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Pasternak AV, Newkirk-Thompson C, Howard JH, Onate JC, Hew-Butler T. Four Cases of Acute Kidney Injury Requiring Dialysis in Ultramarathoners. Wilderness Environ Med 2023; 34:218-221. [PMID: 36805094 DOI: 10.1016/j.wem.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/01/2022] [Accepted: 12/14/2022] [Indexed: 02/17/2023]
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.
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Affiliation(s)
- Andrew V Pasternak
- Silver Sage Center for Family Medicine, Reno School of Medicine, University of Nevada, Reno, NV.
| | | | | | - John C Onate
- University of California Davis School of Medicine, Sacramento, CA
| | - Tamara Hew-Butler
- Division of Kinesiology, Health and Sport Studies, Wayne State University, Detroit, MI
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Tidmas V, Brazier J, Bottoms L, Muniz D, Desai T, Hawkins J, Sridharan S, Farrington K. Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16887. [PMID: 36554767 PMCID: PMC9779673 DOI: 10.3390/ijerph192416887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Increasingly popular, ultra-endurance participation exposes athletes to extremely high levels of functional and structural damage. Ultra-endurance athletes commonly develop acute kidney injury (AKI) and other pathologies harmful to kidney health. There is strong evidence that non-steroidal anti-inflammatory drugs, common amongst ultra-athletes, is linked to increased risk and severity of AKI and potentially ischaemic renal injury, i.e., acute tubular necrosis. Ultra-endurance participation also increases the risk of exertional rhabdomyolysis, exercise-associated hyponatremia, and gastrointestinal symptoms, interlinked pathologies all with potential to increase the risk of AKI. Hydration and fuelling both also play a role with the development of multiple pathologies and ultimately AKI, highlighting the need for individualised nutritional and hydration plans to promote athlete health. Faster athletes, supplementing nitrates, and being female also increase the risk of developing AKI in this setting. Serum creatinine criteria do not provide the best indicator for AKI for ultra-athletes therefore further investigations are needed to assess the practicality and accuracy of new renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL). The potential of recurring episodes of AKI provide need for further research to assess the longitudinal renal health impact of ultra-participation to provide appropriate advice to athletes, coaches, medical staff, and event organisers.
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Affiliation(s)
- Victoria Tidmas
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Jon Brazier
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Lindsay Bottoms
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Daniel Muniz
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Terun Desai
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Janine Hawkins
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Sivakumar Sridharan
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
- Renal Unit, Lister Hospital, East and North Herts Trust, Stevenage SG1 4AB, UK
| | - Ken Farrington
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
- Renal Unit, Lister Hospital, East and North Herts Trust, Stevenage SG1 4AB, UK
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Rojas-Valverde D, Martínez-Guardado I, Sánchez-Ureña B, Timón R, Scheer V, Pino-Ortega J, Olcina G. Outpatient Assessment of Mechanical Load, Heat Strain and Dehydration as Causes of Transitional Acute Kidney Injury in Endurance Trail Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910217. [PMID: 34639516 PMCID: PMC8508486 DOI: 10.3390/ijerph181910217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022]
Abstract
Background: This study aimed to globally assess heat strain, dehydration, and mechanical load as acute kidney injury (AKI) indicators in amateur endurance trail athletes during a 35.3 km run. Methods: Thirty amateur experienced trail runners completed an endurance trail run (total positive ascend 1815 m). The following assessments were performed at four measurement time points (pre-, during, immediately post [-post0h], and after 24 h of the finish of the run [-post24h]): serum test (creatinine, blood ureic nitrogen, albumin, creatine kinase, blood ureic nitrogen: creatinine ratio, creatinine clearance, and glomerular filtration rate), mechanical load (impacts and Player Load), heat strain and dehydration (hematocrit, urine solids, body weight and urine specific gravity), pain and exertion perception (rate of perceived exertion, lumbar and bipodal, and one-leg squat pain), and urinalysis (pH, protein, glucose, erythrocytes, and urine specific gravity). Results: There were pre vs. post0h changes in all serum biomarkers (F = 5.4–34.45, p < 0.01). The change in these biomarkers correlated with an increase in mechanical load indicators (r = 0.47–59, p < 0.05). A total of 40% and 23.4% of participants presented proteinuria and hematuria, respectively. Pain and perceived exertion increased significantly due to effort made during the endurance trail running (F = 4.2–176.4, p < 0.01). Conclusions: Endurance trail running may lead to an increase in blood and urine indicators of transitional AKI. The difference in blood and urine markers was significantly related to the mechanical load during running, suggesting potential kidney overload and cumulative mechanical load.
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Affiliation(s)
- Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 86-3000, Costa Rica
- Clínica de Lesiones Deportivas (Rehab & Readapt), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional de Costa Rica, Heredia 86-3000, Costa Rica
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain; (R.T.); (G.O.)
- Correspondence: (D.R.-V.); (I.M.-G.); Tel.: +506-88250219 (D.R.-V.)
| | - Ismael Martínez-Guardado
- Faculty of Life and Natural Sciences, University of Nebrija, 28015 Madrid, Spain
- Correspondence: (D.R.-V.); (I.M.-G.); Tel.: +506-88250219 (D.R.-V.)
| | - Braulio Sánchez-Ureña
- Programa de Ciencias del Ejercicio y la Salud, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia 86-3000, Costa Rica;
| | - Rafael Timón
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain; (R.T.); (G.O.)
| | - Volker Scheer
- Ultra Sports Science Foundation, 69310 Pierre-Bénite, France;
| | - José Pino-Ortega
- Biovetmed & Sportsci Research Group, University of Murcia, 30720 San Javier, Spain;
| | - Guillermo Olcina
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain; (R.T.); (G.O.)
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Anemia in Sports: A Narrative Review. Life (Basel) 2021; 11:life11090987. [PMID: 34575136 PMCID: PMC8472039 DOI: 10.3390/life11090987] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 12/12/2022] Open
Abstract
Recent years have brought about new understandings regarding the pathogenesis of anemia in sports. From hemodilution and redistribution considered to contribute to the so-called “sports anemia” to iron deficiency caused by increased demands, dietary restrictions, decreased absorption, increased losses, hemolysis, and sequestration, to genetic determinants of different types of anemia (some related to sport), the anemia in athletes deserves a careful and multifactorial approach. Dietary factors that reduce iron absorption (e.g., phytate, polyphenols) and that augment iron’s bioavailability (e.g., ascorbic acid) should be considered. Celiac disease, more prevalent in female athletes, may underlie an unexplained iron deficiency anemia. Iron loss during exercise occurs in several ways: sweating, hematuria, gastrointestinal bleeding, inflammation, and intravascular and extravascular hemolysis. From a practical point of view, assessing iron status, especially in the athletes at risk for iron deficiency (females, adolescents, in sports with dietary restrictions, etc.), may improve the iron balance and possibly the performance. Hemoglobin and serum ferritin are measures that are easily employable for the evaluation of patients’ iron status. Cutoff values should probably be further assessed with respect to the sex, age, and type of sport. A healthy gut microbiome influences the iron status. Athletes at risk of iron deficiency should perform non-weight-bearing, low-intensity sports to avoid inducing hemolysis.
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Sharma A, Tok AIY, Alagappan P, Liedberg B. Point of care testing of sports biomarkers: Potential applications, recent advances and future outlook. Trends Analyt Chem 2021. [DOI: 10.1016/j.trac.2021.116327] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Khodaee M, Irion B, Spittler J, Saeedi A, Hoffman MD. Characteristics of runners meeting acute kidney injury criteria following a 161‐km ultramarathon. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine & Orthopedics University of Colorado School of Medicine Denver USA
| | - Bjørn Irion
- Western Orthopedics and Sports Medicine Grand Junction CO USA
| | - Jack Spittler
- Department of Family Medicine & Orthopedics University of Colorado School of Medicine Denver USA
| | - Anahita Saeedi
- Department of Biostatistics School of Public Health & Health Sciences University of Massachusetts Amherst MA USA
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Pradas F, Falcón D, Peñarrubia-Lozano C, Toro-Román V, Carrasco L, Castellar C. Effects of Ultratrail Running on Neuromuscular Function, Muscle Damage and Hydration Status. Differences According to Training Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5119. [PMID: 34065969 PMCID: PMC8150532 DOI: 10.3390/ijerph18105119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 12/19/2022]
Abstract
The status of trail running races has exponentially grown in recent years. The present study aimed to: (a) evaluate the acute response of ultratrail racing in terms of neuromuscular function, muscle damage and hydration status; (b) analyze if responses could differ according to training levels. Twenty runners participated in the present study. The participants were divided into amateur training level (n = 10; 43.30 ± 4.52 years) or high level competitors (n = 10; 41.40 ± 6.18). Neuromuscular response (squat jump, countermovement jump and Abalakov jump), muscle damage (alanine aminotransferase, bilirubin, creatine kinase and leukocytes) and hydration status (sodium and creatinine) were evaluated before and after the Guara Somontano Ultratrail Race (108 km distance, with an accumulated slope of 5800 m). The height and power achieved by vertical jumps were lower after the race (p < 0.001). The post-race muscle damage and creatinine parameters increased in both groups (p < 0.001). The high-level group obtained lower percentages of change in squat jump and countermovement jump than the amateur-level group (p < 0.05). However, the increase in creatinine was greater for the high-level group (p < 0.05). Ultratrail racing reduces neuromuscular function and increases muscle damage. High-level runners showed less neuromuscular fatigue compared to amateur ones.
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Affiliation(s)
- Francisco Pradas
- ENFYRED Research Group, Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain; (F.P.); (D.F.); (C.P.-L.); (C.C.)
- Department of Corporal Expression, Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain
| | - David Falcón
- ENFYRED Research Group, Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain; (F.P.); (D.F.); (C.P.-L.); (C.C.)
- Department of Corporal Expression, Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain
| | - Carlos Peñarrubia-Lozano
- ENFYRED Research Group, Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain; (F.P.); (D.F.); (C.P.-L.); (C.C.)
- Department of Corporal Expression, Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain
| | - Víctor Toro-Román
- School of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain
| | - Luis Carrasco
- BIOFANEX Research Group, Department of Physical Education and Sport, Faculty of Education Sciences, University of Seville, 41004 Seville, Spain;
| | - Carlos Castellar
- ENFYRED Research Group, Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain; (F.P.); (D.F.); (C.P.-L.); (C.C.)
- Department of Corporal Expression, Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain
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Abstract
Participation in ultramarathons continues to grow, especially among older individuals and among younger runners who may have less running and wilderness experience than many past participants. While ultramarathons tend to have relatively few serious medical issues, adverse medical incidents do occur. These factors make it increasingly important that appropriate safety precautions and medical support are defined and implemented at these events to enhance the safety of participants, spectators, and volunteers. This document establishes the minimum recommended level of medical support that should be available at ultramarathons based on current knowledge and the experience of the authors. It offers a balance that is intended to avoid excessive stress on the local medical system while also precluding undue burden on events to provide medical support beyond that which is practical. We propose a three-level classification system to define the extent of medical services, personnel, systems, supplies, and equipment in place and recommend the level of medical support based on event size, distance/duration, remoteness, and environmental conditions that may be encountered during the event. This document also outlines the recommended education and training of medical providers and discusses other medical and logistical considerations related to the provision of medical support at ultramarathons. We suggest that ultramarathon organizers review and adopt these recommendations to enhance safety and reduce the risk of adverse events to participants.
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Khodaee M, Saeedi A, Irion B, Spittler J, Hoffman MD. Proteinuria in a high-altitude 161-km (100-mile) ultramarathon. PHYSICIAN SPORTSMED 2021; 49:92-99. [PMID: 32529961 DOI: 10.1080/00913847.2020.1782153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Urine dipstick analysis (UDA) is a useful tool in clinical practices. Abnormalities in UDA parameters have been observed as a result of extreme exercise. The exact incidence of UDA abnormalities, particularly proteinuria, as the result of running ultramarathons is unknown. The purpose of this study was to estimate the incidence of proteinuria and to identify the characteristics of those with proteinuria. METHODS We conducted a prospective observational study using urine samples from volunteer athletes before and immediately after the Leadville Trail 100 Run in August 2014. There were 33 runners with both pre-race and post-race samples and a total of 70 provided post-race samples. Demographic information was collected as a part of a larger study. RESULTS At least one abnormality was demonstrated in 89% of post-race urine samples. Twenty-one (30%) runners had post-race proteinuria (≥1+). Serum creatine kinase concentration (CK) was the only variable that was significantly correlated with the incidence of proteinuria in a multiple logistic regression model. CONCLUSION A majority of runners developed abnormalities in their UDA. Proteinuria was common and found to be associated with serum CK concentration.
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Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine & Orthopedics, University of Colorado School of Medicine , Denver, CO, USA
| | - Anahita Saeedi
- Department of Biostatistics, Shahid Beheshti University , Tehran, Iran
| | - Bjørn Irion
- Western Orthopedics and Sports Medicine , Grand Junction, CO, USA
| | - Jack Spittler
- Department of Family Medicine & Orthopedics, University of Colorado School of Medicine , Denver, CO, USA
| | - Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, University of California Davis , Sacramento, CA, USA
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Adetunji AE, Ayenale M, Akhigbe I, Akerele LO, Isibor E, Idialu J, Aideloje FO, Emuebonam E, Aire C, Adomeh DI, Odia I, Atafo RO, Okonofua MO, Owobu A, Ogbaini-Emovon E, Tobin EA, Asogun DA, Okogbenin SA, Sabeti P, Happi CT, Günther S, Azubuike CO, Rafiu M, Odike A, Olomu SC, Ibadin MO, Okokhere PO, Akpede GO. Acute kidney injury and mortality in pediatric Lassa fever versus question of access to dialysis. Int J Infect Dis 2020; 103:124-131. [PMID: 33176203 DOI: 10.1016/j.ijid.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To assess the prevalence of acute kidney injury (AKI), and its impact on outcome in hospitalized pediatric patients with Lassa fever (LF). METHODS We reviewed the presenting clinical and laboratory features and outcomes of 40 successive hospitalized children with PCR-confirmed LF. The diagnosis and staging of AKI was based on KDIGO criteria. We compared groups of patients using t- or χ2 tests as necessary, and took p-values <0.05 as indicative of the presence of significant differences. RESULTS Sixteen (40%) children had AKI. Case fatality rate (CFR) was 9/16 (56%) in children with and 1/24 (4%) in those without AKI (OR [95% CI] of CFR associated with AKI = 29.57 [3.17, 275.7]). Presentation with abnormal bleeding (p = 0.008), encephalopathy (p = 0.004), hematuria plus proteinuria (p = 0.013), and elevated serum transaminase levels (p <0.02) were significantly associated with an increased prevalence of AKI. CONCLUSION AKI prevalence in hospitalized pediatric patients with Lassa fever is high, and correlated with illness severity/CFR. The high prevalence underscores the need for access to hemodialysis, and clinical presentation and/or presence of hematuria plus proteinuria could serve as a ready prompt for referral for such specialized care.
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Affiliation(s)
- Adewale E Adetunji
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Magdalene Ayenale
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Irene Akhigbe
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Lilian O Akerele
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Efosa Isibor
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Juliet Idialu
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Florence O Aideloje
- Department of Nursing Services, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ekene Emuebonam
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Chris Aire
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Donatus I Adomeh
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ikponmwosa Odia
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Rebecca O Atafo
- Nursing Services Unit, Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Martha O Okonofua
- Nursing Services Unit, Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Adaugo Owobu
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ephraim Ogbaini-Emovon
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ekaete A Tobin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Danny A Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvanus A Okogbenin
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Pardis Sabeti
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | - Christian T Happi
- Department of Biological Sciences and African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria
| | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, and German Center for Infection Research (DZIF), Partner site Hamburg - Lübeck - Borstel - Riems, Germany
| | | | - Mojeed Rafiu
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Angela Odike
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvia C Olomu
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Michael O Ibadin
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Peter O Okokhere
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - George O Akpede
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
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Rojas-Valverde D, Olcina G, Sánchez-Ureña B, Pino-Ortega J, Martínez-Guardado I, Timón R. Proteinuria and Bilirubinuria as Potential Risk Indicators of Acute Kidney Injury during Running in Outpatient Settings. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:medicina56110562. [PMID: 33120965 PMCID: PMC7692335 DOI: 10.3390/medicina56110562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Background and objectives: The purpose of this study was to explore which urinary markers could indicate acute kidney injury (AKI) during prolonged trail running in outpatient settings. Materials and Methods: Twenty-nine experienced trail runners (age 39.1 ± 8.8 years, weight 71.9 ± 11 kg, height 171.9 ± 8.3 cm) completed a 35 km event (cumulative positive ascend of 1815 m, altitude = 906 to 1178 m.a.s.l.) under a temperature of 25.52 ± 1.98 °C and humidity of 79.25 ± 7.45%). Two participant groups (AKI = 17 and No-AKI = 12) were made according to AKI diagnosis criteria based on pre- and post-race values of serum creatinine (sCr) (an increase of 1.5 times from baseline). Blood and urinalysis were performed immediately pre- and post-race. Results: Pre- vs. post-race differences in sCr and sBUN were found in both AKI and No-AKI groups (p < 0.01). Differences in post-race values were found between groups (p = 0.03). A total of 52% of AKI runners presented significant increases in proteinuria (χ2 = 0.94, p = 0.01) and 47% in bilirubinuria (χ2 = 0.94, p = 0.04). Conversely, No-AKI participants presented no significant increases in urine markers. Conclusions: These study’s findings may suggest the potential use of urinalysis as an accessible alternative in the outpatient setting to early identify transitional AKI until a clinical confirmation is performed.
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Affiliation(s)
- Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 86-3000, Costa Rica
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10005 Cáceres, Spain;
- Correspondence: (D.R.-V.); (G.O.); (R.T.); Tel.: +506-8825-0219 (D.R.-V.)
| | - Guillermo Olcina
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10005 Cáceres, Spain;
- Correspondence: (D.R.-V.); (G.O.); (R.T.); Tel.: +506-8825-0219 (D.R.-V.)
| | - Braulio Sánchez-Ureña
- Programa Ciencias del Ejercicio y la Salud (PROCESA), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 86-3000, Costa Rica;
| | - José Pino-Ortega
- Departmento de Actividad Física y Deporte, Facultad Ciencias del Deporte, 30720 Murcia, Spain;
| | - Ismael Martínez-Guardado
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10005 Cáceres, Spain;
| | - Rafael Timón
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10005 Cáceres, Spain;
- Correspondence: (D.R.-V.); (G.O.); (R.T.); Tel.: +506-8825-0219 (D.R.-V.)
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Chapman CL, Johnson BD, Parker MD, Hostler D, Pryor RR, Schlader Z. Kidney physiology and pathophysiology during heat stress and the modification by exercise, dehydration, heat acclimation and aging. Temperature (Austin) 2020; 8:108-159. [PMID: 33997113 PMCID: PMC8098077 DOI: 10.1080/23328940.2020.1826841] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
The kidneys' integrative responses to heat stress aid thermoregulation, cardiovascular control, and water and electrolyte regulation. Recent evidence suggests the kidneys are at increased risk of pathological events during heat stress, namely acute kidney injury (AKI), and that this risk is compounded by dehydration and exercise. This heat stress related AKI is believed to contribute to the epidemic of chronic kidney disease (CKD) occurring in occupational settings. It is estimated that AKI and CKD affect upwards of 45 million individuals in the global workforce. Water and electrolyte disturbances and AKI, both of which are representative of kidney-related pathology, are the two leading causes of hospitalizations during heat waves in older adults. Structural and physiological alterations in aging kidneys likely contribute to this increased risk. With this background, this comprehensive narrative review will provide the first aggregation of research into the integrative physiological response of the kidneys to heat stress. While the focus of this review is on the human kidneys, we will utilize both human and animal data to describe these responses to passive and exercise heat stress, and how they are altered with heat acclimation. Additionally, we will discuss recent studies that indicate an increased risk of AKI due to exercise in the heat. Lastly, we will introduce the emerging public health crisis of older adults during extreme heat events and how the aging kidneys may be more susceptible to injury during heat stress.
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Affiliation(s)
- Christopher L. Chapman
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Blair D. Johnson
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Mark D. Parker
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - David Hostler
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, USA
| | - Riana R. Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, USA
| | - Zachary Schlader
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA
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de Souza RF, Augusto RL, de Moraes SRA, de Souza FB, Gonçalves LVDP, Pereira DD, Moreno GMM, de Souza FMA, Andrade-da-Costa BLDS. Ultra-Endurance Associated With Moderate Exercise in Rats Induces Cerebellar Oxidative Stress and Impairs Reactive GFAP Isoform Profile. Front Mol Neurosci 2020; 13:157. [PMID: 32982688 PMCID: PMC7492828 DOI: 10.3389/fnmol.2020.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/29/2020] [Indexed: 12/11/2022] Open
Abstract
Ultra-endurance (UE) race has been associated with brain metabolic changes, but it is still unknown which regions are vulnerable. This study investigated whether high-volume training in rodents, even under moderate intensity, can induce cerebellar oxidative and inflammatory status. Forty-five adult rats were divided into six groups according to a training period, followed or not by an exhaustion test (ET) that simulated UE: control (C), control + ET (C-ET), moderate-volume (MV) training and MV-ET, high-volume training (HV) and HV-ET. The training period was 30 (MV) and 90 (HV) min/day, 5 times/week for 3 months as a continuous running on a treadmill at a maximum velocity of 12 m/min. After 24 h, the ET was performed at 50% maximum velocities up to the animals refused to run, and then serum lactate levels were evaluated. Serum and cerebellar homogenates were obtained 24 h after ET. Serum creatine kinase (CK), lactate dehydrogenase (LDH), and corticosterone levels were assessed. Lipid peroxidation (LP), nitric oxide (NO), Interleukin 1β (IL-1β), and GFAP proteins, reduced and oxidized glutathione (GSH and GSSG) levels, superoxide dismutase (SOD) and catalase (CAT) activities were quantified in the cerebellum. Serum lactate concentrations were lower in MV-ET (∼20%) and HV-ET (∼40%) compared to the C-ET group. CK and corticosterone levels were increased more than ∼ twofold by HV training compared to control. ET increased CK levels in MV-ET vs. MV group (P = 0.026). HV induced higher LP levels (∼40%), but an additive effect of ET was only seen in the MV-ET group (P = 0.02). SOD activity was higher in all trained groups vs. C and C-ET (P < 0.05). CAT activity, however, was intensified only in the MV group (P < 0.02). The 50 kDa GFAP levels were enhanced in C-ET and MV-ET vs. respective controls, while 42 kDa (∼40%) and 39 kDa (∼26%) isoform levels were reduced. In the HV-ET group, the 50 KDa isoform amount was reduced ∼40-60% compared to the other groups and the 39 KDa isoform, increased sevenfold. LDH levels, GSH/GSSG ratio, and NO production were not modified. ET elevated IL-1β levels in the CT and MV groups. Data shows that cerebellar resilience to oxidative damage may be maintained under moderate-volume training, but it is reduced by UE running. High-volume training per se provoked systemic metabolic changes, cerebellar lipid peroxidation, and unbalanced enzymatic antioxidant resource. UE after high-volume training modified the GFAP isoform profile suggesting impaired astrocyte reactivity in the cerebellum.
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Affiliation(s)
- Raphael Fabricio de Souza
- Laboratory of Neurophysiology, Department of Physiology and Pharmacology, Center of Biosciences, Federal University of Pernambuco, Recife, Brazil
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil
- Department of Physical Education, Federal University of Sergipe, São Cristovão, Brazil
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports – GEPEPS, Federal University of Sergipe, São Cristovão, Brazil
| | - Ricielle Lopes Augusto
- Laboratory of Neurophysiology, Department of Physiology and Pharmacology, Center of Biosciences, Federal University of Pernambuco, Recife, Brazil
| | - Silvia Regina Arruda de Moraes
- Laboratory of Neuromuscular Plasticity, Department of Anatomy, Center of Biosciences, Federal University of Pernambuco, Recife, Brazil
| | - Fabio Borges de Souza
- Laboratory of Neurophysiology, Department of Physiology and Pharmacology, Center of Biosciences, Federal University of Pernambuco, Recife, Brazil
| | - Lílian Vanessa da Penha Gonçalves
- Laboratory of Neurophysiology, Department of Physiology and Pharmacology, Center of Biosciences, Federal University of Pernambuco, Recife, Brazil
| | - Danielle Dutra Pereira
- Laboratory of Neurophysiology, Department of Physiology and Pharmacology, Center of Biosciences, Federal University of Pernambuco, Recife, Brazil
| | - Gisele Machado Magalhães Moreno
- Laboratory of Neurophysiology, Department of Physiology and Pharmacology, Center of Biosciences, Federal University of Pernambuco, Recife, Brazil
| | - Fernanda Maria Araujo de Souza
- Laboratory of Neuropharmacology and Integrative Physiology, Center of Biosciences, Federal University of Alagoas, Maceió, Brazil
| | - Belmira Lara da Silveira Andrade-da-Costa
- Laboratory of Neurophysiology, Department of Physiology and Pharmacology, Center of Biosciences, Federal University of Pernambuco, Recife, Brazil
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil
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Hsu P, Lin K, Hsu P, Kao WF, Hsu Y, Liu H. Prediction of acute kidney injury during the prerace stage of a 48‐hour ultramarathon. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Po‐Ya Hsu
- Department of Computer Science and Engineering University of California San Diego CA USA
| | - Kuan‐Yu Lin
- Department of Nursing Central Taiwan University of Science and Technology Taichung Taiwan
| | - Po‐Han Hsu
- Department of Computer Science and Engineering University of California San Diego CA USA
| | - Wei Fong Kao
- Department of Emergency Medicine Taipei Medical University Taipei Taiwan
| | - Yi‐Chung Hsu
- Department of Nurse Practitioner Fu Jen Catholic University Hospital Taipei Taiwan
| | - Hsin‐Li Liu
- Department of Nursing Central Taiwan University of Science and Technology Taichung Taiwan
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Schlader ZJ, Hostler D, Parker MD, Pryor RR, Lohr JW, Johnson BD, Chapman CL. The Potential for Renal Injury Elicited by Physical Work in the Heat. Nutrients 2019; 11:nu11092087. [PMID: 31487794 PMCID: PMC6769672 DOI: 10.3390/nu11092087] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
An epidemic of chronic kidney disease (CKD) is occurring in laborers who undertake physical work in hot conditions. Rodent data indicate that heat exposure causes kidney injury, and when this injury is regularly repeated it can elicit CKD. Studies in humans demonstrate that a single bout of exercise in the heat increases biomarkers of acute kidney injury (AKI). Elevations in AKI biomarkers in this context likely reflect an increased susceptibility of the kidneys to AKI. Data largely derived from animal models indicate that the mechanism(s) by which exercise in the heat may increase the risk of AKI is multifactorial. For instance, heat-related reductions in renal blood flow may provoke heterogenous intrarenal blood flow. This can promote localized ischemia, hypoxemia and ATP depletion in renal tubular cells, which could be exacerbated by increased sodium reabsorption. Heightened fructokinase pathway activity likely exacerbates ATP depletion occurring secondary to intrarenal fructose production and hyperuricemia. Collectively, these responses can promote inflammation and oxidative stress, thereby increasing the risk of AKI. Equivalent mechanistic evidence in humans is lacking. Such an understanding could inform the development of countermeasures to safeguard the renal health of laborers who regularly engage in physical work in hot environments.
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Affiliation(s)
- Zachary J Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA.
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN 47405, USA.
| | - David Hostler
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Mark D Parker
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - James W Lohr
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Blair D Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Christopher L Chapman
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
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Chlíbková D, Žákovská A, Rosemann T, Knechtle B, Bednář J. Body Composition Changes During a 24-h Winter Mountain Running Race Under Extremely Cold Conditions. Front Physiol 2019; 10:585. [PMID: 31139095 PMCID: PMC6527803 DOI: 10.3389/fphys.2019.00585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/26/2019] [Indexed: 12/20/2022] Open
Abstract
Background: To date, no study has focused on body composition characteristics and on parameters associated with skeletal muscle damage and renal function in runners participating in a 24-h winter race held under extremely cold environmental conditions (average temperature of -14.3°C). Methods: Anthropometric characteristics, plasma urea (PU), plasma creatinine (Pcr), creatine kinase (CK), plasma volume (PV) and total body water (TBW) were assessed pre- and post-race in 20 finishers (14 men and 6 women). Results: In male runners, body mass (BM) (p = 0.003) and body fat (BF) (p = 0.001) decreased [-1.1 kg (-1.4%) and -1.1 kg (-13.4%), respectively]; skeletal muscle mass (SM) and TBW remained stable (p > 0.05). In female runners, BF decreased (p = 0.036) [-1.3 kg (-7.8%)] while BM, SM and TBW remained stable (p > 0.05). The change (Δ) in BM was not related to Δ BF; however, Δ BM was related to Δ SM [r = 0.58, p = 0.007] and Δ TBW (r = 0.59, p = 0.007). Δ SM correlated with Δ TBW (r = 0.51, p = 0.021). Moreover, Δ BF was negatively associated with Δ SM (r = -0.65, p = 0.002). PV (p < 0.001), CK (p < 0.001), Pcr (p = 0.004) and PU (p < 0.001) increased and creatinine clearance (CrCl) decreased (p = 0.002). The decrease in BM was negatively related to the increase in CK (r = -0.71, p < 0.001). Δ Pcr was positively related to Δ PU (r = 0.64, p = 0.002). The decrease in CrCl was negatively associated with the increase in both PU (r = -0.72, p < 0.001) and CK (r = -0.48, p = 0.032). Conclusion: The 24-h running race under extremely cold conditions led to a significant BF decrease, whereas SM and TBW remained stable in both males and females. Nevertheless, the increase in CK, Pcr and PU was related to the damage of SM with transient impaired renal function.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czechia
| | - Alena Žákovská
- Institute of Experimental Biology, Masaryk University, Brno, Czechia
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Josef Bednář
- Institute of Mathematics, Brno University of Technology, Brno, Czechia
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Little CE, Lipman GS, Migliaccio D, Young DS, Krabak BJ. Accuracy of Estimated Creatinine in Multistage Ultramarathon Runners. Wilderness Environ Med 2019; 30:129-133. [PMID: 30872022 DOI: 10.1016/j.wem.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Ultramarathon running is increasing in popularity worldwide, as is the growing body of research on these athletes. Multiple studies have examined acute kidney injury through estimated baseline creatinine (Cr) and glomerular filtration rate (GFR). Values are estimated through an age-based formula of GFR and the modification of diet in renal disease (MDRD) equation. However, the accuracy of this practice in a cohort of healthy athletes is unknown. METHODS A prospective analysis of the first 40-km (25-mi) stage of 6-stage 250-km (155-mi) multistage ultramarathons in the Sahara, Namibia, Atacama, and Gobi Deserts. Runners had prerace measured baseline Cr compared to estimated values through age-based estimated GFR and back calculation of Cr through the MDRD equation. RESULTS Forty-eight participants (27% female, age 39±10 y) had Cr values analyzed. The mean measured Cr was 0.99±0.17, which was 11% higher than an estimated Cr of 0.88±0.14 (P<0.01). Estimated age-based GFR was 95.9±5.8 mL⋅min-1 compared to GFR based on measured Cr and MDRD of 86.1±14.6 (P<0.001). CONCLUSIONS Estimated values of GFR and Cr by standard age-based values and MDRD equation were significantly inaccurate, which would overinflate the incidence of acute kidney injury. Future studies should devise a new model for estimation of baseline Cr that is validated in this population.
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Affiliation(s)
- Colin E Little
- University of Utah Division of Emergency Medicine, Salt Lake City, UT.
| | | | - Daniel Migliaccio
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David S Young
- Department of Emergency Medicine, University of Colorado, Denver, CO
| | - Brian J Krabak
- Department of Sports Medicine, University of Washington, Seattle, WA
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YAMAGATA TETSUYUKI, SAKURABA KEISHOKU. Changes in Urine Components and Characteristics During a 415-km Mountain Ultra-Marathon. JUNTENDO IJI ZASSHI 2019. [DOI: 10.14789/jmj.2019.65.jmj19-oa03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- TETSUYUKI YAMAGATA
- Department of Sports Medicine, Juntendo University Graduate School of Medicine
- Department of Physical Therapy, Japanese School of Technology for Social Medicine
| | - KEISHOKU SAKURABA
- Department of Sports Medicine, Juntendo University Graduate School of Medicine
- Department of Sports Medicine, Juntendo University Faculty of Health and Sports Science
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Hoffman MD. Predicted Risk for Exacerbation of Exercise-Associated Hyponatremia from Indiscriminate Postrace Intravenous Hydration of Ultramarathon Runners. J Emerg Med 2018; 56:177-184. [PMID: 30545731 DOI: 10.1016/j.jemermed.2018.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Asymptomatic or mildly symptomatic exercise-associated hyponatremia (EAH) can be exacerbated by aggressive hydration. OBJECTIVE This work predicts the percentage of athletes at risk for exacerbation of EAH from indiscriminate hydration after an ultramarathon. METHODS Postrace serum sodium, creatinine, creatine kinase (CK), and urea nitrogen concentrations were determined for 161-km ultramarathon participants. Body mass was measured prior to and immediately after the race. Incidents when serum CK was > 20,000 U/L or creatinine ≥ 1.5 times estimated baseline were considered to be "at risk for receiving I.V. hydration" if presenting to a hospital. Those with EAH without body mass loss during the race were considered "overhydrated" and "at risk for EAH exacerbation." RESULTS Among 627 finishers, 16 (2.6%) were at risk for EAH exacerbation. Considering 421 observations at risk for receiving I.V. hydration, 16 (47.1%) of the 34 observations with EAH were at risk for EAH exacerbation. Among those at risk for receiving I.V. hydration and with EAH, serum urea nitrogen and creatine concentration as a multiple of estimated baseline were lower (p < 0.05) for those at risk for EAH exacerbation, compared with those without overhydration, but there were no clinically useful laboratory findings to distinguish these two groups due to considerable overlap of values. CONCLUSIONS Whether in the field or hospital setting, I.V. hydration of an athlete after an ultramarathon carries a notable risk for exacerbating EAH, so clinicians should use caution when hydrating athletes after endurance events.
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Affiliation(s)
- Martin D Hoffman
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, California; University of California Davis Medical Center, Sacramento, California; Ultra Sports Science Foundation, El Dorado Hills, California
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Belli T, Macedo DV, de Araújo GG, Dos Reis IGM, Scariot PPM, Lazarim FL, Nunes LAS, Brenzikofer R, Gobatto CA. Mountain Ultramarathon Induces Early Increases of Muscle Damage, Inflammation, and Risk for Acute Renal Injury. Front Physiol 2018; 9:1368. [PMID: 30349484 PMCID: PMC6186806 DOI: 10.3389/fphys.2018.01368] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose: This study aimed to investigate changes in muscle damage during the course of a 217-km mountain ultramarathon (MUM). In an integrative perspective, inflammatory response and renal function were also studied. Methods: Six male ultra-runners were tested four times: pre-race, at 84 km, at 177 km, and immediately after the race. Blood samples were analyzed for serum muscle enzymes, acute-phase protein, cortisol, and renal function biomarkers. Results: Serum creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) increased significantly throughout the race (P < 0.001, P < 0.001; P = 0.002, respectively), and effect size (ES) denoted a large magnitude of muscle damage. These enzymes increased from pre-race (132 ± 18, 371 ± 66, and 28 ± 3 U/L, respectively) to 84 km (30, 1.8, and 3.9-fold, respectively); further increased from 84 to 177 km (4.6, 2.9, and 6.1-fold, respectively), followed by a stable phase until the finish line. Regarding the inflammatory response, significant differences were found for C-reactive protein (CRP) (P < 0.001) and cortisol (P < 0.001). CRP increased from pre-race (0.9 ± 0.3 mg/L) to 177 km (243-fold), cortisol increased from pre-race (257 ± 30 mmol/L) to the 84 km (2.9-fold), and both remained augmented until the finish line. Significant changes were observed for creatinine (P = 0.03), urea (P = 0.001), and glomerular filtration rate (GFR) (P < 0.001), and ES confirmed a moderate magnitude of changes in renal function biomarkers. Creatinine and urea increased, and GFR decreased from pre-race (1.00 ± 0.03 mg/dL, 33 ± 6 mg/dL, and 89 ± 5 ml/min/1.73 m2, respectively) to 84 km (1.3, 3.5, and 0.7-fold, respectively), followed by a plateau phase until the finish line. Conclusion: This study shows evidence that muscle damage biomarkers presented early peak levels and they were followed by a plateau phase during the last segment of a 217-km MUM. The acute-phase response had a similar change of muscle damage. In addition, our data showed that our volunteers meet the risk criteria for acute kidney injury from 84 km until they finished the race, without demonstrating any clinical symptomatology.
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Affiliation(s)
- Taisa Belli
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
| | - Denise Vaz Macedo
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, Brazil
| | - Gustavo Gomes de Araújo
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
| | | | - Pedro Paulo Menezes Scariot
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
| | - Fernanda Lorenzi Lazarim
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, Brazil
| | - Lázaro Alessandro Soares Nunes
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, Brazil
| | - René Brenzikofer
- Laboratory of Instrumentation for Biomechanics (LIB), Faculty of Physical Education, University of Campinas, Campinas, Brazil
| | - Claudio Alexandre Gobatto
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
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Knechtle B, Nikolaidis PT. Physiology and Pathophysiology in Ultra-Marathon Running. Front Physiol 2018; 9:634. [PMID: 29910741 PMCID: PMC5992463 DOI: 10.3389/fphys.2018.00634] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
In this overview, we summarize the findings of the literature with regards to physiology and pathophysiology of ultra-marathon running. The number of ultra-marathon races and the number of official finishers considerably increased in the last decades especially due to the increased number of female and age-group runners. A typical ultra-marathoner is male, married, well-educated, and ~45 years old. Female ultra-marathoners account for ~20% of the total number of finishers. Ultra-marathoners are older and have a larger weekly training volume, but run more slowly during training compared to marathoners. Previous experience (e.g., number of finishes in ultra-marathon races and personal best marathon time) is the most important predictor variable for a successful ultra-marathon performance followed by specific anthropometric (e.g., low body mass index, BMI, and low body fat) and training (e.g., high volume and running speed during training) characteristics. Women are slower than men, but the sex difference in performance decreased in recent years to ~10–20% depending upon the length of the ultra-marathon. The fastest ultra-marathon race times are generally achieved at the age of 35–45 years or older for both women and men, and the age of peak performance increases with increasing race distance or duration. An ultra-marathon leads to an energy deficit resulting in a reduction of both body fat and skeletal muscle mass. An ultra-marathon in combination with other risk factors, such as extreme weather conditions (either heat or cold) or the country where the race is held, can lead to exercise-associated hyponatremia. An ultra-marathon can also lead to changes in biomarkers indicating a pathological process in specific organs or organ systems such as skeletal muscles, heart, liver, kidney, immune and endocrine system. These changes are usually temporary, depending on intensity and duration of the performance, and usually normalize after the race. In longer ultra-marathons, ~50–60% of the participants experience musculoskeletal problems. The most common injuries in ultra-marathoners involve the lower limb, such as the ankle and the knee. An ultra-marathon can lead to an increase in creatine-kinase to values of 100,000–200,000 U/l depending upon the fitness level of the athlete and the length of the race. Furthermore, an ultra-marathon can lead to changes in the heart as shown by changes in cardiac biomarkers, electro- and echocardiography. Ultra-marathoners often suffer from digestive problems and gastrointestinal bleeding after an ultra-marathon is not uncommon. Liver enzymes can also considerably increase during an ultra-marathon. An ultra-marathon often leads to a temporary reduction in renal function. Ultra-marathoners often suffer from upper respiratory infections after an ultra-marathon. Considering the increased number of participants in ultra-marathons, the findings of the present review would have practical applications for a large number of sports scientists and sports medicine practitioners working in this field.
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Affiliation(s)
- Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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Abstract
Zusammenfassung. Wir stellen die wichtigsten Erkenntnisse zu Organschädigungen durch einen Ultramarathon zusammen. Nach einem Ultramarathon können kardiale Biomarker wie CK, CK-MB, kardiales Troponin I (cTnI) und N-terminales pro-Brain Natriuretic Peptide (NT-pro BNP) erhöht sein. Bis 80 % und mehr der Finisher klagen über Verdauungsprobleme, die einer der Hauptgründe sind, einen Ultramarathon nicht zu finishen. Bis zu 90 % der Läufer, die einen Ultramarathon aufgeben, klagen über Übelkeit. Nach einem Ultramarathon steigen die Leberwerte oft an, schwerwiegende Konsequenzen bleiben meist aus. Risikofaktoren für eine Einschränkung der Nierenfunktion sind eine ausgeprägte Muskelschädigung mit Rhabdomyolyse, Dehydratation, Hypotonie, Hyperurikämie, Hyponatriämie, geringe Wettkampferfahrung sowie die Einnahme von NSARs. Ultraläufer leiden nach einem Ultramarathon oft an Infekten der oberen Atemwege.
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Affiliation(s)
- Beat Knechtle
- 1 Medbase St. Gallen
- 2 Institut für Hausarztmedizin, Universität Zürich
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Chlíbková D, Nikolaidis PT, Rosemann T, Knechtle B, Bednář J. Fluid Metabolism in Athletes Running Seven Marathons in Seven Consecutive Days. Front Physiol 2018; 9:91. [PMID: 29483882 PMCID: PMC5816349 DOI: 10.3389/fphys.2018.00091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/26/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose: Hypohydration and hyperhydration are significant disorders of fluid metabolism in endurance performance; however, little relevant data exist regarding multi-stage endurance activities. The aim of the present study was to examine the effect of running seven marathons in 7 consecutive days on selected anthropometric, hematological and biochemical characteristics with an emphasis on hydration status. Methods: Participants included 6 women and 20 men (age 42.6 ± 6.2 years). Data was collected before day 1 (B1) and after day 1 (A1), 4 (A4), and 7 (A7). Results: The average marathon race time was 4:44 h:min (ranging from 3:09 – 6:19 h:min). Plasma sodium, plasma potassium and urine sodium were maintained during the race. Body mass (p < 0.001, η2 = 0.501), body fat (p < 0.001, η2 = 0.572) and hematocrit (p < 0.001, η2 = 0.358) decreased. Plasma osmolality (Posm) (p < 0.001, η2 = 0.416), urine osmolality (Uosm) (p < 0.001, η2 = 0.465), urine potassium (p < 0.001, η2 = 0.507), urine specific gravity (Usg) (p < 0.001, η2 = 0.540), plasma urea (PUN) (p < 0.001, η2 = 0.586), urine urea (UUN) (p < 0.001, η2 = 0.532) and transtubular potassium gradient (p < 0.001, η2 = 0.560) increased at A1, A4, and A7 vs. B1. Posm correlated with PUN at A1 (r = 0.59, p = 0.001) and A4 (r = 0.58, p = 0.002). The reported post-race fluid intake was 0.5 ± 0.2 L/h and it correlated negatively with plasma [Na+] (r = −0.42, p = 0.007) at A4 and (r = −0.50, p = 0.009) at A7. Uosm was associated with UUN at A1 (r = 0.80, p < 0.001), at A4 (r = 0.81, p < 0.001) and at A7 (r = 0.86, p < 0.001) and with Usg (r = 0.71, p < 0.001) at A1, (r = 0.52, p = 0.006) at A4 and (r = 0.46, p = 0.02) at A7. Conclusions: Despite the decrease in body mass, fluid and electrolyte balance was maintained with no decrease in plasma volume after running seven marathons in seven consecutive days. Current findings support the hypothesis that body mass changes do not reflect changes in the hydration status during prolonged exercise.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czechia
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Josef Bednář
- Faculty of Mechanical Engineering, Brno University of Technology, Brno, Czechia
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Lipman GS, Shea K, Christensen M, Phillips C, Burns P, Higbee R, Koskenoja V, Eifling K, Krabak BJ. Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial. Emerg Med J 2017; 34:637-642. [PMID: 28679502 DOI: 10.1136/emermed-2016-206353] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite 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. METHODS Multisite 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%. RESULTS Eighty-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). CONCLUSION There 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 NUMBER NCT02272725.
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Affiliation(s)
- Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kate Shea
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mark Christensen
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Caleb Phillips
- Department of Computational Sciences, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Patrick Burns
- Emergency Medicine Residency, University of Washington, Seattle, USA
| | - Rebecca Higbee
- Stanford-Kaiser Emergency Medicine Residency, Stanford, USA
| | - Viktoria Koskenoja
- Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, USA
| | - Kurt Eifling
- Washington University in St. Louis Emergency Medicine Residency, St. Louis, USA
| | - Brian J Krabak
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, USA
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Hodgson LE, Walter E, Venn RM, Galloway R, Pitsiladis Y, Sardat F, Forni LG. Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review. BMJ Open Sport Exerc Med 2017; 3:e000093. [PMID: 29259804 PMCID: PMC5731225 DOI: 10.1136/bmjsem-2015-000093] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/23/2016] [Accepted: 03/26/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION A growing body of evidence suggests even small rises in serum creatinine (SCr) are of considerable clinical relevance. Given that participants in endurance events are exposed to potential (repeated) renal insults, a systematic review was undertaken to collate current evidence for acute kidney injury (AKI), complicating such events. METHODS A systematic review of studies and case reports meeting inclusion criteria on Medline and EMBASE (inception to October 2015). Included: studies with markers of renal function before and after endurance or ultraendurance events; case reports of severe AKI. Two reviewers assessed risk of bias using the Newcastle-Ottawa scale. RESULTS Eleven case report publications (n=27 individuals) of severe AKI, were retrieved, with risk factors including systemic illness or nephrotoxic medications usually identified. From 30 studies of endurance and ultraendurance events, mean rise in SCr was 29 (±12.3) µmol/L after marathon or ultramarathon (17 studies, n=568 participants) events. Where follow-up tests were conducted, SCr returned to baseline within 48 hours. Rises in biomarkers suggest potential parenchymal insult, rather than simply muscle breakdown. However, evidence of long-term deleterious effects is lacking. CONCLUSIONS Raised levels of SCr are reported immediately after endurance events. It is not clear whether this is either clinically significant, or if repeated participation predisposes to long-term sequelae. The aetiology of severe exercise-associated AKI is usually multifactorial, with risk factors generally identified in the rare cases reported. On-site biochemistry, urine analysis and biomarkers of AKI may help identify collapsed runners who are at significant short-term risk and allow suitable follow-up.
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Affiliation(s)
- LE Hodgson
- Department of Anaesthesia, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK
| | - E Walter
- Department of Emergency Medicine, Royal Sussex County Hospital, East Sussex, UK
| | - RM Venn
- Department of Anaesthesia, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK
| | - R Galloway
- Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - Y Pitsiladis
- Department of Emergency Medicine, Royal Sussex County Hospital, East Sussex, UK
| | - F Sardat
- Department of Intensive Care, Surrey Peri-operative Anaesthesia Critical care collaborative Research group (SPACeR), Royal Surrey County Hospital, Surrey, UK
| | - LG Forni
- Department of Emergency Medicine, Royal Sussex County Hospital, East Sussex, UK
- The centre for sport and exercise science and medicine (SESAME), Sport and Service Management, Eastbourne, UK
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Hoffman MD, Valentino TR, Stuempfle KJ, Hassid BV. A Placebo-Controlled Trial of Riboflavin for Enhancement of Ultramarathon Recovery. SPORTS MEDICINE-OPEN 2017; 3:14. [PMID: 28349501 PMCID: PMC5368102 DOI: 10.1186/s40798-017-0081-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/16/2017] [Indexed: 11/23/2022]
Abstract
Background Riboflavin is known to protect tissue from oxidative damage but, to our knowledge, has not been explored as a means to control exercise-related muscle soreness. This study investigated whether acute ingestion of riboflavin reduces muscle pain and soreness during and after completion of a 161-km ultramarathon and improves functional recovery after the event. Methods In this double-blind, placebo-controlled trial, participants of the 2016 161-km Western States Endurance Run were assigned to receive a riboflavin or placebo capsule shortly before the race start and when reaching 90 km. Capsules contained either 100 mg of riboflavin or 95 mg of maltodextrin and 5 mg of 10% ß-carotene. Subjects provided muscle pain and soreness ratings before, during, and immediately after the race and for the 10 subsequent days. Subjects also completed 400-m runs at maximum speed on days 3, 5, and 10 after the race. Results For the 32 (18 in the riboflavin group, 14 in the placebo group) race finishers completing the study, muscle pain and soreness ratings during and immediately after the race were found to be significantly lower (p = .043) for the riboflavin group. Analysis of the 400-m run times also showed significantly faster (p < .05) times for the riboflavin group than the placebo group at post-race days 3 and 5. Both groups showed that muscle pain and soreness had returned to pre-race levels by 5 days after the race and that 400-m run times had returned to pre-race performance levels by 10 days after the race. Conclusions This preliminary work suggests that riboflavin supplementation before and during prolonged running might reduce muscle pain and soreness during and at the completion of the exercise and may enhance early functional recovery after the exercise.
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Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, USA. .,Ultra Sports Science Foundation, El Dorado Hills, CA, USA.
| | - Taylor R Valentino
- Department of Kinesiology, San Francisco State University, San Francisco, CA, USA
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Adherence to Follow-Up Recommendations by Triathlon Competitors Receiving Event Medical Care. Emerg Med Int 2017; 2017:1375181. [PMID: 28203462 PMCID: PMC5288540 DOI: 10.1155/2017/1375181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/28/2016] [Accepted: 01/04/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction. We sought to investigate triathlete adherence to recommendations for follow-up for participants who received event medical care. Methods. Participants of the 2011 Ironman Syracuse 70.3 (Syracuse, NY) who sought evaluation and care at the designated finish line medical tent were contacted by telephone approximately 3 months after the initial encounter to measure adherence with the recommendation to seek follow-up care after event. Results. Out of 750 race participants, 35 (4.6%) athletes received event medical care. Of these 35, twenty-eight (28/35; 80%) consented to participate in the study and 17 (61%) were available on telephone follow-up. Of these 17 athletes, 11 (11/17; 65%) of participants reported that they had not followed up with a medical professional since the race. Only 5 (5/17; 29%) confirmed that they had seen a medical provider in some fashion since the race; of these, only 2 (2/17; 12%) sought formal medical follow-up resulting from the recommendation whereas the remaining athletes merely saw their medical providers coincidentally or as part of routine care. Conclusion. Only 2 (2/17; 12%) of athletes who received event medical care obtained postrace follow-up within a one-month time period following the race. Event medical care providers must be aware of potential nonadherence to follow-up recommendations.
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Hoffman MD, Stuempfle KJ. Is Sodium Supplementation Necessary to Avoid Dehydration During Prolonged Exercise in the Heat? J Strength Cond Res 2016; 30:615-20. [PMID: 26907835 DOI: 10.1519/jsc.0000000000001138] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The primary purpose of this work was to gain further insight into the need for sodium supplementation for maintenance of appropriate hydration during prolonged exercise under hot conditions. Participants of a 161-km ultramarathon (ambient temperature reaching 39° C) underwent body weight measurements immediately before, during, and after the race, and completed a postrace questionnaire about supplemental sodium intake and drinking strategies during 4 race segments. The postrace questionnaire was completed by 233 (78.7%) race finishers. Significant direct relationships were found for percentage weight change during the race with intake rate (r = 0.18, p = 0.0058) and total amount (r = 0.24, p = 0.0002) of sodium in supplements. Comparing those using no sodium supplements throughout the race (n = 15) with those using sodium supplements each race segment (n = 138), body weight change across the course showed significant group (p = 0.022), course location (p < 0.0001), and interaction (p = 0.0098) effects. Posttests revealed greater weight loss at 90 km (p = 0.016, -3.2 ± 1.6% vs. -2.2 ± 1.5%, mean ± SD) and the finish (p = 0.014, -3.2 ± 1.5% vs. -1.9 ± 1.9%) for those using no sodium supplements compared with those using sodium supplements each segment. Six runners who used no sodium supplements, drank to thirst, and only drank water or a mixture of mostly water with some electrolyte-containing drink finished with mean weight change of -3.4%. Although the use of supplemental sodium enhanced body weight maintenance, those not using sodium supplements maintained a more appropriate weight than those consistently using sodium supplements. Therefore, we conclude that the supplemental sodium is unnecessary to maintain appropriate hydration during prolonged exercise in the heat.
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Affiliation(s)
- Martin D Hoffman
- 1Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, California; and2Health Sciences Department, Gettysburg College, Gettysburg, Pennsylvania
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Abstract
OBJECTIVE Examine whether the acute kidney injury (AKI) commonly observed among ultramarathon participants places the individual at risk for subsequent AKI of worse magnitude. DESIGN Observational. SETTING Western States Endurance Run. PARTICIPANTS Race finishers with postrace blood studies. INDEPENDENT VARIABLE Acute kidney injury after 1 race. MAIN OUTCOME MEASURES Extent of AKI in subsequent race. RESULTS Among 627 finishes in which serum creatinine values were known, 36.2% met "risk" or "injury" criterion with this group characterized by having faster finish times, greater body weight loss during the race, and higher postrace serum creatine kinase and urea nitrogen concentrations when compared with those not meeting the criteria. We identified 38 runners who had undergone postrace blood analyses at multiple races among which 16 (42.1%) met the risk or injury criterion at the first race. Of those 16 runners, 12 (75%) met the criteria at a subsequent race, an incidence that was higher (P = 0.0026) than the overall 36.2% incidence. For most (56.2%) of the 16 runners meeting the criteria at the first race, the subsequent race caused less increase in serum creatinine concentration and decrement in estimated glomerular filtration rate than the first race. CONCLUSIONS Mild AKI is common in 161-km ultramarathons, but there was no evidence that previous AKI caused greater renal dysfunction from a subsequent exercise stimulus of similar magnitude. This offers some reassurance to runners and their physicians that mild to moderate AKI in the setting of an ultramarathon is not cumulative or without complete recovery of kidney function when stressed.
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Affiliation(s)
- Martin D. Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA, United States
| | - Robert H. Weiss
- Department of Medicine, Department of Veterans Affairs, Northern California Health Care System, and Division of Nephrology, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, United States
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Abstract
OBJECTIVE Determine prevalence, incidence, and risk factors of acute kidney injury (AKI) during multistage ultramarathons. DESIGN Prospective observational cohort study. SETTING Jordanian Desert 2012; Atacama Desert, Chile 2012 and 2013; and Gobi Desert 2013 RacingThePlanet 250 km, 6-stage, ultramarathons. PARTICIPANTS One hundred twenty-eight participants (384 measurements) from the Jordan (25, 19.5%), Gobi (35, 27.3%), 2012 Atacama (24, 18.8%), and 2013 Atacama (44, 34.4%) races. INTERVENTIONS Blood samples and weights were gathered and analyzed immediately after stage 1 (40 km), 3 (120 km), and 5 (225 km). MAIN OUTCOME MEASURES Changes in serum creatinine (Cr), cumulative incidence, and prevalence of AKI were calculated for each stage with "risk of injury" defined as 1.5 × baseline Cr and "injury" defined as 2 × Cr. RESULTS Cumulative incidence of AKI was 41.4%. Stage 1 had 56 (43.8%) with risk of AKI and 24 (18.8%) with injury; in stage 3, 61 (47.7%) were at risk, 41 (32%) had injury; in stage 5, 62 (48.4%) runners were at risk and 36 (28.1%) had injury. Acute kidney injury was significantly associated with females [odds ratio (OR), 4.64; 95% confidence interval (CI), 2.07-10.37; P < 0.001], lower pack weight (OR, 0.71; 95% CI, 0.56-0.91; P < 0.007), and percentage weight loss (OR, 0.87; 95% CI, 0.78-0.97; P < 0.015). Lowest quintile of finishers was less likely to develop AKI (OR, 0.18; 95% CI, 0.04-0.78; P < 0.022). CONCLUSIONS Prevalence of AKI was 63%-78% during multistage ultramarathons. Female sex, lower pack weight, and greater weight loss were associated with renal impairment.
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Larson HH, Khalili-Borna D, Uzosike E, Sugiyama D. Medical Coverage of Ultramarathons and Its Unique Challenges. Curr Sports Med Rep 2016; 15:154-60. [PMID: 27172078 DOI: 10.1249/jsr.0000000000000267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Medical coverage of ultramarathons must take into account unique logistical, environmental, and psychological components in addition to the medical conditions that may arise. Each ultramarathon is unique and carries with it distinct specific challenges with regard to appropriate planning and organizing. The medical issues encountered with ultramarathons can overlap with those seen in other endurance events, but the extreme and protracted nature of ultramarathons also lends itself to various other medical challenges not frequently encountered in other aspects of sports medicine. This article gives an overview of logistical considerations that go into the medical planning, as well as information regarding diagnosis and acute management of some of the most common and most important conditions that one might encounter when covering an ultramarathon.
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Hoffman MD, Badowski N, Chin J, Stuempfle KJ, Parise CA. Determinants of recovery from a 161-km ultramarathon. J Sports Sci 2016; 35:669-677. [PMID: 27167683 DOI: 10.1080/02640414.2016.1183808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The primary study objective was to identify determinants of short-term recovery from a 161-km ultramarathon. Participants completed 400 m runs at maximum speed before the race and on days 3 and 5 post-race, provided a post-race blood sample for plasma creatine kinase (CK) concentration, and provided lower body muscle pain and soreness ratings (soreness, 10-point scale) and overall muscular fatigue scores (fatigue, 100-point scale) pre-race and for 7 days post-race. Among 72 race finishers, soreness and fatigue had statistically returned to pre-race levels by 5 days post-race; and 400 m times at days 3 and 5 remained 26% (P = 0.001) and 12% (P = 0.01) slower compared with pre-race, respectively. CK best modelled soreness, fatigue and per cent change in post-race 400 m time. Runners with the highest CKs had 1.5 points higher (P < 0.001) soreness and 11.2 points higher (P = 0.006) fatigue than runners with the lowest CKs. For the model of 400 m time, a significant interaction of time with CK (P < 0.001) indicates that higher CKs were linked with a slower rate of return to pre-race 400 m time. Since post-race CK was the main modifiable determinant of recovery following the ultramarathon, appropriate training appears to be the optimal approach to enhance ultramarathon recovery.
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Affiliation(s)
- Martin D Hoffman
- a Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs , Northern California Health Care System , Sacramento , CA , USA.,b University of California Davis Medical Center , Sacramento , CA , USA
| | - Natalie Badowski
- c Department of Emergency Medicine , Stanford University School of Medicine , Stanford , CA , USA
| | - Joseph Chin
- d State University of New York Upstate Medical University , Syracuse , NY , USA
| | | | - Carol A Parise
- f Sutter Institute for Medical Research , Sacramento , CA , USA
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Abstract
Study Design Randomized controlled trial. Background Postexercise recovery techniques are widely used, but little research has examined their effectiveness. Objectives To examine the effectiveness of massage and pneumatic compression on recovery from a 161-km ultramarathon. Methods Participants in the 2015 161-km Western States Endurance Run were randomized to a 20-minute postrace intervention of massage, intermittent sequential pneumatic compression, or supine rest. Each subject completed two 400-m runs at maximum speed before the race and on days 3 and 5 after the race, and also provided muscle pain and soreness ratings and overall muscular fatigue scores before and for 7 days after the race. Results Among the 72 runners who finished the race and completed the study, comparison among intervention groups revealed no significant group or interaction effect on 400-m run time, but there was a significant (P<.0001) time effect. Immediately posttreatment, massage resulted in lower muscle pain and soreness ratings compared with the supine-rest control condition (P<.0001), while both massage (P<.0001) and pneumatic compression (P<.01) resulted in lower overall muscular fatigue scores compared with the control group. There were no significant differences between groups in any outcome 1 to 7 days after the race. Conclusion Single 20-minute sessions of postrace massage and intermittent sequential pneumatic compression provide some immediate subjective benefit. There is no evidence, however, that such treatments provide extended subjective or functional benefits of clinical importance. The trial was registered at www.clinicaltrials.gov (NCT02530190). Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2016;46(5):320-326. Epub 23 Mar 2016. doi:10.2519/jospt.2016.6455.
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Special Considerations in Medical Screening for Participants in Remote Endurance Events. Sports Med 2016; 45:1121-31. [PMID: 26002285 DOI: 10.1007/s40279-015-0342-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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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The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis. Clin Exp Nephrol 2016; 20:153-61. [DOI: 10.1007/s10157-015-1204-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/19/2015] [Indexed: 01/23/2023]
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Hou SK, Chiu YH, Tsai YF, Tai LC, Hou PC, How CK, Yang CC, Kao WF. Clinical Impact of Speed Variability to Identify Ultramarathon Runners at Risk for Acute Kidney Injury. PLoS One 2015; 10:e0133146. [PMID: 26176768 PMCID: PMC4503592 DOI: 10.1371/journal.pone.0133146] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/23/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ultramarathon is a high endurance exercise associated with a wide range of exercise-related problems, such as acute kidney injury (AKI). Early recognition of individuals at risk of AKI during ultramarathon event is critical for implementing preventative strategies. OBJECTIVES To investigate the impact of speed variability to identify the exercise-related acute kidney injury anticipatively in ultramarathon event. METHODS This is a prospective, observational study using data from a 100 km ultramarathon in Taipei, Taiwan. The distance of entire ultramarathon race was divided into 10 splits. The mean and variability of speed, which was determined by the coefficient of variation (CV) in each 10 km-split (25 laps of 400 m oval track) were calculated for enrolled runners. Baseline characteristics and biochemical data were collected completely 1 week before, immediately post-race, and one day after race. The main outcome was the development of AKI, defined as Stage II or III according to the Acute Kidney Injury Network (AKIN) criteria. Multivariate analysis was performed to determine the independent association between variables and AKI development. RESULTS 26 ultramarathon runners were analyzed in the study. The overall incidence of AKI (in all Stages) was 84.6% (22 in 26 runners). Among these 22 runners, 18 runners were determined as Stage I, 4 runners (15.4%) were determined as Stage II, and none was in Stage III. The covariates of BMI (25.22 ± 2.02 vs. 22.55 ± 1.96, p = 0.02), uric acid (6.88 ± 1.47 vs. 5.62 ± 0.86, p = 0.024), and CV of speed in specific 10-km splits (from secondary 10 km-split (10th - 20th km-split) to 60th - 70th km-split) were significantly different between runners with or without AKI (Stage II) in univariate analysis and showed discrimination ability in ROC curve. In the following multivariate analysis, only CV of speed in 40th - 50th km-split continued to show a significant association to the development of AKI (Stage II) (p = 0.032). CONCLUSIONS The development of exercise-related AKI was not infrequent in the ultramarathon runners. Because not all runners can routinely receive laboratory studies after race, variability of running speed (CV of speed) may offer a timely and efficient tool to identify AKI early during the competition, and used as a surrogate screening tool, at-risk runners can be identified and enrolled into prevention trials, such as adequate fluid management and avoidance of further NSAID use.
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Affiliation(s)
- Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Yu-Hui Chiu
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yi-Fang Tsai
- Department of General Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Chen Tai
- Department of General Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peter C. Hou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chorng-Kuang How
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Fong Kao
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Chlíbková D, Knechtle B, Rosemann T, Tomášková I, Novotný J, Žákovská A, Uher T. Rhabdomyolysis and exercise-associated hyponatremia in ultra-bikers and ultra-runners. J Int Soc Sports Nutr 2015; 12:29. [PMID: 26113805 PMCID: PMC4480906 DOI: 10.1186/s12970-015-0091-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/17/2015] [Indexed: 01/06/2023] Open
Abstract
Background Exercise-associated hyponatremia (EAH), rhabdomyolysis and renal failure appear to be a unique problem in ultra-endurance racers. Methods We investigated the combined occurrence of EAH and rhabdomyolysis in seven different ultra-endurance races and disciplines (i.e. multi-stage mountain biking, 24-h mountain biking, 24-h ultra-running and 100-km ultra-running). Results Two (15.4 %) ultra-runners (man and woman) from hyponatremic ultra-athletes (n = 13) and four (4 %) ultra-runners (four men) from the normonatremic group (n = 100) showed rhabdomyolysis following elevated blood creatine kinase (CK) levels > 10,000 U/L without the development of renal failure and the necessity of a medical treatment. Post-race creatine kinase, plasma and urine creatinine significantly increased, while plasma [Na+] and creatine clearance decreased in hyponatremic and normonatremic athletes, respectively. The percentage increase of CK was higher in the hyponatremic compared to the normonatremic group (P < 0.05). Post-race CK levels were higher in ultra-runners compared to mountain bikers (P < 0.01), in faster normonatremic (P < 0.05) and older and more experienced hyponatremic ultra-athletes (P < 0.05). In all finishers, pre-race plasma [K+] was related to post-race CK (P < 0.05). Conclusions Hyponatremic ultra-athletes tended to develop exercise-induced rhabdomyolysis more frequently than normonatremic ultra-athletes. Ultra-runners tended to develop rhabdomyolysis more frequently than mountain bikers. We found no association between post-race plasma [Na+] and CK concentration in both hypo- and normonatremic ultra-athletes.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czech Republic
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Ivana Tomášková
- Faculty of Forestry and Wood Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Jan Novotný
- Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Alena Žákovská
- Institute of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Tomáš Uher
- Center for Adult Medicine in Bohunice, University Hospital Brno, Brno, Czech Republic
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Hoffman MD, Stuempfle KJ. Muscle Cramping During a 161-km Ultramarathon: Comparison of Characteristics of Those With and Without Cramping. SPORTS MEDICINE-OPEN 2015; 1:24. [PMID: 26284165 PMCID: PMC4532703 DOI: 10.1186/s40798-015-0019-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/08/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND This work sought to identify characteristics differing between those with and without muscle cramping during a 161-km ultramarathon. METHODS In this observational study, race participants underwent body weight measurements before, during, and after the race; completed a post-race questionnaire about muscle cramping and "near" cramping (controllable, not reaching full-blown cramping), drinking strategies, and use of sodium supplementation during four race segments; and underwent a post-race blood draw for determination of serum sodium and blood creatine kinase (CK) concentrations. RESULTS The post-race questionnaire was completed by 280 (74.5 %) of the 376 starters. A post-race blood sample was provided by 181 (61.1 %) of the 296 finishers, and 157 (53.0 %) of finishers completed the post-race survey and also provided a post-race blood sample. Among those who completed the survey, the prevalence of cramping and near cramping was 14.3 and 26.8 %, respectively, with greatest involvement being in the calf (54 %), quadriceps (44 %), and hamstring (33 %) muscles. Those with cramping or near cramping were more likely to have a prior history of muscle cramping during an ultramarathon (p < 0.0001) and had higher blood CK concentrations (p = 0.001) than those without cramping. Weight change during the race, use of sodium supplements, intake rate of sodium in supplements, and post-race serum sodium concentration did not differ between those with and without cramping. CONCLUSIONS Muscle cramping is most common in those with a prior history of cramping and greater muscle damage during an ultramarathon, suggesting an association with relative muscular demand. Impaired fluid and sodium balance did not appear to be an etiology of muscle cramping during an ultramarathon.
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Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, 10535 Hospital Way, Sacramento, CA USA
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Lipman GS, Krabak BJ, Waite BL, Logan SB, Menon A, Chan GK. A prospective cohort study of acute kidney injury in multi-stage ultramarathon runners: the Biochemistry in Endurance Runner Study (BIERS). Res Sports Med 2014; 22:185-92. [PMID: 24650338 DOI: 10.1080/15438627.2014.881824] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of the study was to evaluate the prevalence of acute kidney injury (AKI) during a multi-stage ultramarathon foot race. A prospective observational study was taken during the Gobi 2008; Sahara 2008; and Namibia 2009 RacingThePlanet 7-day, 6-stage, 150-mile foot ultramarathons. Blood was analyzed before, and immediately after stage 1 (25 miles), 3 (75 miles), and 5 (140 miles). Creatinine (Cr), glomerular filtration rate (GFR), and incidence of AKI were calculated and defined by RIFLE criteria. Thirty participants (76% male, mean age 40 + 11 years) were enrolled. There were significant declines in GFR after each stage compared with the pre-race baseline (p < 0.001), with the majority of participants (55-80%) incurring AKI. The majority of study participants encountered significant renal impairment; however, no apparent cumulative effect was observed, with resolution of renal function to near baseline levels between stages.
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Affiliation(s)
- Grant S Lipman
- a Stanford University School of Medicine, Surgery , Stanford , CA , USA
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Tiselius HG. Should we modify the principles of risk evaluation and recurrence preventive treatment of patients with calcium oxalate stone disease in view of the etiologic importance of calcium phosphate? Urolithiasis 2014; 43 Suppl 1:47-57. [PMID: 25086904 DOI: 10.1007/s00240-014-0698-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 07/23/2014] [Indexed: 12/22/2022]
Abstract
Prevention of recurrent calcium oxalate (CaOx) stone formation in the urinary tract is important to avoid negative effects on renal function, patient suffering and to reduce health care cost. Present shortcomings in this regard can be explained both by insufficient understanding of the mechanisms of stone formation and by poor patient compliance to those regimens that nevertheless have proven effective. During the past years, we have got increased insights in the nature of CaOx stone formation and it is suggested that the improved understanding of this process can be used for a more dynamic risk evaluation and treatment regimen directed to specific risk periods that can be identified in the individual patients. Some of the possibilities with regard to the important role of calcium phosphate are discussed in this article.
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Affiliation(s)
- Hans-Göran Tiselius
- Divison of Urology, Department of Clinical Science, Intervention and Technology, Karolinska institutet, Stockholm, Sweden,
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Krabak BJ, Waite B, Lipman G. Evaluation and treatment of injury and illness in the ultramarathon athlete. Phys Med Rehabil Clin N Am 2014; 25:845-63. [PMID: 25442162 DOI: 10.1016/j.pmr.2014.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Participation in ultramarathon races and knowledge of these athletes continues to increase as the sport becomes more popular. Physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long-term medical issues. In this article, the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners are reviewed.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics, and Sports Medicine, University of Washington Sports Medicine, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98195, USA; Seattle Children's Sports Medicine, 4800 Sand Point Way Northeast, Seattle, WA 98145, USA.
| | - Brandee Waite
- Physical Medicine and Rehabilitation, Sports Medicine, University of California Davis, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA
| | - Grant Lipman
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Dr Alway Bldg M121 MC 5119, Stanford, CA 94305, USA
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Hoffman MD, Stuempfle KJ. Hydration Strategies, Weight Change and Performance in a 161 km Ultramarathon. Res Sports Med 2014; 22:213-25. [PMID: 24950110 DOI: 10.1080/15438627.2014.915838] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Martin D. Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA, USA
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Hoffman MD, Weiss RH. Symptomatic hypotonic hyponatremia presenting at high altitude. Wilderness Environ Med 2014; 25:362-3. [PMID: 24768570 DOI: 10.1016/j.wem.2014.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation Department of Veterans Affairs Northern California Health Care System and University of California Davis Medical Center Sacramento, CA
| | - Robert H Weiss
- Department of Medicine Department of Veterans Affairs Northern California Health Care System Division of Nephrology Department of Internal Medicine University of California Davis Medical Center Sacramento, CA
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Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines. Sports Med 2014; 44:1055-69. [DOI: 10.1007/s40279-014-0189-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hoffman MD, Hew-Butler T, Stuempfle KJ. Exercise-associated hyponatremia and hydration status in 161-km ultramarathoners. Med Sci Sports Exerc 2013; 45:784-91. [PMID: 23135369 DOI: 10.1249/mss.0b013e31827985a8] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE This work combines and reanalyzes 5 yr of exercise-associated hyponatremia (EAH) research at 161-km ultramarathons in northern California with primary purposes to define the relationship between postrace blood sodium concentration ([Na]) and change in body weight; to examine the interactions among EAH incidence, ambient temperature, and hydration state; and to explore the effect of hydration status on performance. METHODS Prerace and postrace body weight and finish time data were obtained on 887 finishers, and postrace [Na] was also obtained on a subset of 669 finishers. RESULTS EAH incidence was 15.1% overall (range, 4.6%-51.0% by year) and had a significant positive relationship with ambient temperature. Of the runners with EAH, 23.8% were classified as overhydrated (weight change, ≥0), 40.6% were euhydrated (weight change, <0% to -3%), and 35.6% were dehydrated (weight change, <-3%) at the finish. There was a weak significant relationship (r = 0.17, P < 0.0001) between postrace [Na] and change in body weight such that a lower [Na] was more common with increased weight loss. Considering all finishers examined, 18.5% were dehydrated and 34.9% were overhydrated at the finish. There was a weak significant relationship (r = 0.092, P = 0.006) between change in body weight and performance in that faster runners tended to lose more weight. Top finishers varied in body weight change from ∼1% gain to ∼6% loss. CONCLUSIONS EAH incidence can be high in 161-km ultramarathons in northern California. In this environment, EAH is more common with dehydration than overhydration and is more common in hotter ambient temperature conditions. Because weight loss >3% does not seem to have an adverse effect on performance, excessive sodium supplementation and aggressive fluid ingestion beyond the dictates of thirst are ill advised.
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Affiliation(s)
- Martin D Hoffman
- Department of Veterans Affairs, Northern California Health Care System, Mather, CA 95655-1200, USA.
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Alterations in coagulatory and fibrinolytic systems following an ultra-marathon. Eur J Appl Physiol 2013; 113:2705-12. [PMID: 23974848 DOI: 10.1007/s00421-013-2709-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to examine coagulatory and fibrinolytic responses to the Western States Endurance Run (WSER, June 23 to 24, 2012). The WSER is a 161-km (100 mile) trail foot race through the Sierra Nevada Mountains that involves 6,030 m of climb and 7,001 m of descent. METHODS We examined 12 men and 4 women [mean (95 % CI), age 44.6 years (38.7-50.6)] who completed the race (24.64 h; range 16.89-29.46). Blood samples were collected the morning before the race, immediately post-race, and 1 (D1) and 2 (D2) days post-race (corresponding to 51-54 h and 75-78 h from the start of the race, respectively). Hypercoagulable state was characterized by prothrombin fragment 1+2 (PTF 1+2) and thrombin-antithrombin complex (TAT). Fibrinolytic state was assessed by plasminogen activator inhibitor antigen (PAI-1 Ag), tissue plasminogen activator antigen (tPA Ag), and D-Dimer. Muscle damage was assessed by serum creatine kinase (CK) and myoglobin concentrations. RESULTS Significant (P ≤ 0.05) increases were observed immediately post-race for thrombin generation markers, PTF 1+2 (3.9-fold) and TAT (2.4-fold); markers of fibrinolysis, tPA Ag (4.0-fold), PAI-1 Ag (4.5-fold), and D-Dimer (2.2-fold); and muscle damage markers, CK (154-fold) and myoglobin (114-fold). Most markers continued to be elevated at D1, as seen by PTF 1+2, TAT (1.5- and 1.3-fold increase at D1), and D-Dimer (2.5- and 2.1-fold increase at D1 and D2, respectively). Additionally, PTF 1+2:tPA and TAT:tPA ratios, which assessed balance between coagulation and fibrinolysis, were slightly, but significantly increased at D1 (69 and 36 %) and D2 (19 and 31 %). CK and myoglobin also remained elevated at D1 (54- and 7-fold) and D2 (25- and 2-fold) time points. CONCLUSION The WSER produced extensive muscle damage and activated the coagulation and fibrinolytic systems. Since we observed a slight imbalance response between the two systems, a limited potential for thrombotic episodes is apparent in these highly trained athletes.
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