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Hodgson LE, Walter E, Venn RM, et al. Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review. BMJ Open Sport Exerc Med. 2017;3(1):e000093doi: 10.1136/bmjsem-2015-000093.
Hodgson, L. E., Walter, E., Venn, R. M., Galloway, R., Pitsiladis, Y., Sardat, F., & Forni, L. G. (2017). Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review. BMJ open sport & exercise medicine, 3(1), e000093. https://doi.org/10.1136/bmjsem-2015-000093
Hodgson, L E, et al. "Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review." BMJ open sport & exercise medicine vol. 3,1 (2017): e000093. doi: https://doi.org/10.1136/bmjsem-2015-000093
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 Jun 14;3(1):e000093. doi: 10.1136/bmjsem-2015-000093. eCollection 2017. PMID: 29259804; PMCID: PMC5731225.
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BMJ Open Sport Exerc Med. 2017 Jun 14;3(1):e000093. doi: 10.1136/bmjsem-2015-000093. eCollection 2017.

Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review.

BMJ open sport & exercise medicine

L E Hodgson, E Walter, R M Venn, R Galloway, Y Pitsiladis, F Sardat, L G Forni

Affiliations

  1. Department of Anaesthesia, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK.
  2. Department of Emergency Medicine, Royal Sussex County Hospital, East Sussex, UK.
  3. Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK.
  4. Department of Intensive Care, Surrey Peri-operative Anaesthesia Critical care collaborative Research group (SPACeR), Royal Surrey County Hospital, Surrey, UK.
  5. The centre for sport and exercise science and medicine (SESAME), Sport and Service Management, Eastbourne, UK.

PMID: 29259804 PMCID: PMC5731225 DOI: 10.1136/bmjsem-2015-000093

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.

Keywords: acute kidney injury; biomarkers; endurance events; marathon; non-steroidal anti-inflammatories

Conflict of interest statement

Competing interests: None declared.

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