Variation in renal responses to exercise in the heat with progressive acclimatisation
File(s)
Accepted version
Accepted version
Author(s)
Type
Journal Article
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.
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.
Date Issued
2019-09
Date Acceptance
2019-04-27
Citation
Journal of Science and Medicine in Sport, 2019, 22 (9), pp.1004-1009
ISSN
1440-2440
Publisher
Elsevier
Start Page
1004
End Page
1009
Journal / Book Title
Journal of Science and Medicine in Sport
Volume
22
Issue
9
Copyright Statement
© 2019 Published by Elsevier Ltd on behalf of Sports Medicine Australia. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
Society for Endocrinology
Identifier
https://www.sciencedirect.com/science/article/pii/S144024401930235X?via%3Dihub
Grant Number
N/A
Subjects
Science & Technology
Life Sciences & Biomedicine
Sport Sciences
Heat stroke
Renal insufficiency
Chronic
Thermotolerance
Cytokines
Vasopressins
ACUTE KIDNEY INJURY
PERCEIVED EXERTION
BIOMARKERS
MARKERS
RATINGS
STRAIN
HOT
Chronic
Cytokines
Heat stroke
Renal insufficiency
Thermotolerance
Vasopressins
Acclimatization
Acute Kidney Injury
Adult
Biomarkers
Creatinine
Exercise
Glomerular Filtration Rate
Glycopeptides
Hot Temperature
Humans
Hydrocortisone
Interleukin-6
Kidney
Male
Military Personnel
Normetanephrine
Prospective Studies
Stress, Physiological
Young Adult
Kidney
Humans
Normetanephrine
Creatinine
Hydrocortisone
Glycopeptides
Interleukin-6
Glomerular Filtration Rate
Exercise
Prospective Studies
Acclimatization
Adult
Military Personnel
Male
Hot Temperature
Stress, Physiological
Young Adult
Acute Kidney Injury
Biomarkers
1106 Human Movement and Sports Sciences
1117 Public Health and Health Services
Sport Sciences
Publication Status
Published
Date Publish Online
2019-05-04