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Acute kidney injury associated with endurance events—is it a cause for concern? A systematic review
  1. LE Hodgson1,
  2. E Walter2,
  3. RM Venn1,
  4. R Galloway3,
  5. Y Pitsiladis2,
  6. F Sardat4,
  7. LG Forni2,5
  1. 1 Department of Anaesthesia, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK
  2. 2 Department of Emergency Medicine, Royal Sussex County Hospital, East Sussex, UK
  3. 3 Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
  4. 4 Department of Intensive Care, Surrey Peri-operative Anaesthesia Critical care collaborative Research group (SPACeR), Royal Surrey County Hospital, Surrey, UK
  5. 5 The centre for sport and exercise science and medicine (SESAME), Sport and Service Management, Eastbourne, UK
  1. Correspondence to Dr LG Forni; luiforni{at}


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.

  • acute kidney injury
  • marathon
  • endurance events
  • non-steroidal anti-inflammatories
  • biomarkers

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  • Contributors LH: conception, design, literature search, risk of bias assessment, write-up. EW: conception, design, literature search, write-up. RV: conception, design, literature search, write-up. RG: conception, literature search, write-up. YP: conception design, write-up. FS: literature search, write-up. LF: conception design, literature search, risk of bias assessment, write-up.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.