CureusEvaluating the Safety of Creatine Monohydrate in Adolescents: A Systematic Review of Renal, Hepatic, and Cardiometabolic Outcomes

⚠️ Small Study / Early Comparative Evidence
A PRISMA-guided systematic review of five studies published 2015-2025 found creatine monohydrate was generally well tolerated in adolescent and physically active pediatric populations, with no serious adverse events attributed to supplementation across renal, hepatic, and cardiometabolic domains.

Clinical Considerations

• Across three RCTs and two cohort studies, no clinically meaningful changes were observed in serum creatinine, eGFR, or liver enzymes within reported follow-up periods.
• Long-term cardiometabolic data derived from a 7-year cohort showed no associations with hypertension, dyslipidemia, diabetes, or elevated BMI, though exposure was self-reported and not specific to creatine monotherapy.
• Study populations were heterogeneous, including adolescents with SSRI-resistant depression and juvenile dermatomyositis, limiting generalizability to healthy adolescent athletes.
• Authors flagged over-the-counter supplement quality variability as a real-world consideration not captured in controlled trials.

Practice Applications

• Recognize the evidence base as limited to five heterogeneous studies with short interventional follow-up.
• Interpret elevated serum creatinine in supplemented adolescents cautiously, as creatine intake itself can raise creatinine without renal dysfunction.
• Counsel families about variability in commercial supplement purity and dosing accuracy.
• Avoid extrapolating these findings to long-term safety in healthy adolescent athletes pending larger prospective trials.

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