A Prospective Cohort Study of Acute Kidney Injury in Multi-stage Ultramarathon Runners: The Biochemistry in Endurance Runner Study (BIERS)

Lipman, Grant S.; Krabak, Brian J.; Waite, Brandee; Logan, Sarah B.; Menon, Anil; Chan, Garrett K.

doi:10.1080/15438627.2014.881824

Cited by 52 publications

(76 citation statements)

References 15 publications

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“…Estimating normal baseline serum electrolyte values in healthy runners is a well-established practice in ultramarathon research 2–4. It was unlikely there were spuriously elevated values from using an estimated baseline creatinine from the beginning of a mid-race stage as these Cr have been found to be similar to measured pre-race levels 2. Data from the four events were combined into a single cohort for analysis as each race had similar lengths and demands and grouped data between events is a common practice 3 25…”

Section: Discussionmentioning

confidence: 99%

Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial

et al. 2017

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BackgroundDespite concerns that non-steroidal anti-inflammatory drugs (NSAIDs) contribute to acute kidney injury (AKI), up to 75% of ultramarathon runners ingest these during competition. The effect of NSAID on AKI incidence in ultramarathon runners is unclear.MethodsMultisite randomised double-blind placebo-controlled trial in the Gobi, Atacama, Ecuador and Sri Lankan deserts to determine whether ibuprofen (400 mg every 4 hours) would be non-inferior to placebo during a 50-mile (80 km) foot race. The primary outcome was incidence of AKI defined as severity categories of ‘risk’ of injury of 1.5× baseline creatinine (Cr) or ‘injury’ as 2× Cr, combined to calculate total incidence at the finish line. Non-inferiority margin for difference in AKI rates was defined as 15%.ResultsEighty-nine participants (47% ibuprofen and 53% placebo) were enrolled with similar demographics between groups. The overall incidence of AKI was 44%. Intent-to-treat analysis found 22 (52%) ibuprofen versus 16 (34%) placebo users developed AKI (18% difference, 95% CI –4% to 41%; OR 2.1, 95% CI 0.9 to 5.1) with a number needed to harm of 5.5. Greater severity of AKI was seen with ibuprofen compared with placebo (risk=38% vs 26%; 95% CI –9% to 34%; injury=14% vs 9%; 95% CI –10% to 21%). Slower finishers were less likely to encounter AKI (OR 0.67, 95% CI 0.47 to 0.98) and greater weight loss (−1.3%) increased AKI (OR 1.24, 95% CI 1.00 to 1.63).ConclusionThere were increased rates of AKI in those who took ibuprofen, and although not statistically inferior to placebo by a small margin, there was a number needed to harm of 5.5 people to cause 1 case of AKI. Consideration should therefore be taken before ingesting NSAID during endurance running as it could exacerbate renal injury.Trial registration numberNCT02272725.

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Section: Discussionmentioning

confidence: 99%

Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial

et al. 2017

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“…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%

Biochemistry in Endeavor Adventure Racers Study (BEARS)

Wetschler

Radler

Christensen

et al. 2017

Cureus

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Background: Adventure sports events consist of a combination of two or more endurance disciplines, such as orienteering, running, and rock climbing, that range from a day’s to a week’s duration. No studies have examined acute kidney injury (AKI) in adventure sports athletes.Objectives: To describe the prevalence of AKI in participants in the Endeavor Team Challenge, a 30-hour, 40-mile adventure race.Methods: In this prospective observational study, body weights were recorded at race registration. At the finish line, blood sample results by point-of-care testing and weights were recorded. Changes in serum creatinine (Cr) from an estimated baseline value and severity of AKI were calculated, with “risk of injury” defined as 1.5 x baseline Cr, and “injury” defined as 2 x baseline Cr. These two categories of AKI were combined to calculate the total prevalence. Results: There were 88 enrolled study participants with complete data available on 46 (52%). The mean age of those enrolled in the study was 36.8 years (+/- 7.7), 90% were males, and body mass index (BMI) was 25.7 kg/m2 (+/- 2.4). Of the competitors who completed the study, 34 (73%) had some degree of AKI, with 27 (58%) found to be at "risk" and seven (15%) with "injury". There was a significant correlation between weight loss and elevated Cr (r = -0.29, p = 0.047), with a trend towards nonsteroidal anti-inflammatory drug (NSAID) use being correlated with AKI (p = 0.058).Conclusion: Acute kidney injury was observed in the majority of the Endeavor Team Challenge adventure racers, similar to what has been observed in multistage ultramarathons, and greater than after standard marathons and single-stage ultramarathons.

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“…In general, it appears that resting kidney function normalizes relatively rapidly after the stress of marathon [32] and ultramarathon distance running events [33], even when the criteria for acute kidney injury have been met. Furthermore, kidney dysfunction does not seem to accumulate over the course of multistage events [33].…”

Section: Kidney Injurymentioning

confidence: 98%

“…Furthermore, kidney dysfunction does not seem to accumulate over the course of multistage events [33]. However, while resting kidney function may appear normal, it is not clear if kidney function recovers to fully accommodate the stress from subsequent ultra-endurance exercise after a prior kidney injury or repetitive episodes of injury.…”

Section: Kidney Injurymentioning

confidence: 99%

Special Considerations in Medical Screening for Participants in Remote Endurance Events

et al. 2015

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As participation at remote endurance events increases, so does the need to screen participants for potentially problematic medical conditions, but this process has been ill-defined to date. This article aims to outline a general approach to screening and discusses common or important medical conditions that may need consideration in the screening process. Medical conditions that are considered low risk may translate to high-risk conditions in the setting of a remote and austere location. Medical directors of remote endurance events should have a familiarity with assessing risks and applying informed consent principles to participation. While there are no specific standards on medical disqualification from an event based on medical history alone, several systematic considerations should be made that allow for an assessment of risk to an individual for a specific event. The medical director and event director, in discussion with the athlete and treating clinician when appropriate, should come to a consensus on participation when high-risk medical conditions become apparent during the screening process. Both modifications and accommodations to participation may be used to mitigate both clinical and medicolegal risk and allow for participation.

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A Prospective Cohort Study of Acute Kidney Injury in Multi-stage Ultramarathon Runners: The Biochemistry in Endurance Runner Study (BIERS)

Cited by 52 publications

References 15 publications

Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial

Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial

Biochemistry in Endeavor Adventure Racers Study (BEARS)

Special Considerations in Medical Screening for Participants in Remote Endurance Events

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