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

Khodaee, Morteza; Irion, Bjørn; Spittler, Jack; Saeedi, Anahita; Hoffman, Martin D.

doi:10.1002/tsm2.276

Cited by 4 publications

(13 citation statements)

References 38 publications

(66 reference statements)

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“…These selected articles were fully reviewed and evaluated to verify whether they met the inclusion criteria. A total of 28 articles were accepted for final review, 13 of which focused on AKI ( Table 1 ) [ 28 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ] and the remaining 15 on EAH ( Table 2 ) [ 24 , 27 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]. Nine of the studies reported combined results of AKI and EAH [ 24 , 27 , 28 , 44 , 45 , 49 , 51 , 52 , 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…The one-stage category included races ranging from 45 to 217 km. Single-stage races were classified into three different groups according to length [ 5 ]: 14 extra-long races (≥100 km) [ 24 , 44 , 47 , 50 , 51 , 52 , 53 , 54 , 57 , 58 , 59 , 62 , 64 , 66 , 67 ], 3 long ones (70–99 km) [ 27 , 28 , 45 ] and 8 medium ones (>42.195–69 km) [ 44 , 47 , 49 , 54 , 55 , 60 , 64 , 65 ]. The cumulative elevation gains and losses ranged between 645 m [ 59 ] and 12,000 m [ 51 ].…”

Section: Resultsmentioning

confidence: 99%

“…AKI cases were classified according to severity using the AKIN, KDIGO or RIFLE criteria [ 31 , 33 ]. AKI cases were distributed as follows: 392 subjects met the risk-stage criteria (35.22%) [ 16 , 44 , 45 , 46 , 47 , 49 , 50 , 52 , 54 ], 75 subjects suffered AKI in the injury stage (6.73%) [ 24 , 28 , 42 , 46 , 48 , 53 ] and only one subject met the criteria for failure (0.01%), but he did not require renal replacement therapy. This case occurred in a 95-mile ultra-trail [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

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Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review

et al. 2022

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Background and objectives: Ultra-trail races can cause episodes of acute kidney injury (AKI) and exercise-associated hyponatremia (EAH) in healthy subjects without previous renal pathology. This systematic review aims to review the incidence of these two syndromes together and separately taking into account the length and elevation of the ultra-trail race examined. Materials and Methods: A systematic review was conducted through electronic search in four electronic databases (PubMed, EBSCO, Web of Science and Alcorze). Results: A total of 1127 articles published between January 2006 and December 31, 2021 were included, 28 of which met the inclusion criteria. The studies were categorized according to the length and stages of the race in four categories: medium (42 to 69 km), long (70 to 99 km), extra (>100 km) and multi-stage if they included various stages. A total of 2950 runners (666 females and 2284 males) were extracted from 28 publications. The AKI incidence found was 42.04% (468 cases of 1113), and 195 of 2065 were diagnosed with EAH, accounting for 9.11%. The concurrence of both pathologies together reached 11.84% (27 individuals) from a total of 228 runners with AKI and EAH simultaneously analyzed. Sorted by race category, the AKI+EAH cases were distributed as follows: 18 of 27 in the extra (13.63% and n = 132), 4 in the large (5.79% and n = 69) and 5 in the medium category (18.15% and n = 27). Conclusions: According to these results, extra and medium races showed a similar incidence of AKI+EAH. These findings underline the importance of the duration and intensity of the race and may make them responsible for the etiology of these medical conditions. Due to their variable incidence, EAH and AKI are often underdiagnosed, leading to poorer prognosis, increased condition seriousness and hindered treatment. The results of this review urge participants, coaches and race organizers to take measures to improve the early diagnosis and urgent treatment of possible EAH and AKI cases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review

et al. 2022

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“…In the last few years, several studies have focused on studying acute kidney injury (AKI) after performing a physically demanding exercise ( Lipman et al, 2014 ; Traiperm et al, 2016 ; Mansour et al, 2017 ; González et al, 2019 ; Rojas-Valverde et al, 2019 ; Poussel et al, 2020 ; Khodaee et al, 2021 ). Contrary to other acute pathological alterations, renal function has been shown to be normalized 24 h after running a long-distance race.…”

Section: Introductionmentioning

confidence: 99%

“…Contrary to other acute pathological alterations, renal function has been shown to be normalized 24 h after running a long-distance race. As a result, the collection of biomarkers related to AKI have been usually restricted to the running phase ( Lipman et al, 2014 ; Belli et al, 2018 ) or to the first 24 h of the recovery phase ( McCullough et al, 2011 ; Traiperm et al, 2016 ; Mansour et al, 2017 ; Khodaee et al, 2021 ). However, we observed that glomerular filtration rate (GFR) significantly worsened 48 h after marathon running ( González et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Renal Function Recovery Strategies Following Marathon in Amateur Runners

et al. 2022

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Long distance races have a physiological impact on runners. Up to now, studies analyzing these physiological repercussions have been mainly focused on muscle and cardiac damage, as well as on its recovery. Therefore, a limited number of studies have been done to explore acute kidney failure and recovery after performing extreme exercises. Here, we monitored renal function in 76 marathon finishers (14 females) from the day before participating in a marathon until 192 h after crossing the finish line (FL). Renal function was evaluated by measuring serum creatinine (sCr) and the glomerular filtration rate (GFR). We randomly grouped our cohort into three intervention groups to compare three different strategies for marathon recovery: total rest (REST), continuous running at their ventilatory threshold 1 (VT1) intensity (RUN), and elliptical workout at their VT1 intensity (ELLIPTICAL). Interventions in the RUN and ELLIPTICAL groups were performed at 48, 96, and 144 h after marathon running. Seven blood samples (at the day before the marathon, at the FL, and at 24, 48, 96, 144, and 192 h post-marathon) and three urine samples (at the day before the marathon, at the finish line, and at 48 h post-marathon) were collected per participant. Both heart rate monitors and triaxial accelerometers were used to control the intensity effort during both the marathon race and the recovery period. Contrary to our expectations, the use of elliptical machines for marathon recovery delays renal function recovery. Specifically, the ELLIPTICAL group showed a significantly lower ∆GFR compared to both the RUN group (p = 4.5 × 10−4) and the REST group (p = 0.003). Hence, we encourage runners to carry out an active recovery based on light-intensity continuous running from 48 h after finishing the marathon. In addition, full resting seems to be a better strategy than performing elliptical workouts.

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Incidence of exercise-associated hyponatremia during a high-altitude 161-km ultramarathon

Khodaee

Saeedi²,

Harris-Spinks

et al. 2021

Phys Act Nutr

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[Purpose] Exercise-associated hyponatremia (EAH) is a well-known condition among endurance athletes at low altitudes. The incidence of EAH during ultramarathons at high altitudes warrants further investigation. This prospective observational study was conducted on the participants of the Leadville Trail 100 run, a 161- km race held at a high altitude (2,800 m-3,840 m).[Methods] Venous blood samples were collected before and immediately after the race. The participants completed an electronic survey after the race. Our main outcome measure was the post-race serum sodium ([Na+]) level.[Results] Of the 672 athletes who started the race, 351 (52%) successfully completed the event within the 30- hour cut-off. Post-race blood samples were collected from 84 runners (66 finishers). Both pre- and post-race blood samples were collected from 37 participants. Twenty percent of the post-race participants had EAH. Only one post-race participant had a [Na+] level of <130 mmol/L. All participants with EAH were asymptomatic. One participant had an abnormal pre-race [Na+] level (134 mmol/L). Female participants had a significantly higher rate of EAH than male participants (40% vs. 16%; p=0.039). Age, body mass index, weight changes, race completion status, nonsteroidal anti-inflammatory drug use, and urine specific gravity were not associated with the development of EAH. Lower postrace [Na+] levels were associated with higher serum creatine kinase values (R2=0.1, p<0.005).[Conclusion] High altitude (3,840 m peak) does not appear to enhance the incidence of EAH after an ultramarathon footrace. This suggests that ambient temperature (low temperatures reduce risk), sex (female predilection), endurance running, and overhydration are more prominent risk factors for EAH than high altitude.

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

Cited by 4 publications

References 38 publications

Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review

Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review

Renal Function Recovery Strategies Following Marathon in Amateur Runners

Incidence of exercise-associated hyponatremia during a high-altitude 161-km ultramarathon

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