effects on skeletal muscle performance, recent literature increasingly addresses cognitive outcomes and persistent concerns regarding renal safety.
Objective: To provide a narrative review of current evidence on creatine monohydrate in athletic and physically active populations, focusing on physical performance, cognition, and kidney-related outcomes.
Methods: Literature from PubMed, Scopus, Web of Science, and Google Scholar was narratively synthesized, prioritizing randomized trials, systematic reviews, meta-analyses, and key position stands, while retaining seminal studies for mechanistic context.
Results: Creatine consistently improves maximal strength, power output, repeated sprint ability, and lean mass accretion when combined with training. Cognitive benefits appear more heterogeneous but are most promising under sleep deprivation, mental fatigue, or other conditions of elevated cerebral energy demand. In healthy users, creatine may modestly increase serum creatinine without indicating structural kidney injury; current controlled evidence does not show clinically meaningful deterioration in renal function.
Conclusions: Creatine monohydrate remains the reference form of creatine for athletic practice, with strong support for performance enhancement, emerging support for cognitive resilience, and a reassuring renal safety profile in healthy athletic populations.
References
Antonio, J., Candow, D. G., Forbes, S. C., Gualano, B., Jagim, A. R., Rawson, E. S., Smith-Ryan, A. E., VanDusseldorp, T. A., Willoughby, D. S., & Ziegenfuss, T. N. (2021). Common questions and misconceptions about creatine supplementation: What does the scientific evidence really show? Journal of the International Society of Sports Nutrition, 18, 13. https://doi.org/10.1186/s12970-021-00412-w
Avgerinos, K. I., Spyrou, N., Bougioukas, K. I., & Kapogiannis, D. (2018). Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Experimental Gerontology, 108, 166–173. https://doi.org/10.1016/j.exger.2018.04.013
Burke, D. G., Chilibeck, P. D., Parise, G., Candow, D. G., Mahoney, D., & Tarnopolsky, M. A. (2003). Effect of creatine and weight training on muscle creatine and performance in vegetarians. Medicine & Science in Sports & Exercise, 35(11), 1946–1955. https://doi.org/10.1249/01.MSS.0000093614.17517.79
Cook, C. J., Crewther, B. T., Kilduff, L. P., Drawer, S., & Gaviglio, C. M. (2011). Skill execution and sleep deprivation: Effects of acute caffeine or creatine supplementation—A randomized placebo-controlled trial. Journal of the International Society of Sports Nutrition, 8, 2. https://doi.org/10.1186/1550-2783-8-2
Dechent, P., Pouwels, P. J. W., Wilken, B., Hanefeld, F., & Frahm, J. (1999). Increase of total creatine in human brain after oral supplementation of creatine-monohydrate. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 277(3), R698–R704. https://doi.org/10.1152/ajpregu.1999.277.3.R698
Dolan, E., Gualano, B., & Rawson, E. S. (2019). Beyond muscle: The effects of creatine supplementation on brain creatine, cognitive processing, and traumatic brain injury. European Journal of Sport Science, 19(1), 1–14. https://doi.org/10.1080/17461391.2018.1500644
Forbes, S. C., Cordingley, D. M., Cornish, S. M., Gualano, B., Roschel, H., Ostojic, S. M., Rawson, E. S., Roy, B. D., Prokopidis, K., Giannos, P., & Candow, D. G. (2022). Effects of creatine supplementation on brain function and health. Nutrients, 14(5), 921. https://doi.org/10.3390/nu14050921
Gordji-Nejad, A., Matusch, A., Kleedörfer, S., Patel, H. J., Drzezga, A., Elmenhorst, D., Binkofski, F., & Bauer, A. (2024). Single dose creatine improves cognitive performance and induces changes in cerebral high energy phosphates during sleep deprivation. Scientific Reports, 14, 4937. https://doi.org/10.1038/s41598-024-54249-9
Green, A. L., Simpson, E. J., Littlewood, J. J., Macdonald, I. A., & Greenhaff, P. L. (1996). Carbohydrate ingestion augments creatine retention during creatine feeding in humans. Acta Physiologica Scandinavica, 158(2), 195–202. https://doi.org/10.1046/j.1365-201X.1996.528300000.x
Greenwood, M., Kreider, R. B., Melton, C., Rasmussen, C., Lancaster, S., Cantler, E., Milnor, P., & Almada, A. (2003). Creatine supplementation during college football training does not increase the incidence of cramping or injury. Molecular and Cellular Biochemistry, 244(1–2), 83–88. https://doi.org/10.1023/A:1022413202549
Gualano, B., Ugrinowitsch, C., Novaes, R. B., Artioli, G. G., Shimizu, M. H., Seguro, A. C., Harris, R. C., & Lancha, A. H., Jr. (2008). Effects of creatine supplementation on renal function: A randomized, double-blind, placebo-controlled clinical trial. European Journal of Applied Physiology, 103(1), 33–40. https://doi.org/10.1007/s00421-007-0669-3
Gualano, B., de Salles Painelli, V., Roschel, H., Lugaresi, R., Dorea, E., Artioli, G. G., Lima, F. R., da Silva, M. E. R., Cunha, M. R., Seguro, A. C., Shimizu, M. H., Garcia Otaduy, M. C., Sapienza, M. T., Leite, C. C., Bonfá, E., & Lancha, A. H., Jr. (2011). Creatine supplementation does not impair kidney function in type 2 diabetic patients: A randomized, double-blind, placebo-controlled, clinical trial. European Journal of Applied Physiology, 111(5), 749–756. https://doi.org/10.1007/s00421-010-1676-3
Gutiérrez-Hellín, J., Del Coso, J., Franco-Andrés, A., Gamonales, J. M., Espada, M. C., González-García, J., López-Moreno, M., & Varillas-Delgado, D. (2025). Creatine supplementation beyond athletics: Benefits of different types of creatine for women, vegans, and clinical populations—A narrative review. Nutrients, 17(1), 95. https://doi.org/10.3390/nu17010095
Harris, R. C., Söderlund, K., & Hultman, E. (1992). Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clinical Science, 83(3), 367–374. https://doi.org/10.1042/cs0830367
Hultman, E., Söderlund, K., Timmons, J. A., Cederblad, G., & Greenhaff, P. L. (1996). Muscle creatine loading in men. Journal of Applied Physiology, 81(1), 232–237. https://doi.org/10.1152/jappl.1996.81.1.232
Jagim, A. R., & Kerksick, C. M. (2021). Creatine supplementation in children and adolescents. Nutrients, 13(2), 664. https://doi.org/10.3390/nu13020664
Jäger, R., Harris, R. C., Purpura, M., & Francaux, M. (2007). Comparison of new forms of creatine in raising plasma creatine levels. Journal of the International Society of Sports Nutrition, 4, 17. https://doi.org/10.1186/1550-2783-4-17
Kambis, K. W., & Pizzedaz, S. K. (2003). Short-term creatine supplementation improves maximum quadriceps contraction in women. International Journal of Sport Nutrition and Exercise Metabolism, 13(1), 87–96. https://doi.org/10.1123/ijsnem.13.1.87
Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., Candow, D. G., Kleiner, S. M., Almada, A. L., & Lopez, H. L. (2017). International Society of Sports Nutrition position stand: Safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14, 18. https://doi.org/10.1186/s12970-017-0173-z
Longobardi, I., Gualano, B., Seguro, A. C., & Roschel, H. (2023). Is it time for a requiem for creatine supplementation-induced kidney failure? A narrative review. Nutrients, 15(6), 1466. https://doi.org/10.3390/nu15061466
McMorris, T., Harris, R. C., Swain, J., Corbett, J., Collard, K., Dyson, R. J., Dye, L., Hodgson, C., & Draper, N. (2006). Effect of creatine supplementation and sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state, and plasma concentrations of catecholamines and cortisol. Psychopharmacology, 185(1), 93–103. https://doi.org/10.1007/s00213-005-0269-z
Merege-Filho, C. A. A., Otaduy, M. C. G., de Sá-Pinto, A. L., de Oliveira, M. O., Gonçalves, L. S., Hayashi, A. P. T., Roschel, H., Pereira, R. M. R., Silva, C. A., Brucki, S. M. D., Leite, C. C., & Gualano, B. (2017). Does brain creatine content rely on exogenous creatine in healthy youth? A proof-of-principle study. Applied Physiology, Nutrition, and Metabolism, 42(2), 128–134. https://doi.org/10.1139/apnm-2016-0406
Naeini, E. K., Eskandari, M., Mortazavi, M., Gholaminejad, A., & Karevan, N. (2025). Effect of creatine supplementation on kidney function: A systematic review and meta-analysis. BMC Nephrology, 26, 622. https://doi.org/10.1186/s12882-025-04558-6
Poortmans, J. R., & Francaux, M. (2000). Adverse effects of creatine supplementation: Fact or fiction? Sports Medicine, 30(3), 155–170. https://doi.org/10.2165/00007256-200030030-00001
Preen, D., Dawson, B., Goodman, C., Beilby, J., & Ching, S. (2003). Creatine supplementation: A comparison of loading and maintenance protocols on creatine uptake by human skeletal muscle. International Journal of Sport Nutrition and Exercise Metabolism, 13(1), 97–111. https://doi.org/10.1123/ijsnem.13.1.97
Rae, C., Digney, A. L., McEwan, S. R., & Bates, T. C. (2003). Oral creatine monohydrate supplementation improves brain performance: A double-blind, placebo-controlled, cross-over trial. Proceedings of the Royal Society B: Biological Sciences, 270(1529), 2147–2150. https://doi.org/10.1098/rspb.2003.2492
Rawson, E. S., & Venezia, A. C. (2011). Use of creatine in the elderly and evidence for effects on cognitive function in young and old. Amino Acids, 40(5), 1349–1362. https://doi.org/10.1007/s00726-011-0855-9
Roschel, H., Gualano, B., Ostojic, S. M., & Rawson, E. S. (2021). Creatine supplementation and brain health. Nutrients, 13(2), 586. https://doi.org/10.3390/nu13020586
Sale, C., Harris, R. C., Florance, J., Kumps, A., Sanvura, R., & Poortmans, J. R. (2009). Urinary creatine and methylamine excretion following 4 × 5 g × day−1 or 20 × 1 g × day−1 of creatine monohydrate for 5 days. Journal of Sports Sciences, 27(7), 759–766. https://doi.org/10.1080/02640410902838237
Silva, A. S., Pertille, A., Reis Barbosa, C. G., de Oliveira Silva, J. A., de Jesus, D. V., Ribeiro, A. G. S. V., de Oliveira, L. F., & Baganha, R. J. (2019). Effects of creatine supplementation on renal function: A systematic review and meta-analysis. Journal of Renal Nutrition, 29(6), 480–489. https://doi.org/10.1053/j.jrn.2019.03.004
Smith-Ryan, A. E., Cabre, H. E., Eckerson, J. M., & Candow, D. G. (2021). Creatine supplementation in women’s health: A lifespan perspective. Nutrients, 13(3), 877. https://doi.org/10.3390/nu13030877
Steenge, G. R., Lambourne, J., Casey, A., Macdonald, I. A., & Greenhaff, P. L. (1998). Stimulatory effect of insulin on creatine accumulation in human skeletal muscle. American Journal of Physiology-Endocrinology and Metabolism, 275(6), E974–E979. https://doi.org/10.1152/ajpendo.1998.275.6.E974
Steenge, G. R., Simpson, E. J., & Greenhaff, P. L. (2000). Protein- and carbohydrate-induced augmentation of whole body creatine retention in humans. Journal of Applied Physiology, 89(3), 1165–1171. https://doi.org/10.1152/jappl.2000.89.3.1165
Syrotuik, D. G., & Bell, G. J. (2004). Acute creatine monohydrate supplementation: A descriptive physiological profile of responders vs. nonresponders. Journal of Strength and Conditioning Research, 18(3), 610–617. https://doi.org/10.1519/12392.1
Tam, R., Mitchell, L., & Forsyth, A. (2025). Does creatine supplementation enhance performance in active females? A systematic review. Nutrients, 17(2), 238. https://doi.org/10.3390/nu17020238
Tarnopolsky, M. A., & MacLennan, D. P. (2000). Creatine monohydrate supplementation enhances high-intensity exercise performance in males and females. International Journal of Sport Nutrition and Exercise Metabolism, 10(4), 452–463. https://doi.org/10.1123/ijsnem.10.4.452
Vilar Neto, J. O., da Silva, C. A., Meneses, G. C., Pinto, D. V., Brito, L. C., da Cruz Fonseca, S. G., de Souza, J. E. R., de Castro, T. B., de Sousa, G. B., Silva, R. A. C., & de França, E. E. T. (2020). Novel renal biomarkers show that creatine supplementation is safe: A double-blind, placebo-controlled randomized clinical trial. Toxicology Research, 9(3), 263–270. https://doi.org/10.1093/toxres/tfaa028
Volek, J. S., Mazzetti, S. A., Farquhar, W. B., Barnes, B. R., & Kraemer, W. J. (2001). Physiological responses to short-term exercise in the heat after creatine loading. Medicine & Science in Sports & Exercise, 33(7), 1101–1108. https://doi.org/10.1097/00005768-200107000-00011
Wallimann, T., Wyss, M., Brdiczka, D., Nicolay, K., & Eppenberger, H. M. (1992). Intracellular compartmentation, structure and function of creatine kinase isoenzymes in tissues with high and fluctuating energy demands: The “phosphocreatine circuit” for cellular energy homeostasis. Biochemical Journal, 281(Pt 1), 21–40. https://doi.org/10.1042/bj2810021
Wax, B., Kerksick, C. M., Jagim, A. R., Mayo, J. J., Lyons, B. C., & Kreider, R. B. (2021). Creatine for exercise and sports performance, with recovery considerations for healthy populations. Nutrients, 13(6), 1915. https://doi.org/10.3390/nu13061915
Wu, G. (2020). Important roles of dietary taurine, creatine, carnosine, anserine and 4-hydroxyproline in human nutrition and health. Amino Acids, 52(3), 329–360. https://doi.org/10.1007/s00726-020-02823-6
Xu, C., Bi, S., Zhang, W., & Luo, L. (2024). The effects of creatine supplementation on cognitive function in adults: A systematic review and meta-analysis. Frontiers in Nutrition, 11, 1424972. https://doi.org/10.3389/fnut.2024.1424972
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Copyright (c) 2026 Adam Śmietana, Monika Białowąs, Weronika Białowąs, Michał Maćkowski, Sandra Balon, Kacper Piotr Urban, Piotr Szwed, Natalia Julia Sojka, Karolina Maria Dubiel, Jakub Jan Magnowski
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