High intensity resistance training causes muscle damage and increases biomarkers of acute kidney injury in healthy individuals

Abstract Background Fluid overload, a critical consequence of acute kidney injury (AKI), is associated with worse outcomes. The optimal fluid removal rate per day during continuous renal replacement therapy (CRRT) is unknown. The purpose of this study is to evaluate the impact of the ultrafiltration rate on mortality in critically ill patients with AKI receiving CRRT. Methods This was a retrospective cohort study where we reviewed 1398 patients with AKI who received CRRT between December 2006 and November 2015 at the Mayo Clinic, Rochester, MN, USA. The net ultrafiltration rate (UFNET) was categorized into low- and high-intensity groups (<35 and ≥35 mL/kg/day, respectively). The impact of different UFNET intensities on 30-day mortality was assessed using logistic regression after adjusting for age, sex, body mass index, fluid balance from intensive care unit (ICU) admission to CRRT initiation, Acute Physiologic Assessment and Chronic Health Evaluation III and sequential organ failure assessment scores, baseline serum creatinine, ICU day at CRRT initiation, Charlson comorbidity index, CRRT duration and need of mechanical ventilation. Results The mean ± SD age was 62 ± 15 years, and 827 (59%) were male. There were 696 patients (49.7%) in the low- and 702 (50.2%) in the high-intensity group. Thirty-day mortality was 755 (54%). There were 420 (60%) deaths in the low-, and 335 (48%) in the high-intensity group (P < 0.001). UFNET ≥35 mL/kg/day remained independently associated with lower 30-day mortality (adjusted odds ratio = 0.47, 95% confidence interval 0.37–0.59; P < 0.001) compared with <35 mL/kg/day. Conclusions More intensive fluid removal, UFNET ≥35 mL/kg/day, among AKI patients receiving CRRT is associated with lower mortality. Future prospective studies are required to confirm this finding.

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The dark side of high-intensity renal replacement therapy of acute kidney injury in critically ill patients

International Urology and Nephrology ◽

10.1007/s11255-010-9733-8 ◽

2010 ◽

Vol 42 (2) ◽

pp. 435-440 ◽

Cited By ~ 10

Author(s):

Helmut Schiffl

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

High Intensity ◽

Kidney Injury ◽

Dark Side

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Clinical Rhabdomyolysis With Acute Kidney Injury Secondary to High-Intensity Rosuvastatin Use: A Case Report

Cureus ◽

10.7759/cureus.10932 ◽

2020 ◽

Author(s):

Deepak Chitralli ◽

Ronak Raheja ◽

Kishore Br

Keyword(s):

Acute Kidney Injury ◽

Case Report ◽

High Intensity ◽

Kidney Injury

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Acute Kidney Injury Biomarker Responses to Short-Term Heat Acclimation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17041325 ◽

2020 ◽

Vol 17 (4) ◽

pp. 1325 ◽

Cited By ~ 3

Author(s):

Riana R. Pryor ◽

J. Luke Pryor ◽

Lesley W. Vandermark ◽

Elizabeth L. Adams ◽

Rachel M. Brodeur ◽

...

Keyword(s):

Acute Kidney Injury ◽

Relative Humidity ◽

Serum Creatinine ◽

High Intensity ◽

Kidney Injury ◽

Heat Acclimation ◽

High Intensity Exercise ◽

Strenuous Exercise ◽

Hot Environment ◽

Clinical Biomarkers

The combination of hyperthermia, dehydration, and strenuous exercise can result in severe reductions in kidney function, potentially leading to acute kidney injury (AKI). We sought to determine whether six days of heat acclimation (HA) mitigates the rise in clinical biomarkers of AKI during strenuous exercise in the heat. Twenty men completed two consecutive 2 h bouts of high-intensity exercise in either hot (n = 12, 40 °C, 40% relative humidity) or mild (n = 8, 24 °C, 21% relative humidity) environments before (PreHA) and after (PostHA) 4 days of 90–120 min of exercise per day in a hot or mild environment. Increased clinical biomarkers of AKI (CLINICAL) was defined as a serum creatinine increase ≥0.3 mg·dL−1 or estimated glomerular filtration rate (eGFR) reduction >25%. Creatinine similarly increased in the hot environment PreHA (0.35 ± 0.23 mg·dL−1) and PostHA (0.39 ± 0.20 mg·dL−1), with greater increases than the mild environment at both time points (0.11 ± 0.07 mg·dL−1, 0.08 ± 0.06 mg·dL−1, p ≤ 0.001), respectively. CLINICAL occurred in the hot environment PreHA (n = 9, 75%), with fewer participants with CLINICAL PostHA (n = 7, 58%, p = 0.007), and no participants in the mild environment with CLINICAL at either time point. Percent change in plasma volume was predictive of changes in serum creatinine PostHA and percent changes in eGFR both PreHA and PostHA. HA did not mitigate reductions in eGFR nor increases in serum creatinine during high-intensity exercise in the heat, although the number of participants with CLINICAL was reduced PostHA.

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Exercising in a hot environment with muscle damage: effects on acute kidney injury biomarkers and kidney function

AJP Renal Physiology ◽

10.1152/ajprenal.00091.2013 ◽

2013 ◽

Vol 305 (6) ◽

pp. F813-F820 ◽

Cited By ~ 37

Author(s):

Naushad A. Junglee ◽

Umberto Di Felice ◽

Alberto Dolci ◽

Matthew B. Fortes ◽

Mahdi M. Jibani ◽

...

Keyword(s):

Acute Kidney Injury ◽

Muscle Damage ◽

Kidney Function ◽

Interleukin 6 ◽

Heat Stroke ◽

Kidney Injury ◽

Random Order ◽

Mean Difference ◽

Exercise Induced ◽

Hot Environments

Unaccustomed strenuous physical exertion in hot environments can result in heat stroke and acute kidney injury (AKI). Both exercise-induced muscle damage and AKI are associated with the release of interleukin-6, but whether muscle damage causes AKI in the heat is unknown. We hypothesized that muscle-damaging exercise, before exercise in the heat, would increase kidney stress. Ten healthy euhydrated men underwent a randomized, crossover trial involving both a 60-min downhill muscle-damaging run (exercise-induced muscle damage; EIMD), and an exercise intensity-matched non-muscle-damaging flat run (CON), in random order separated by 2 wk. Both treatments were followed by heat stress elicited by a 40-min run at 33°C. Urine and blood were sampled at baseline, after treatment, and after subjects ran in the heat. By design, EIMD induced higher plasma creatine kinase and interleukin-6 than CON. EIMD elevated kidney injury biomarkers (e.g., urinary neutrophil gelatinase-associated lipocalin (NGAL) after a run in the heat: EIMD-CON, mean difference [95% CI]: 12 [5, 19] ng/ml) and reduced kidney function (e.g., plasma creatinine after a run in the heat: EIMD-CON, mean difference [95% CI]: 0.2 [0.1, 0.3] mg/dl), where CI is the confidence interval. Plasma interleukin-6 was positively correlated with plasma NGAL ( r = 0.9, P = 0.001). Moreover, following EIMD, 5 of 10 participants met AKIN criteria for AKI. Thus for the first time we demonstrate that muscle-damaging exercise before running in the heat results in a greater inflammatory state and kidney stress compared with non-muscle-damaging exercise. Muscle damage should therefore be considered a risk factor for AKI when performing exercise in hot environments.

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Inflammation-Related Factors Identified as Biomarkers of Dehydration and Subsequent Acute Kidney Injury in Agricultural Workers

Biological Research For Nursing ◽

10.1177/10998004211016070 ◽

2021 ◽

pp. 109980042110160

Author(s):

Madelyn C. Houser ◽

Valerie Mac ◽

Daniel J. Smith ◽

Roxana C. Chicas ◽

Nezahualcoyotl Xiuhtecutli ◽

...

Keyword(s):

Acute Kidney Injury ◽

Muscle Damage ◽

Interleukin 6 ◽

Kidney Injury ◽

Agricultural Workers ◽

Unknown Etiology ◽

C Reactive Protein ◽

Reactive Protein ◽

Markers Of Inflammation ◽

Work Shifts

Globally, there is increasing recognition that agricultural workers are at risk for chronic kidney disease of unknown etiology (CKD u). Recurrent heat exposure, physical exertion, dehydration, muscle damage, and inflammation are hypothesized to contribute to the development of CKD u, but the relative importance of these processes and the interactions among them remain unclear. Moreover, there is a need to identify biomarkers that could distinguish individuals who are at greatest risk for kidney damage to target preventative interventions for CKD u. In this study, we evaluated dehydration and markers of inflammation, muscle damage, and renal function in agricultural workers at a non-workday baseline assessment. Urine specific gravity and kidney function were measured before and after work shifts on three subsequent days, and heat index, core body temperature, and heart rate were monitored during the work shifts. A combination of direct comparisons and machine learning algorithms revealed that reduced levels of uromodulin and sodium in urine and increased levels of interleukin-6 and C-reactive protein in serum were indicative of dehydration at baseline, and that dehydration, high body mass index, reduced urine uromodulin, and increased serum interleukin-6, C-reactive protein, and lipopolysaccharide-binding protein at baseline were predictive of acute kidney injury on subsequent workdays. Our findings suggest a method for identifying agricultural workers at greatest risk for kidney injury and reveal potential mechanisms responsible for this process, including pathways overlapping in dehydration and kidney injury. These results will guide future studies confirming these mechanisms and introducing interventions to protect kidney health in this vulnerable population.

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Effects of Exercise on Acute Kidney Injury Biomarkers and the Potential Influence of Fluid Intake

Annals of Nutrition and Metabolism ◽

10.1159/000515022 ◽

2021 ◽

pp. 1-7

Author(s):

Loris Allan Juett ◽

Lewis J. James ◽

Stephen Andrew Mears

Keyword(s):

Acute Kidney Injury ◽

Muscle Damage ◽

Fluid Intake ◽

Kidney Injury ◽

Strenuous Exercise ◽

Physical Work ◽

Tubular Injury ◽

Potential Influence ◽

Water Ingestion ◽

Renal Tubular

Acute kidney injury (AKI) incidence (diagnosed by changes in serum creatinine [Cr]) following prolonged endurance events has been reported to be anywhere from 4 to 85%, and hypohydration may contribute to this. Whilst an increase in serum Cr indicates impaired kidney function, this might be influenced by muscle damage. Therefore, the use of other AKI biomarkers which can detect renal tubular injury may be more appropriate. The long-term consequences of AKI are not well understood, but there are some potential concerns of an increased subsequent risk of chronic kidney disease (CKD). Therefore, this brief review explores the effects of exercise training/competition on novel AKI biomarkers and the potential influence of fluid intake. The increase in novel AKI biomarkers following prolonged endurance events suggests renal tubular injury. This is likely due to the long duration and relatively high exercise intensity, producing increased sympathetic tone, body temperature, hypohydration, and muscle damage. Whilst muscle damage appears to be an important factor in the pathophysiology of exercise-associated AKI, it may require coexisting hypohydration. Fluid intake seems to play a role in exercise-associated AKI, as maintaining euhydration with water ingestion during simulated physical work in the heat appears to attenuate rises in AKI biomarkers. The composition of fluid intake may also be important, as high-fructose drinks have been shown to exacerbate AKI biomarkers. However, it is yet to be seen if these findings are applicable to athletes performing strenuous exercise in a temperate environment. Additionally, further work should examine the effects of repeated bouts of strenuous exercise on novel AKI biomarkers.

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