Background Investigation into strenuous activity and kidney function has gained interest given increasing marathon participation. Study Design Prospective observational study Setting & Participants Runners participating in the 2015 Hartford Marathon Predictor Completing a marathon Outcomes Acute kidney injury (AKI) as defined by AKI Network (AKIN) criteria. Stage 1 AKI was defined as 1.5- to 2-fold or 0.3 mg/dL increase in serum creatinine within 48 hours of day 0 and stage 2 was defined as a > 2- to 3-fold increase in creatinine. Microscopy score was defined by the number of granular casts and renal tubular epithelial cells. Measurements Samples were collected 24 hours pre-marathon (Day 0), immediately post- marathon (Day 1) and 24 hours post-marathon (Day 2). Measurements of serum creatinine, creatine kinase, and urine albumin were completed as well as urine microscopy analysis. Six injury urine biomarkers (IL-6, IL-8, IL-18, kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, and tumor necrosis factor α) and two repair urine biomarkers (YKL-40 and monocyte chemoattractant protein 1) were measured. Results 22 marathon runners were included. Mean age was 44 years and 41% were male. 82% of runners developed a rise in creatinine equivalent to AKIN-defined AKI stages 1 and 2. 73% had microscopy diagnoses of tubular injury. Serum creatinine, urine albumin, and injury and repair biomarkers peaked on Day 1 and were significantly elevated compared to Day 0 and Day 2. Serum creatine kinase levels continued to significantly rise from Day 0 to Day 2. Limitations Small sample size and limited clinical data available at all time points. Conclusions Marathon runners developed AKI and urine sediments diagnostic of tubular injury. Rise in injury and repair biomarkers suggests structural damage to renal tubules occurring after marathon. The results of our study should be validated in larger cohorts with longer follow-up of kidney function.

The CREATE-ECLA Randomized Controlled TrialThe CREATE-ECLA Trial Group Investigators* See also pp 427 and 489.

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