Incidence and Prevalence of Acute Kidney Injury During Multistage Ultramarathons

Lipman, Grant S.; Krabak, Brian J.; Rundell, Sean D.; Shea, Katherine M.; Badowski, Natalie; Little, Colin

doi:10.1097/jsm.0000000000000253

Cited by 32 publications

(82 citation statements)

References 37 publications

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“…Because weight loss (a proxy for dehydration) was significantly associated with elevated Cr, we theorize that there is a pathophysiologic contribution of hypovolemia and subsequent decreased renal perfusion as the cause of AKI. This significant association has been previously observed in ultramarathons [7]. Our observed lack of significant association between NSAID use and development of AKI correlates with prior running-specific observational studies [7,14].…”

Section: Discussionsupporting

confidence: 74%

“…This significant association has been previously observed in ultramarathons [7]. Our observed lack of significant association between NSAID use and development of AKI correlates with prior running-specific observational studies [7,14].…”

Section: Discussionsupporting

confidence: 74%

“…We noted a greater prevalence of AKI in this adventure race (74%) compared to marathons (40%) [13] and single-stage ultramarathons (34%) [14] but similar to that seen in multistage ultramarathon runners (55-85%) [6][7]. This suggests that continuous multidiscipline events with relatively short running sections can generate similar renal stress to that generated by purely running events.…”

Section: Discussionmentioning

confidence: 50%

“…The presence of acute kidney injury (AKI) in athletes is a well-researched topic in multiple populations: healthy marathon race finishers [2][3], marathon racers seeking medical care [4][5], and ultramarathon race participants [6][7]. Renal dysfunction during endurance events is thought to be due to a multifactorial combination of dehydration, injury from muscle breakdown, heat stress, and the use of non-steroidal anti-inflammatory drugs (NSAIDs), although acute renal failure is rare in this population [8].…”

Section: Introductionmentioning

confidence: 99%

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Wetschler

Radler

Christensen

et al. 2017

Cureus

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

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Wetschler

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Christensen

et al. 2017

Cureus

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“…Temporal changes in GFR, plasma creatinine and plasma urea might lead to reduced renal functions in relation to natremic status (11) and may contribute to fluid overload with limited urinary excretion (11) in Case 2 and Case 3. In the study of Lipman et al (50), acute renal injury was more prevalent in females and significantly associated with greater body mass loss during multi-stage ultra-endurance marathons, even though women lost less body mass than men. However, the "risk of acute kidney injury" defined as 1.5 × baseline creatinine or "acute kidney injury" defined as 2 × creatinine or a clinically relevant decrease in renal functions defined as >25% decrease in GFR from baseline (58) was not observed in any of the athletes.…”

Section: Hematological Parameters Plasma Urea Plasma Creatinine Andmentioning

confidence: 99%

Description of Three Female 24-h Ultra-Endurance Race Winners in Various Weather Conditions and Disciplines

et al. 2017

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A The incidence of exercise-associated hyponatremia (EAH) is higher in women than in men. We present three cases of a very mild post-race EAH in female winners of three 24-h ultra races in various weather conditions and disciplines with post-race plasma sodium [Na] levels of 134 mM (Case 1), 133 mM (Case 2) and 134 mM (Case 3). Moreover, Case 1 and Case 2 showed elevated creatine kinase concentrations of >10,000 U/l with an absence of renal function abnormality. The common characteristics were female sex, veteran recreational category, long race experience in the particular sports discipline, excellent race performance, similar total weekly training hours and the presence of luteal phase of the menstrual cycle during the race. Hematocrit and hemoglobin decreased and post-race K/Na ratio in urine increased in all three cases. In addition, an increased body mass and a decreased urine specific gravity and urine osmolality suggested over-drinking in Case 1. A decrease in the glomerular filtration rate and creatine clearance accompanied by an increase in urine [Na] may contribute to fluid overload in Cases 2 and 3. Furthermore, urine osmolality reached a level indicating antidiuretic hormone secretion in all the present cases. Therefore, we recommend that race medical personnel should not forget to look for EAH even in fast and experienced female athletes and during races in different environmental conditions.

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Characteristics of runners meeting acute kidney injury criteria following a 161‐km ultramarathon

Khodaee

Irion²,

Spittler

et al. 2021

Translational Sports Med

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The incidence of acute kidney injury (AKI) associated with ultramarathon running is varied partially because onsite measurement of serum creatinine concentration (Cr) is rarely performed at races due to logistical challenges. We conducted a prospective observational study using blood samples from volunteer athletes before and immediately after the Leadville Trail 100 Run in August 2014. The goals of our study were to determine the incidence of those meeting the AKI criteria immediately following the ultramarathon race and to evaluate the utility of using medical equations to back‐calculate creatinine levels for runners without known baseline creatinine levels and to identify possible risk factors for developing AKI. We were able to collect pre‐race and post‐race blood samples on 64 and 84 volunteers, respectively. AKI was defined as a Cr increase (≥1.5 times or ≥0.3 mg/dl from baseline). Of the 37 runners for whom we had both pre‐ and post‐race blood samples, 18 (49%) met the criteria for AKI. Using two different methods of back‐calculating baseline estimated creatinine (a fixed eGFR [estimated glomerular filtration rate] and an aged‐based eGFR), 6 (16%) and 22 (59%) of 37 runners met the criteria for AKI, respectively. We found that there is no accurate way to estimate baseline Cr in this population.

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Incidence and Prevalence of Acute Kidney Injury During Multistage Ultramarathons

Abstract: Prevalence of AKI was 63%-78% during multistage ultramarathons. Female sex, lower pack weight, and greater weight loss were associated with renal impairment.

Cited by 32 publications

References 37 publications

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Description of Three Female 24-h Ultra-Endurance Race Winners in Various Weather Conditions and Disciplines

Characteristics of runners meeting acute kidney injury criteria following a 161‐km ultramarathon

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