Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation's Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month's responses were authored by Danielle S. Wentworth, MSN, FNP-BC, who practices in the Division of Nephrology at the University of Virginia Health System in Charlottesville, and Barbara Weis Malone, DNP, FNP-C, FNKF, who is an Assistant Professor in the Adult/Gerontology NP Program in the College of Nursing, and a Nurse Practitioner in the School of Medicine, at the University of Colorado Anschutz Medical Campus.
The other recent study examined use of NSAIDs by ultramarathon runners (ie, those who run more than 26.219 miles). In an intention-to-treat analysis, 52% of runners taking ibuprofen developed AKI, compared with 34% of those receiving placebo; the number needed to treat was 5.5. AKI was also more severe in NSAID users than in placebo users. The results were not statistically significant due to an underpowered study (N = 89). However, the authors also observed that slower runners were less likely to develop AKI, and those who lost the most weight during the race were more likely to develop AKI—suggesting that lower intensity running and adequate hydration may help prevent kidney injury.2
In summary: While marathon runners are prone to AKI, the injury seems to be transient and does not progress to CKD. Furthermore, use of NSAIDs during endurance running may contribute to AKI development, so patients should be advised to use caution with these analgesics. Finally, remind your endurance runners to stay hydrated, since it may help to limit kidney damage. As for the casual runner? The impact on the kidney remains unclear and needs further investigation. —DSW
Danielle S. Wentworth, MSN, FNP-BC Division of Nephrology, University of Viriginia Health System, Charlottesville
