Variation in renal responses to exercise in the heat with progressive acclimatisation

Omassoli, Jessica; Hill, Neil; Woods, David R.; Delves, Simon K.; Fallowfield, Joanne L.; Brett, Stephen; Wilson, David E.; Corbett, Richard; Allsopp, Adrian; Stacey, Michael

doi:10.1016/j.jsams.2019.04.010

Cited by 28 publications

(44 citation statements)

References 33 publications

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“…Omassoli et al suggested that limiting work intensity based on ratings of perceived exertion may be useful to prevent AKI [31]. However, our results indicate similar perceived exertion among individuals who met and did not meet the clinical biomarkers thresholds for AKI.…”

Section: Discussioncontrasting

confidence: 56%

“…Omassoli et al studied the impact of HA on clinical biomarkers of AKI during moderate intensity work in 27 • C Wet Bulb Globe Temperature, a slightly cooler environment than the current study [31]. Both studies used a duration of six days of HA to compare renal responses and found nearly identical responses of GFR and creatinine PreHA.…”

Section: Discussionmentioning

confidence: 72%

“…Increased clinical biomarkers of AKI (CLINICAL) were defined by two criteria: (1) the Kidney Disease Improving Global Outcomes criterion of an increase in serum creatinine ≥0.3 mg•dL −1 from pre-exercise [9] or (2) the Risk, Injury, Failure, Loss, Endstage Renal Disease criterion of a reduction in estimated glomerular filtration rate (eGFR) >25%, used in chronic kidney disease assessment [8]. These criteria were chosen due to their common use in clinical settings and use in similar previous research [31]. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation [38].…”

Section: Data Management and Statistical Analysismentioning

confidence: 99%

“…Nevertheless, this was the first study to report changes in clinical biomarkers of AKI in healthy collegiate athletes throughout HA. Second, Omassoli et al investigated changes in clinical biomarkers of AKI across a 23 days HA period [31]. HA reduced post-exercise serum creatinine and the number of individuals classified as having Stage I AKI during one hour of moderate intensity work in a warm environment.…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury Biomarker Responses to Short-Term Heat Acclimation

Pryor

Vandermark

et al. 2020

IJERPH

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The combination of hyperthermia, dehydration, and strenuous exercise can result in severe reductions in kidney function, potentially leading to acute kidney injury (AKI). We sought to determine whether six days of heat acclimation (HA) mitigates the rise in clinical biomarkers of AKI during strenuous exercise in the heat. Twenty men completed two consecutive 2 h bouts of high-intensity exercise in either hot (n = 12, 40 °C, 40% relative humidity) or mild (n = 8, 24 °C, 21% relative humidity) environments before (PreHA) and after (PostHA) 4 days of 90–120 min of exercise per day in a hot or mild environment. Increased clinical biomarkers of AKI (CLINICAL) was defined as a serum creatinine increase ≥0.3 mg·dL−1 or estimated glomerular filtration rate (eGFR) reduction >25%. Creatinine similarly increased in the hot environment PreHA (0.35 ± 0.23 mg·dL−1) and PostHA (0.39 ± 0.20 mg·dL−1), with greater increases than the mild environment at both time points (0.11 ± 0.07 mg·dL−1, 0.08 ± 0.06 mg·dL−1, p ≤ 0.001), respectively. CLINICAL occurred in the hot environment PreHA (n = 9, 75%), with fewer participants with CLINICAL PostHA (n = 7, 58%, p = 0.007), and no participants in the mild environment with CLINICAL at either time point. Percent change in plasma volume was predictive of changes in serum creatinine PostHA and percent changes in eGFR both PreHA and PostHA. HA did not mitigate reductions in eGFR nor increases in serum creatinine during high-intensity exercise in the heat, although the number of participants with CLINICAL was reduced PostHA.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 72%

Section: Data Management and Statistical Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury Biomarker Responses to Short-Term Heat Acclimation

Pryor

Vandermark

et al. 2020

IJERPH

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“…While the majority of our sample had activity readings in the moderate workload category, the association between higher workload and AKI suggests that workers who work multiple days in a row may incur injuries that compound across a working period. On the other hand, one study of AKI conducted in the lab during exercise in the heat showed that as participants were acclimated to exertion in the heat, subsequent elevations in serum creatinine were not as severe, due to the capacity of the kidneys for autoregulation . The importance of acclimatization cannot be understated in agricultural workers and is part of the NIOSH recommendations to prevent heat‐related illness in workers.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury and workload in a sample of California agricultural workers

Moyce

Armitage

Mitchell

et al. 2019

American J Industrial Med

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Background: Kidney damage is associated with an increased workload in high ambient temperatures and may represent a pathway to chronic kidney disease of unknown origin in agricultural workers. We tested the associations of workload and heat with acute kidney dysfunction in California agricultural workers. Methods:We recruited a convenience sample of 471 agricultural workers from 29 farms in California during two summer harvest seasons. The sustained 3-minute maximum workload was estimated using accelerometer data collected from Actical monitors and individual heat load through elevations in core body temperature. Acute kidney injury (AKI) was defined by a change in serum creatinine of ≥0.3 mg/dL or ≥1.5 times the preshift creatinine over the course of the work shift. Associations between AKI and workload were modeled using logistic regression, controlling for demographic, physiologic, and occupational variables.Results: Of the total, 357 workers (75.8%) had accelerometer readings in the moderate workload category, 93 (19.7%) had readings in the vigorous category. 177 (36%) had elevations of core body temperature ≥1°C; 72 workers (14.9%) demonstrated evidence of AKI after a single day of agricultural work. The workload category was associated with an increased adjusted odds of AKI (1.92; 95% confidence interval, 1.05-3.51). Piece-rate work was also associated with increased adjusted odds of AKI (3.02; 95% CI, 1.44-6.34).Conclusions: Heavy occupational workload and piece-rate work were associated with acute effects on the renal health of agricultural workers. This indicates that occupations requiring high physical effort put workers at risk for AKI, possibly independent of ambient and core body temperature. Changes to agricultural practices may reduce the risk of renal disorders for these workers.

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Physiological mechanisms of the impact of heat during pregnancy and the clinical implications: review of the evidence from an expert group meeting

et al. 2022

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Many populations experience high seasonal temperatures. Pregnant women are considered vulnerable to extreme heat because ambient heat exposure has been linked to pregnancy complications including preterm birth and low birthweight. The physiological mechanisms that underpin these associations are poorly understood. We reviewed the existing research evidence to clarify the mechanisms that lead to adverse pregnancy outcomes in order to inform public health actions. A multi-disciplinary expert group met to review the existing evidence base and formulate a consensus regarding the physiological mechanisms that mediate the effect of high ambient temperature on pregnancy. A literature search was conducted in advance of the meeting to identify existing hypotheses and develop a series of questions and themes for discussion. Numerous hypotheses have been generated based on animal models and limited observational studies. There is growing evidence that pregnant women are able to appropriately thermoregulate; however, when exposed to extreme heat, there are a number of processes that may occur which could harm the mother or fetus including a reduction in placental blood flow, dehydration, and an inflammatory response that may trigger preterm birth. There is a lack of substantial evidence regarding the processes that cause heat exposure to harm pregnant women. Research is urgently needed to identify what causes the adverse outcomes in pregnancy related to high ambient temperatures so that the impact of climate change on pregnant women can be mitigated.

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Variation in renal responses to exercise in the heat with progressive acclimatisation

Cited by 28 publications

References 33 publications

Acute Kidney Injury Biomarker Responses to Short-Term Heat Acclimation

Acute Kidney Injury Biomarker Responses to Short-Term Heat Acclimation

Acute kidney injury and workload in a sample of California agricultural workers

Physiological mechanisms of the impact of heat during pregnancy and the clinical implications: review of the evidence from an expert group meeting

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