Four Cases of Acute Kidney Injury Requiring Dialysis in Ultramarathoners

Abstract

Transient acute kidney injury (AKI) following ultraendurance footraces is a common biochemical diagnosis. However, severe AKI requiring renal replacement therapy is uncommon in ultramarathoners. We report 4 runners (3 men; mean age, 44 ± 3 y) who required prolonged (10-42 d) dialysis following the Western States 100 Mile Endurance Run over a 3-y span (0.38% of starters). The maximum ambient temperatures on the race day ranged from 36.6 • to 38.3 • C. The runners presented to local hospitals 17 to 32 h after running, with laboratories confirming rhabdomyolysis, hyponatremia (mean serum sodium concentration, 127±2 mmol⋅L -1 ), and AKI (mean serum creatinine concentration, 8.5±2 mg⋅dL -1 ). The case-cluster report highlights the potential synergistic effects of high ambient temperatures, muscle damage, and electrolyte imbalance on protracted renal dysfunction in ultramarathoners competing in a warming world.

Insult of Ultraendurance Events on Blood Pressure: A Systematic Review and Meta-Analysis

“…Decreased renal perfusion in exercise is a physiological change, not necessarily an indicator of renal damage [48]. However, when considering the characteristic increase in various serum markers in this athlete population, such as the increases in creatine kinase and myoglobin, the loss of renal perfusion may contribute to renal damage and a decreased glomerular filtration rate [49,50].…”

Ultraendurance Sports: A Call to Action

“…Medically, of interest, is acute kidney injury and a recent case report finds the potential catastrophic effects of warming temperatures, muscle damage, and electrolyte imbalance on renal failure in ultramarathoners. This imbalance calls to action medical social work expertise, eco-social work futures, and climate interventions (Pasternak et al, 2023). Nutrition, especially for amateur ultramarathoners, is an important field to contribute to.…”