Variation in renal responses to exercise in the heat with progressive acclimatisation. Issue 9 (September 2019)

• Record Type: Journal Article
• Authors: Omassoli, Jessica; Hill, Neil E.; Woods, David R.; Delves, Simon K.; Fallowfield, Joanne L; Brett, Stephen J.; Wilson, Duncan; Corbett, Richard W.; Allsopp, Adrian J.; Stacey, Michael J.
• Is Part Of: Journal of science and medicine in sport. Volume 22:Issue 9(2019)
• Page Start: 1004
• Page End: 1009
• Publication Date: 2019-09
• Subjects: Heat stroke -- Renal insufficiency -- Chronic -- Thermotolerance -- Cytokines -- Vasopressins; Sports sciences -- Periodicals; Sports medicine -- Periodicals; Exercise -- Physiological aspects -- Periodicals; Sports -- physiology -- Periodicals; Sports Medicine -- Periodicals; Sportgeneeskunde; 617.102705
• DOI: 10.1016/j.jsams.2019.04.010
• Languages: English
• ISSNs: 1440-2440

Abstract

Abstract: Objectives: To investigate changes in renal status from exercise in the heat with acclimatisation and to evaluate surrogates markers of Acute Kidney Injury. Design: Prospective observational cohort study. Methods: 20 male volunteers performed 60 min standardised exercise in the heat, at baseline and on four subsequent occasions during a 23-day acclimatisation regimen. Blood was sampled before and after exercise for serum creatinine, copeptin, interleukin-6, normetanephrine and cortisol. Fractional excretion of sodium was calculated for corresponding urine samples. Ratings of Perceived Exertion were reported every 5 min during exercise. Acute Kidney Injury was defined as serum creatinine rise ≥26.5 μmol L −1 or fall in estimated glomerular filtration rate >25%. Predictive values of each candidate marker for developing Acute Kidney Injury were determined by ROC analysis. Results: From baseline to Day 23, serum creatinine did not vary at rest, but showed a significant (P < 0.05) reduction post-exercise (120 [102, 139] versus 102 [91, 112] μmol L −1 ). Acute Kidney Injury was common (26/100 exposures) and occurred most frequently in the unacclimatised state. Log-normalised fractional excretion of sodium showed a significant interaction (exercise by acclimatization day), with post-exercise values tending to rise with acclimatisation. Ratings of Perceived Exertion predicted AKI (AUC 0.76, 95% confidence interval 0.65–0.88), performing at least as well as biochemical markers. Conclusions: Heat acclimatization is associated with reduced markers of renal stress and AKI incidence, perhaps due to improved regional perfusion. Acclimatisation and monitoring Ratings of Perceived Exertion are practical, non-invasive measures that could help to reduce renal injury from exercise in the heat.