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Vauthier J, Touze C, Mauvieux B, Hingrand C, Delaunay P, Besnard S, Jouffroy R, Noirez P, Maboudou P, Parent C, Heyman E, Poussel M. Increased risk of acute kidney injury in the first part of an ultra-trail-Implications for abandonment. Physiol Rep 2024; 12:e15935. [PMID: 38684379 PMCID: PMC11058001 DOI: 10.14814/phy2.15935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 05/02/2024] Open
Abstract
Acute kidneys injuries (AKIs) have been described in marathon and trail running. The currently available data allows assessment of before/after comparisons but does not allow an analysis of what happens during the race. A multidisciplinary assessment protocol was performed during the first trail of Clécy (Normandy France) in November 2021. This allowed an initial assay to be carried out, then at the end of each of the 6 loops of 26 km, and finally after 24 h of recovery. The race extends over 156 km in hilly terrain and 6000 m of elevation gain (D+). The level of impairment according to the RIFLE classification was defined for each runner at each assay. Fifty-five runners were at the start, and the per protocol analysis involved 36 runners (27 men and 9 women, 26 finishers). Fifteen (41.7%) of the riders presented at least one result corresponding to a "RIFLE risk" level. After 24 h of rest, only one runner still had a "RIFLE Risk". The distance around the marathon seems to be the moment of greatest risk. For the first time, we find an association between this renal risk and the probability of abandonment. Many runners are vulnerable to kidney damage during long-duration exercise, which is why it's important to limit risk situations, such as the use of potentially toxic drugs or hydration disorders. The consumption of NSAIDs (nonsteroidal anti-inflammatory drugs) before or during an ultra-distance race should therefore be prohibited. Attention should be paid to hydration disorders.
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Affiliation(s)
- Jean‐Charles Vauthier
- Département de Médecine GénéraleFaculté de MédecineNancyFrance
- Département of General PracticeMaison de Santé des Trois MontsDommartin‐lès‐RemiremontFrance
- INTERPSY 5UR4432Université de LorraineNnacyFrance
| | - Charlie Touze
- Département of General PracticeMaison de Santé des Trois MontsDommartin‐lès‐RemiremontFrance
| | | | | | | | - Stéphane Besnard
- UR 7480 VERTEXUniversité de CaenCaenFrance
- Service d'ORLCentre Hospitalier Universitaire de CaenCaenFrance
| | - Romain Jouffroy
- Intensive Care UnitAmbroise Paré University Hospital, Assistance Publique – Hôpitaux de Paris, and Paris Saclay UniversityBoulogneFrance
- IRMES – Institute for Research in Medicine and Epidemiology of SportInstitut National du Sport, de l'Expertise et de la PerformanceParisFrance
- INSERM U‐1018, Centre de recherche en Epidémiologie et Santé des PopulationsCentre de recherche en Epidémiologie et Santé des Populations, Paris Saclay UniversityParisFrance
| | - Philippe Noirez
- Performance Santé Métrologie Société (EA7507)Université Reims Champagne ArdenneReimsFrance
| | - Patrice Maboudou
- Univ. Lille, CHU Lille, Biologic et Pathologic CenterLilleFrance
| | - Cassandra Parent
- ULR 7369 – URePSSS – Unité de Recherche pluridisciplinaire Sport Santé SociétéUniv. Lille, Univ. LittoralLilleFrance
- Institut de Recherches Cliniques de MontréalMontréalQuébecCanada
| | - Elsa Heyman
- ULR 7369 – URePSSS – Unité de Recherche pluridisciplinaire Sport Santé SociétéUniv. Lille, Univ. LittoralLilleFrance
- Institut Universitaire de FranceParisFrance
| | - Mathias Poussel
- Department of Pulmonary Function Testing and Exercise PhysiologyUniversity Hospital of Nancy, University Centre of Sports Medicine and Adapted Physical Activity, University of LorraineNancyFrance
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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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Lecina M, Castellar-Otín C, López-Laval I, Carrasco Páez L, Pradas F. Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050569. [PMID: 35629986 PMCID: PMC9146822 DOI: 10.3390/medicina58050569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
Background and objectives: Ultra-trail races can cause episodes of acute kidney injury (AKI) and exercise-associated hyponatremia (EAH) in healthy subjects without previous renal pathology. This systematic review aims to review the incidence of these two syndromes together and separately taking into account the length and elevation of the ultra-trail race examined. Materials and Methods: A systematic review was conducted through electronic search in four electronic databases (PubMed, EBSCO, Web of Science and Alcorze). Results: A total of 1127 articles published between January 2006 and December 31, 2021 were included, 28 of which met the inclusion criteria. The studies were categorized according to the length and stages of the race in four categories: medium (42 to 69 km), long (70 to 99 km), extra (>100 km) and multi-stage if they included various stages. A total of 2950 runners (666 females and 2284 males) were extracted from 28 publications. The AKI incidence found was 42.04% (468 cases of 1113), and 195 of 2065 were diagnosed with EAH, accounting for 9.11%. The concurrence of both pathologies together reached 11.84% (27 individuals) from a total of 228 runners with AKI and EAH simultaneously analyzed. Sorted by race category, the AKI+EAH cases were distributed as follows: 18 of 27 in the extra (13.63% and n = 132), 4 in the large (5.79% and n = 69) and 5 in the medium category (18.15% and n = 27). Conclusions: According to these results, extra and medium races showed a similar incidence of AKI+EAH. These findings underline the importance of the duration and intensity of the race and may make them responsible for the etiology of these medical conditions. Due to their variable incidence, EAH and AKI are often underdiagnosed, leading to poorer prognosis, increased condition seriousness and hindered treatment. The results of this review urge participants, coaches and race organizers to take measures to improve the early diagnosis and urgent treatment of possible EAH and AKI cases.
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Affiliation(s)
- Miguel Lecina
- Faculty of Health and Sports Sciences, University of Zaragoza, 22002 Huesca, Spain;
| | - Carlos Castellar-Otín
- ENFYRED Research Group, Faculty of Health and Sports, University of Zaragoza, 22002 Huesca, Spain;
- Correspondence:
| | - Isaac López-Laval
- Department of Physiatry and Nursery, Section of Physical Education and Sports, Faculty of Health Sciences and Sport, University of Zaragoza, 22002 Huesca, Spain;
| | - Luis Carrasco Páez
- Department of Physical Education and Sport, University of Seville, 41013 Seville, Spain;
| | - Francisco Pradas
- ENFYRED Research Group, Faculty of Health and Sports, University of Zaragoza, 22002 Huesca, Spain;
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Mauvieux B, Hingrand C, Drigny J, Hodzic A, Baron P, Hurdiel R, Jouffroy R, Vauthier JC, Pessiglione M, Wiehler A, Degache F, Pavailler S, Heyman E, Plard M, Noirez P, Dubois B, Esculier JF, Nguyen AP, Van Cant J, Roy Baillargeon O, Pairot de Fontenay B, Delaunay PL, Besnard S. Study of the kinetics of the determinants of performance during a mountain ultra marathon: Multidisciplinary protocol of the first Trail Scientifique de Clécy 2021 (Preprint). JMIR Res Protoc 2022; 11:e38027. [PMID: 35704381 PMCID: PMC9244647 DOI: 10.2196/38027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background The growing interest of the scientific community in trail running has highlighted the acute effects of practice at the time of these races on isolated aspects of physiological and structural systems; biological, physiological, cognitive, and muscular functions; and the psychological state of athletes. However, no integrative study has been conducted under these conditions with so many participants and monitoring of pre-, per-, and postrace variables for up to 10 days over a distance close to 100 miles. Objective The aim of this study was to evaluate the kinetics of the performance parameters during a 156 km trail run and 6000 m of elevation gain in pre-, per-, and postrace conditions. The general hypothesis is based on significant alterations in the psychological, physiological, mechanical, biological, and cognitive parameters. Methods The Trail Scientifique de Clécy took place on November 11, 2021. This prospective experimental study provides a comprehensive exploration of the constraints and adaptations of psychophysiological and sociological variables assessed in real race conditions during a trail running of 156 km on hilly ground and 6000 m of elevation gain (D+). The study protocol allowed for repeatability of study measurements under the same experimental conditions during the race, with the race being divided into 6 identical loops of 26 km and 1000 m D+. Measurements were conducted the day before and the morning of the race, at the end of each lap, after a pit stop, and up to 10 days after the race. A total of 55 participants were included, 43 (78%) men and 12 (22%) women, who were experienced in ultra–trail-running events and with no contraindications to the practice of this sport. Results The launch of the study was authorized on October 26, 2021, under the trial number 21-0166 after a favorable opinion from the Comité de Protection des Personnes Ouest III (21.09.61/SIRIPH 2G 21.01586.000009). Of the 55 runners enrolled, 41 (75%) completed the race and 14 (25%) dropped out for various reasons, including gastric problems, hypothermia, fatigue, and musculoskeletal injuries. All the measurements for each team were completed in full. The race times (ie, excluding the measurements) ranged from 17.8206 hours for the first runner to 35.9225 hours for the last runner. The average time to complete all measurements for each lap was 64 (SD 3) minutes. Conclusions The Trail Scientifique de Clécy, by its protocol, allowed for a multidisciplinary approach to the discipline. This approach will allow for the explanation of the studied parameters in relation to each other and observation of the systems of dependence and independence. The initial results are expected in June 2022. International Registered Report Identifier (IRRID) RR1-10.2196/38027
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Affiliation(s)
| | | | - Joffrey Drigny
- U1075 Comete/INSERM, Université de Caen, Caen, France
- Unité de Médecine du Sport, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Amir Hodzic
- U1075 Comete/INSERM, Université de Caen, Caen, France
- Unité de Médecine du Sport, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Pauline Baron
- ULR 7369 - Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Université du Littoral Côte d'Opale, Dunkerque, France
| | - Rémy Hurdiel
- ULR 7369 - Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Université du Littoral Côte d'Opale, Dunkerque, France
| | - Romain Jouffroy
- Intensive Care Unit, Anaethesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- IRMES - Institute for Research in Medicine and Epidemiology of Sport, Institut National du Sport, de l'Expertise et de la Performance, Paris, France
- INSERM U-1018, Centre de recherche en Epidémiologie et Santé des Populations, Paris Saclay University, Paris, France
| | - Jean-Charles Vauthier
- Departement de Medecine Générale, Faculté de Médecine - Département du Grand Est de recherche en soins primaires, Université de Lorraine, Nancy, France
| | - Mathias Pessiglione
- Motivation, Brain and Behavior lab, Institut du cerveau et de la moelle épinière Inserm U1127, CNRS U9225, Université Pierre et Marie Curie (UPMC-Paris 6), Paris, France
| | - Antonius Wiehler
- Motivation, Brain and Behavior lab, Institut du cerveau et de la moelle épinière Inserm U1127, CNRS U9225, Université Pierre et Marie Curie (UPMC-Paris 6), Paris, France
| | | | | | - Elsa Heyman
- ULR 7369 - Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Université de Lille, LILLE, France
- Institut Universitaire de France, Paris, France
| | - Mathilde Plard
- Espace et Sociétés UMR 6590 CNRS, Université d'Angers, Angers, France
| | - Philippe Noirez
- Performance Santé Métrologie Société (EA7507), Université Reims Champagne Ardenne, Reims, France
| | | | | | - Anh Phong Nguyen
- La Clinique du Coureur, Lac Beauport, QC, Canada
- Neuromusculoskeletal Laboratory, Institut de Recherche Expérimentale et Clinique, Catholic University of Louvain, Louvain La Neuve, Belgium
| | - Joachim Van Cant
- La Clinique du Coureur, Lac Beauport, QC, Canada
- Department of Physical Therapy, Institut Parnasse-ISEI, Brussels, Belgium
| | | | | | | | - Stéphane Besnard
- Explorations Fonctionnelles Neurologiques, Centre Hospitalier Universitaire de Caen, Caen, France
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Lecina M, López I, Castellar C, Pradas F. Extreme Ultra-Trail Race Induces Muscular Damage, Risk for Acute Kidney Injury and Hyponatremia: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111323. [PMID: 34769840 PMCID: PMC8582916 DOI: 10.3390/ijerph182111323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Abstract
A case study involving a healthy trained male athlete who completed a 786 km multi-stage ultra-trail race. Several markers were analyzed in blood and urine samples: creatinine (SCR) for kidney damage, sodium ([Na+]) for hyponatremia, creatine kinase (CK) for exertional rhabdomyolysis, as well as other hematological values. Samples were taken before and after the race and during the recovery period (days 2 and 9 after the race). Results showed: SCR = 1.13 mg/dl, [Na+] =139 mmol/l and CK = 1.099 UI/l. Criteria for the determination of acute kidney damage were not met, and [Na+] concentration was above 135 mEq/L, indicating the absence of hyponatremia. Exertional rhabdomyolysis was suffered by the athlete (baseline CK increased fivefold), though this situation was reverted after 9 days of recovery. Ultra-trail races cause biochemical changes in athletes, which should be known about by healthcare professionals.
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Affiliation(s)
- Miguel Lecina
- Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain; (M.L.); (I.L.)
| | - Isaac López
- Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain; (M.L.); (I.L.)
| | - Carlos Castellar
- ENFYRED Research Group, University of Zaragoza, 22001 Huesca, Spain;
- Correspondence:
| | - Francisco Pradas
- ENFYRED Research Group, University of Zaragoza, 22001 Huesca, Spain;
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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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Michnik A, Sadowska-Krępa E, Kiełboń A, Duch K, Bańkowski S. Blood serum denaturation profile examined by differential scanning calorimetry reflects the effort put into ultramarathon by amateur long-distance runners. J Therm Biol 2021; 99:103013. [PMID: 34420643 DOI: 10.1016/j.jtherbio.2021.103013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/15/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
The impact of participation in the ultramarathon on the health and mental and physical condition is very complex. Undoubtedly, exercise brings many benefits but also involves health risks. Especially such an extreme effort as the one associated with finishing the ultramarathon run, can be dangerous to the health of the runner. With the variety of possible biomarkers of excessive fatigue that threaten health and life, a question arises which of them are the best and which should be considered in amateur long-distance runners showing particularly high individual variability. In this study differential scanning calorimetry (DSC) has been applied to show the overall effect of the 12-h run on blood sera of participants. Serum samples were obtained from the blood of ten male amateur long-distance runners, collected before and immediately after the run. Distinct changes in the shape of DSC curves have been observed for serum after finishing the run relative to pre-race serum. Statistically significant differences between stages "before" and "after" ultramarathon running have been found for parameters of the endothermic transition associated with denaturation of serum proteins. An increase in the temperature (from 70.9 ± 0.9 to 75.8 ± 2.9 °C) and excess heat capacity (from 0.859 ± 0.201 to 1.102 ± 0.226 Jg-1 °C-1) at peak maximum, the enthalpy of serum denaturation (from 18.55 ± 6.52 to 22.08 ± 5.61 Jg-1) and the first moment of the thermal transition with respect to the temperature (from the value of 67.0 ± 2.1 to 72.6 ± 2.1 °C) has been observed. These results show a clear impact of running an ultramarathon on the participant's blood serum.
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Affiliation(s)
- Anna Michnik
- Faculty of Science and Technology, Institute of Biomedical Engineering, The Silesian Centre for Education and Interdisciplinary Research, University of Silesia in Katowice, ul. 75 Pułku Piechoty 1A, 41-500, Chorzow, Poland.
| | - Ewa Sadowska-Krępa
- The Jerzy Kukuczka Academy of Physical Education in Katowice, Institute of Sport Sciences, ul. Mikołowska 72a, 40-065, Katowice, Poland.
| | - Agnieszka Kiełboń
- Faculty of Science and Technology, Institute of Biomedical Engineering, The Silesian Centre for Education and Interdisciplinary Research, University of Silesia in Katowice, ul. 75 Pułku Piechoty 1A, 41-500, Chorzow, Poland.
| | - Klaudia Duch
- Faculty of Science and Technology, Institute of Biomedical Engineering, The Silesian Centre for Education and Interdisciplinary Research, University of Silesia in Katowice, ul. 75 Pułku Piechoty 1A, 41-500, Chorzow, Poland.
| | - Sebastian Bańkowski
- The Jerzy Kukuczka Academy of Physical Education in Katowice, Institute of Sport Sciences, ul. Mikołowska 72a, 40-065, Katowice, Poland.
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Haroutounian A, Amorim FT, Astorino TA, Khodiguian N, Curtiss KM, Matthews ARD, Estrada MJ, Fennel Z, McKenna Z, Nava R, Sheard AC. Change in Exercise Performance and Markers of Acute Kidney Injury Following Heat Acclimation with Permissive Dehydration. Nutrients 2021; 13:nu13030841. [PMID: 33806669 PMCID: PMC8000862 DOI: 10.3390/nu13030841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/25/2022] Open
Abstract
Implementing permissive dehydration (DEH) during short-term heat acclimation (HA) may accelerate adaptations to the heat. However, HA with DEH may augment risk for acute kidney injury (AKI). This study investigated the effect of HA with permissive DEH on time-trial performance and markers of AKI. Fourteen moderately trained men (age and VO2max = 25 ± 0.5 yr and 51.6 ± 1.8 mL·kg−1·min−1) were randomly assigned to DEH or euhydration (EUH). Time-trial performance and VO2max were assessed in a temperate environment before and after 7 d of HA. Heat acclimation consisted of 90 min of cycling in an environmental chamber (40 °C, 35% RH). Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) were assessed pre- and post-exercise on day 1 and day 7 of HA. Following HA, VO2max did not change in either group (p = 0.099); however, time-trial performance significantly improved (3%, p < 0.01) with no difference between groups (p = 0.485). Compared to pre-exercise, NGAL was not significantly different following day 1 and 7 of HA (p = 0.113) with no difference between groups (p = 0.667). There was a significant increase in KIM-1 following day 1 and 7 of HA (p = 0.002) with no difference between groups (p = 0.307). Heat acclimation paired with permissive DEH does not amplify improvements in VO2max or time-trial performance in a temperate environment versus EUH and does not increase markers of AKI.
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Affiliation(s)
- Arpie Haroutounian
- School of Kinesiology, Nutrition, and Food Science, California State University Los Angeles, Los Angeles, CA 90032, USA; (A.H.); (N.K.); (K.M.C.); (A.R.D.M.); (M.J.E.)
| | - Fabiano T. Amorim
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA; (F.T.A.); (Z.F.); (Z.M.); (R.N.)
| | - Todd A. Astorino
- Department of Kinesiology, California State University San Marcos, San Marcos, CA 92096, USA;
| | - Nazareth Khodiguian
- School of Kinesiology, Nutrition, and Food Science, California State University Los Angeles, Los Angeles, CA 90032, USA; (A.H.); (N.K.); (K.M.C.); (A.R.D.M.); (M.J.E.)
| | - Katharine M. Curtiss
- School of Kinesiology, Nutrition, and Food Science, California State University Los Angeles, Los Angeles, CA 90032, USA; (A.H.); (N.K.); (K.M.C.); (A.R.D.M.); (M.J.E.)
| | - Aaron R. D. Matthews
- School of Kinesiology, Nutrition, and Food Science, California State University Los Angeles, Los Angeles, CA 90032, USA; (A.H.); (N.K.); (K.M.C.); (A.R.D.M.); (M.J.E.)
| | - Michael J. Estrada
- School of Kinesiology, Nutrition, and Food Science, California State University Los Angeles, Los Angeles, CA 90032, USA; (A.H.); (N.K.); (K.M.C.); (A.R.D.M.); (M.J.E.)
| | - Zachary Fennel
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA; (F.T.A.); (Z.F.); (Z.M.); (R.N.)
| | - Zachary McKenna
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA; (F.T.A.); (Z.F.); (Z.M.); (R.N.)
| | - Roberto Nava
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA; (F.T.A.); (Z.F.); (Z.M.); (R.N.)
| | - Ailish C. Sheard
- School of Kinesiology, Nutrition, and Food Science, California State University Los Angeles, Los Angeles, CA 90032, USA; (A.H.); (N.K.); (K.M.C.); (A.R.D.M.); (M.J.E.)
- Correspondence: ; Tel.: +1-323-343-5334
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9
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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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10
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Wołyniec W, Ratkowski W, Renke J, Renke M. Changes in Novel AKI Biomarkers after Exercise. A Systematic Review. Int J Mol Sci 2020; 21:E5673. [PMID: 32784748 PMCID: PMC7461060 DOI: 10.3390/ijms21165673] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/26/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
More than 100 substances have been identified as biomarkers of acute kidney injury. These markers can help to diagnose acute kidney injury (AKI) in its early phase, when the creatinine level is not increased. The two markers most frequently studied in plasma and serum are cystatin C and neutrophil gelatinase-associated lipocalin (NGAL). The former is a marker of kidney function and the latter is a marker of kidney damage. Some other promising serum markers, such as osteopontin and netrin-1, have also been proposed and studied. The list of promising urinary markers is much longer and includes cystatin C, NGAL, kidney injury molecule-1 (KIM-1), liver-type fatty-acid-binding protein (L-FABP), interleukin 18, insulin-like growth factor binding protein 7 (IGFBP-7), tissue inhibitor of metalloproteinases-2 (TIMP-2) and many others. Although these markers are increased in urine for no longer than a few hours after nephrotoxic agent action, they are not widely used in clinical practice. Only combined IGFBP-7/TIMP-2 measurement was approved in some countries as a marker of AKI. Several studies have shown that the levels of urinary AKI biomarkers are increased after physical exercise. This systematic review focuses on studies concerning changes in new AKI biomarkers in healthy adults after single exercise. Twenty-seven papers were identified and analyzed in this review. The interpretation of results from different studies was difficult because of the variety of study groups, designs and methodology. The most convincing data concern cystatin C. There is evidence that cystatin C is a better indicator of glomerular filtration rate (GFR) in athletes after exercise than creatinine and also at rest in athletes with a lean mass lower or higher than average. Serum and plasma NGAL are increased after prolonged exercise, but the level also depends on inflammation and hypoxia; therefore, it seems that in physical exercise, it is too sensitive for AKI diagnosis. It may, however, help to diagnose subclinical kidney injury, e.g., in rhabdomyolysis. Urinary biomarkers are increased after many types of exercise. Increases in NGAL, KIM-1, cystatin-C, L-FABP and interleukin 18 are common, but the levels of most urinary AKI biomarkers decrease rapidly after exercise. The importance of this short-term increase in AKI biomarkers after exercise is doubtful. It is not clear if it is a sign of mild kidney injury or physiological metabolic adaptation to exercise.
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Affiliation(s)
- Wojciech Wołyniec
- Department of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 9b Powstania Styczniowego Street, 81-519 Gdynia, Poland;
| | - Wojciech Ratkowski
- Department of Athletics, Gdańsk University of Physical Education and Sport, 1 Górskiego Street, 80-336 Gdańsk, Poland;
| | - Joanna Renke
- Department of General and Medical Biochemistry, University of Gdansk, 59 Wita Stwosza Street, 80-308 Gdańsk, Poland;
| | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 9b Powstania Styczniowego Street, 81-519 Gdynia, Poland;
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11
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Abstract
We present a case of severe, acute kidney injury, rhabdomyolysis and dehydration in a 49-year-old, competitive trail runner, after a 110-km trail race in mountainous terrain. Six days after the event, he presented to the hospital with fatigue, weight gain and oedema. Biochemically the diagnosis of severe, acute kidney injury was made, with increased serum creatinine levels of 13.4 mg/dL (normal range 0.67-1.17 mg/dL). He remained hospitalised for two weeks, and improved with conservative measures, without the need for renal replacement therapy. Likely risk factors included ingestion of non-steroidal anti-inflammatory drugs prior to the event, dehydration and prolonged running in mountainous environment at moderate altitude. Renal function largely returned to baseline levels four months after initial presentation. This case highlights that severe kidney injury can occur, even days after ultra-running events, especially in the presence of associated risk factors. If repeated cases of acute kidney injury can trigger chronic kidney injury is currently unclear and further research in this area is warranted. In the meantime, efforts should be made to educate athletes, coaches and health care professionals about the dangers of acute kidney injury and associated risk factors.
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Affiliation(s)
- Volker Scheer
- Sports Medicine, Ultra Sports Science Foundation, Pierre-Benite, FRA
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12
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Wołyniec W, Kasprowicz K, Giebułtowicz J, Korytowska N, Zorena K, Bartoszewicz M, Rita-Tkachenko P, Renke M, Ratkowski W. Changes in Water Soluble Uremic Toxins and Urinary Acute Kidney Injury Biomarkers After 10- and 100-km Runs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4153. [PMID: 31661892 PMCID: PMC6862582 DOI: 10.3390/ijerph16214153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022]
Abstract
Acute kidney injury (AKI) is described as a relatively common complication of exercise. In clinical practice the diagnosis of AKI is based on serum creatinine, the level of which is dependent not only on glomerular filtration rate but also on muscle mass and injury. Therefore, the diagnosis of AKI is overestimated after physical exercise. The aim of this study was to determine changes in uremic toxins: creatinine, urea, uric acid, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), trimethylamine N-oxide (TMAO) and urinary makers of AKI: albumin, neutrophil gelatinase-associated lipocalin (uNGAL), kidney injury molecule-1 and cystatin-C (uCyst-C) after long runs. Sixteen runners, mean age 36.7 ± 8.2 years, (2 women, 14 men) participating in 10- and 100-km races were studied. Blood and urine were taken before and after the races to assess markers of AKI. A statistically significant increase in creatinine, urea, uric acid, SDMA and all studied urinary AKI markers was observed. TMAO and ADMA levels did not change. The changes in studied markers seem to be a physiological reaction, because they were observed almost in every runner. The diagnosis of kidney failure after exercise is challenging. The most valuable novel markers which can help in post-exercise AKI diagnosis are uCyst-C and uNGAL.
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Affiliation(s)
- Wojciech Wołyniec
- Department of Occupational, Metabolic and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | - Katarzyna Kasprowicz
- Department of Biology, Ecology and Sports Medicine, Gdańsk University of Physical Education and Sport, 80-336 Gdańsk, Poland.
| | - Joanna Giebułtowicz
- Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Natalia Korytowska
- Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Katarzyna Zorena
- Department of Biology Ecology and Sport Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | - Maria Bartoszewicz
- Department of Biology Ecology and Sport Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | | | - Marcin Renke
- Department of Occupational, Metabolic and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | - Wojciech Ratkowski
- Department of Athletics, Department of Athletics, Gdańsk University of Physical Education and Sport, 80-336 Gdańsk, Poland.
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