Marathon Running Causes Temporary Kidney Damage

Triathlon Forum
1

Hello All,

https://qz.com/943754/marathon-running-causes-temporary-kidney-damage/

Excerpts:

"Although marathon runners are widely regarded as some of the healthiest people on Earth, cranking out those 26.2 miles (42 kilometers) does a number on your body. In addition to all wear and tear it puts on your muscles, bones, and heart, it can also affect your kidneys. Researchers at the Yale School of Medicine found that 80% of runners who completed marathons had kidney function that looked similar to patients who just underwent heart surgery.

“You can’t differentiate from someone who had a cardiac surgery, or a person in Intensive Care Unit,” says Chirag Parikh, a nephrologist at Yale and the lead author of the study."
“Michael Joyner, an anesthesiologist at the Mayo Clinic and former competitive marathoner, wasn’t surprised at all by the findings. And neither he nor Parkih find these results concerning for recreational distance runners: Within two days, the runners’ body chemistries were back to normal. Even professional endurance athletes who forgo their recovery period for days at a time—cyclists in major races like the Tour de France or ultramarathoners, who may cover huge distances every day for a week—make full recoveries, unless they have an underlying condition.”

2

we’ve been hearing this for decades. liver enzymes consistent with a heart attack. but was there a heart attack? or was it just coincidental? don’t know. do we have an incidence of kidney disease in those who’ve been hard at it for 30 or 40 years? otherwise, your kidneys had a workout, just like the rest of your body.

3

This paper is another line of evidence that points to the importance of being properly trained for something as dangerous to your body as a marathon or Ironman. If heat load is to blame for some of this kidney damage, proper training that slowly increases the activity of heat shock proteins and hormones related to protecting against heat damage is very important. Once properly trained, the body can endure some pretty brutal conditions with no long term damage.

4

Hello Slowman and All,

It would be interesting to see what the Iron Cowboy’s blood workups looked like after 50 Ironman distances in 50 days in 50 states … and how rapidly he recovered to normal values.

I suppose it is possible that some of those heart enzyme blood values indicate small heart muscle tears … that may heal with some scar tissue … to cause heart nerve signal transmission issues like mine later in life … and require a pacemaker to prevent the heart from skipping beats at very low heart rates.

5

Another aspect in the paper that is important:

This suggests that there is parenchymal damage (primarily tubular) in the kidney secondary to strenuous exercise. However, given nonrenal sites of production for several of these biomarkers, it is also plausible that this increase in biomarker levels is not specific to kidney injury because increased systemic production could lead to increased levels in urine.

So in other words, the biomarker tests are imperfect indicators of kidney damage, and something like marathon running which causes considerable (and less concerning) skeletal muscle damage could be “tricking” the test and looking like kidney damage.

6

Take home message is that physicians as a group still do not understand athletes and consider overweight, under exercised, struggling under the effects of garbage nutrition as the norm for human beings.

7

Take home message is that physicians as a group still do not understand athletes and consider overweight, under exercised, struggling under the effects of garbage nutrition as the norm for human beings.

I’m not sure if I agree with all of that as there is a lot that is understood, but doing something about it is a whole different ballgame. But, to add to the part of your statement that I do agree with, I read this provocative statement this week that really changed my perspective on some things:

"A sedentary life is now so prevalent that it has become common to refer to exercise as having “healthy benefits” even though the exercise-trained state is the biologically normal condition. "

http://www.sciencedirect.com/science/article/pii/S0092867414013178

8

I only skimmed the article but I didnt get that message at all from the article. The only take away that I get is that marathon are as stressful as cardiac surgery. There doesn’t seem to be any implication re sedentary vs athletes. The article did mention that these levels retune to normal quickly so no longTerm issues
To Slowmab The creatine that is elevated is likely the muscle subtype as opposed to the type found in cardiac muscle (ck-mb) but this wasn’t clearly stated
In regards to liver enzymes this is something that can be seen as an inflammatory marker. If you have pneumonia your liver function tests can be elevated as well and can be useful to predict for increasing morbidity in older populations.

9

i think these statements about liver enzymes, creatine levels, marathon as stressful as heart surgery, are simply clickbait. it’s like saying that what goes on in your woodburning stove is exactly the same thing that goes on in a forest fire. which means… what? that i need to quickly evacuate my property and seek shelter? it’s like saying that hypoxic sets in the pool generate precisely the same physiological response as when i try to kill myself via carbon monoxide poisoning. does that mean swimmers are suicidal?

yes, i think it’s pretty clear that those who’ve been hard at it for decades have a high incidence of arrhythmias of one sort or another. why that is i don’t know. otherwise, i’d like to know what the actual data is on major organ health among those who, like many of us, have been at this for 40 or 50 years. i hear anecdotally of a lot of us having arrhythmias. i don’t hear anecdotally of any of us having liver or kidney damage. therefore, this kind of sensationalist horseshit out of academia just does nothing to help and everything to obfuscate.

over the last year i’ve read in the NYT about how all that running hurts your joints in the longrun. then… no! no! it actually helps your joints in the long run! so, to academia, maybe exhale and not make far reaching comments until you can stand behind the statements you make.

10

To clarify, the linked article is wrong regarding semantics. The study measured creatinine and not creatine. Though both are related to muscle breakdown, they are not used the same way. Creatine (CK) is used for excessive muscle breakdown like rhabomyolysis or CK-MB, which is specific to cardiac muscle, is used for heart attacks.
Creatinine is a by product of normal muscle break down which is used for measure how well our kidneys are filtering it out. The higher, the poorer, the kidneys are filtering it out of our blood.

The original article uses creatinine:
http://www.ajkd.org/article/S0272-6386(17)30536-X/fulltext

This is a much better article related to the study above:

https://www.theatlantic.com/health/archive/2017/03/marathon-kidneys/520962/

The only take away I get is that the body is stressed and your body responds. Long term studies are needed. I don’t think there are any real surprises in this study. When perfusion (i.e. blood flow) is restricted/limited (e.g. high intensity endurance events or shock due to infection, loss of blood, etc.) , our bodies shunt blood to protect vital organs. The kidneys are one of the first ones to “suffer.” Some ICUs utilize a device called NIRS (near infrared spectroscopy) which measures perfusion.

11

The sensationalist bullshit that the article’s author wrote aside, the research that they did may simply identify a model from which to do more research. I think from a research perspective (though I’m not a researcher) in regards to the last paragraph where the study’s author wondered if there might be any extrapolation to field workers who work 12 hours and have a higher incidence of kidney disease is what is most interesting rather than healthy athletes. For example at what point do we (as humans) reach a point, if there is a point, that overheating combined with dehydration results in kidney disease. I think that not everything about athletes is about athletes. We as a group just provide a good study group on what extreme events do to the body as it is hard to ask regular people to do the dumb shit we do for fun

12

i would say that correlation is not causation but you need bad outcomes before you can even talk about causation. i have not seen any bad outcomes to kidneys or livers in long distance athletes. maybe i am misinformed about this.

i don’t at all mind someone using athletes as a proxy for some other group, as long as the author doesn’t leave an impression about athletic endeavors that is wholly unsupported by any true facts, yet casts a cloud over the safety of such endeavors.

13

If my liver enzymes are indicating the heart attack while my resting heart rate is in the mid 40s…

14

I completely agree with you. I think the author of the article raised fake fears and was simply trying to find a sensational byline. I can absolutely imagine how the interview with the doctors went.
Interviewer: So, your saying that running a marathon can cause damage Like that seen in heart surgery.
Doctor: yeah,enzyme levels approximate that seen in Cardiac surgery or ICU patients but are transient.
Interviewer: Using the transitive property (or some such mathematical formula) since enzyme levels in marathon = enzyme levels in cardiac surgery then running marathon must be = to cardiac surgery

These types of articles have no value IMO and cause so much disinformation

15

Take home message is that physicians as a group still do not understand athletes and consider overweight, under exercised, struggling under the effects of garbage nutrition as the norm for human beings.

I’m not sure if I agree with all of that as there is a lot that is understood, but doing something about it is a whole different ballgame. But, to add to the part of your statement that I do agree with, I read this provocative statement this week that really changed my perspective on some things:

"A sedentary life is now so prevalent that it has become common to refer to exercise as having “healthy benefits” even though the exercise-trained state is the biologically normal condition. "

http://www.sciencedirect.com/...ii/S0092867414013178

Although running a long distance (the persistent hunting theory aside) has probably always been pretty rare. Walking a lot everyday quite common though.

16

This is nothing new IMO. I almost had kidney damage that stemmed from hip surgery (I had rhabdo). My leg was strained during an 8 hour surgery and started breaking down. Muscles can start breaking down (CK) during exercise and too much breakdown will damage your kidneys. You can be in the best shape and well prepared for the event and still get rhabdo.

17

This is nothing new IMO. I almost had kidney damage that stemmed from hip surgery (I had rhabdo). My leg was strained during an 8 hour surgery and started breaking down. Muscles can start breaking down (CK) during exercise and too much breakdown will damage your kidneys. You can be in the best shape and well prepared for the event and still get rhabdo.

As someone else noted, kidneys are very sensitive to perfusion. The cells that are doing the filtering have some of the highest metabolic activity in the body. This is why people can end up with kidney failure from conditions that have nothing to do with the kidneys initially. Basically anything that compromises blood flow to the them can damage them to some degree or another. But they are fairly resilient and bounce back usually. So not really all that surprising that running a marathon might negatively impact kidney function for a time.

18

Hello All,

https://qz.com/...orary-kidney-damage/

Excerpts:

"Although** marathon runners are widely regarded as some of the healthiest people on Earth**, cranking out those 26.2 miles (42 kilometers) does a number on your body. In addition to all wear and tear it puts on your muscles, bones, and heart, it can also affect your kidneys. Researchers at the Yale School of Medicine found that 80% of runners who completed marathons had kidney function that looked similar to patients who just underwent heart surgery.

well, a model’s only as good as its assumptions, and i’d quibble with this one.

high-end ultra-distance sport isn’t healthy per se. the lifestyle might be, and being active generally is good, but being fit is not the same thing as being healthy. i mean, if you want to live to 100, don’t gun for a 2:20 marathon. just eat smart and go walking every day.

ultimately i’m not terribly surprised that you’d show kidney damage immediately after a marathon - your muscles will all be damaged, and you’re swimming in inflammation. there was some research recently on microscopic markers of damage showing up 6-12 mos after ultras and ironman races.

-mike

19

Hello All,

https://qz.com/...orary-kidney-damage/

Excerpts:

"Although marathon runners are widely regarded as some of the healthiest people on Earth, cranking out those 26.2 miles (42 kilometers) does a number on your body. In addition to all wear and tear it puts on your muscles, bones, and heart, it can also affect your kidneys. Researchers at the Yale School of Medicine found that 80% of runners who completed marathons had kidney function that looked similar to patients who just underwent heart surgery.

This is basic physiology, is it bad? Not really, it can cause issues in certain environments for certain individuals… it will most likley not damage your kidneys long term, just overload them short term, your heart will probably be affected way more long term.

  1. Inadequate ventilation of the lungs causes respiratory acidosis. The rate at which carbon dioxide is eliminated from the body fluids through the lungs falls. This increases the concentration of carbon dioxide in the body fluids. As carbon dioxide levels increase excess carbon dioxide reacts with water to form carbonic acid. The carbonic acid dissociates to form hydrogen ions and bicarbonate ions. The increase in hydrogen ion concentration causes the pH of the body fluids to decrease. If the pH of the body fluids falls below 7.35, symptoms of respiratory acidosis become apparent.

Buffers help resist a decrease in pH, and the kidneys help compensate for failure of the lungs to prevent respiratory acidosis by increasing the rate at which they secrete hydrogen ions into the filtrate and reabsorb bicarbonate ions.

  1. Rhabdomyolysis - more common then not, can be lethal, but in most cases is not.

People have “idiot proof” survival switches built in, before they die during marathon those switches kick in and save their a$$

Theoretical scenario: take some inactive person and let him run marathon, drug him a bit to turn off “survival mechanisms” I bet any money he will die in the process, or will be very close to death. Most of the healthy people will not die, they will stop first, but if you motivate them “properly” they could die.

20

Hello All,

https://qz.com/...orary-kidney-damage/

Excerpts:

"Although marathon runners are widely regarded as some of the healthiest people on Earth, cranking out those 26.2 miles (42 kilometers) does a number on your body. In addition to all wear and tear it puts on your muscles, bones, and heart, it can also affect your kidneys. Researchers at the Yale School of Medicine found that 80% of runners who completed marathons had kidney function that looked similar to patients who just underwent heart surgery.

This is basic physiology, is it bad? Not really, it can cause issues in certain environments for certain individuals… it will most likley not damage your kidneys long term, just overload them short term, your heart will probably be affected way more long term.

  1. Inadequate ventilation of the lungs causes respiratory acidosis. The rate at which carbon dioxide is eliminated from the body fluids through the lungs falls. This increases the concentration of carbon dioxide in the body fluids. As carbon dioxide levels increase excess carbon dioxide reacts with water to form carbonic acid. The carbonic acid dissociates to form hydrogen ions and bicarbonate ions. The increase in hydrogen ion concentration causes the pH of the body fluids to decrease. If the pH of the body fluids falls below 7.35, symptoms of respiratory acidosis become apparent.

Buffers help resist a decrease in pH, and the kidneys help compensate for failure of the lungs to prevent respiratory acidosis by increasing the rate at which they secrete hydrogen ions into the filtrate and reabsorb bicarbonate ions.

  1. Rhabdomyolysis - more common then not, can be lethal, but in most cases is not.

People have “idiot proof” survival switches built in, before they die during marathon those switches kick in and save their a$$

Theoretical scenario: take some inactive person and let him run marathon, drug him a bit to turn off “survival mechanisms” I bet any money he will die in the process, or will be very close to death. Most of the healthy people will not die, they will stop first, but if you motivate them “properly” they could die.

Respiratory acidosis is something that happens to people who can’t clear CO2 adequately, like those with COPD. It’s not something that happens to someone running a marathon. The compensation of the kidneys, mostly by retaining bicarbonate to buffer the acidosis, takes a number of hours to occur maybe even a day or so. Again, not really relevant to an athlete, but usually someone with pulmonary disease of one sort or another.

An endurance athlete experiences a metabolic acidosis (if they are exercising hard enough) due to the production of lactic acid. A significant drop in pH is averted by increased ventilation to blow off that extra acid via CO2 exhalation. So relatively speaking a respiratory alkalosis compensates for the metabolic acidosis.