{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T18:28:58Z","timestamp":1786472938503,"version":"build-2736575974"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Short-term heat acclimation (HA) induces cardiovascular and fluid-regulatory adaptations, but it\u2019s impact on markers of renal tubular injury and acute kidney injury risk (AKI) during exercise-heat stress remains unclear. Fourteen healthy endurance-trained male athletes were randomised to five days of isothermic HA (HOT;\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20097; 32 \u00b0C, 70% relative humidity; target core temperature \u226538.5 \u00b0C), or exercise in thermoneutral conditions (TEMP,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20097). Heat stress tests (HST; 45 min cycling at 32 \u00b0C, 70% RH) were performed pre- and post-intervention. Blood biomarkers of kidney tubular stress (NGAL, KIM-1), fluid-regulation (copeptin, serum osmolality) and sympathetic activity (plasma normetanephrine) were measured at rest and immediately post-HST. HA reduced resting heart rate (\u22128\u2009\u00b1\u20095 bpm,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.007,\n                    <jats:italic>d<\/jats:italic>\n                    \u2009=\u20091.0), increased plasma volume (+7.3 \u00b1 5.1%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.022) and sweat loss (+500\u2009\u00b1\u2009539 mL,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.018,\n                    <jats:italic>d<\/jats:italic>\n                    \u2009=\u20091.1). Copeptin rose during the pre-intervention HST in both groups (HOT:\u2009+\u200911\u2009\u00b1\u20096; TEMP:\u2009+\u200912\u2009\u00b1\u200913 pmol\u00b7L\u2009\u207b\u2009\u00b9,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05), but not post-intervention. NGAL increased only in TEMP during HST1 (+45\u2009\u00b1\u200929 \u03bcg\u00b7L\u2009\u207b\u2009\u00b9,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.030), while KIM-1 remained unchanged. No group x time interactions were observed for any biomarkers (p\u2009&gt;\u20090.05). Five days of HA improved cardiovascular and thermoregulatory responses but did not alter renal stress markers or fluid-regulatory responses during exercise in the heat. These findings suggest short-term HA enhances heat tolerance but may not attenuate renal biomarker responses associated with early tubular stress under hot, humid conditions.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0345346","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:30:56Z","timestamp":1786469456000},"page":"e0345346","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Five days of heat acclimation improves cardiovascular and thermoregulatory responses without altering renal stress biomarkers in endurance athletes"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9916-7390","authenticated-orcid":true,"given":"Daniel","family":"Snape","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barney","family":"Wainwright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain T.","family":"Parsons","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Stacey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Woods","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"O\u2019Hara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"issue":"2","key":"pone.0345346.ref001","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1002\/j.2040-4603.2015.tb00612.x","article-title":"Heat Stroke","volume":"5","author":"LR Leon","year":"2015","journal-title":"Comprehensive Physiology"},{"issue":"9","key":"pone.0345346.ref002","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.3390\/nu11092087","article-title":"The Potential for Renal Injury Elicited by Physical Work in the Heat","volume":"11","author":"ZJ Schlader","year":"2019","journal-title":"Nutrients"},{"key":"pone.0345346.ref003","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1113\/jphysiol.2004.063289","article-title":"Sustained and generalized extracellular fluid expansion following heat acclimation","volume":"559","author":"MJ Patterson","year":"2004","journal-title":"J Physiol"},{"issue":"2","key":"pone.0345346.ref004","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1080\/23328940.2020.1826841","article-title":"Kidney physiology and pathophysiology during heat stress and the modification by exercise, dehydration, heat acclimation and aging","volume":"8","author":"CL Chapman","year":"2020","journal-title":"Temperature (Austin)"},{"issue":"4","key":"pone.0345346.ref005","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.3390\/ijerph17041325","article-title":"Acute Kidney Injury Biomarker Responses to Short-Term Heat Acclimation","volume":"17","author":"RR Pryor","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0345346.ref006","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1053\/j.ajkd.2015.08.021","article-title":"Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy","volume":"67","author":"C Roncal-Jimenez","year":"2016","journal-title":"Am J Kidney Dis"},{"issue":"2","key":"pone.0345346.ref007","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1053\/j.ajkd.2017.01.045","article-title":"Kidney Injury and Repair Biomarkers in Marathon Runners","volume":"70","author":"SG Mansour","year":"2017","journal-title":"Am J Kidney Dis"},{"issue":"5","key":"pone.0345346.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejim.2011.02.007","article-title":"Significant variation of traditional markers of liver injury after a half-marathon run","volume":"22","author":"G Lippi","year":"2011","journal-title":"Eur J Intern Med"},{"issue":"1","key":"pone.0345346.ref009","article-title":"Effect of exercise on kidney-relevant biomarkers in the general population: a systematic review and meta-analysis","volume":"15","author":"Q Liu","year":"2025","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0345346.ref010","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s00421-017-3740-8","article-title":"Copeptin reflects physiological strain during thermal stress","volume":"118","author":"MJ Stacey","year":"2018","journal-title":"Eur J Appl Physiol"},{"issue":"1","key":"pone.0345346.ref011","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00421-017-3758-y","article-title":"Heart rate variability and plasma nephrines in the evaluation of heat acclimatisation status","volume":"118","author":"MMJ Stacey","year":"2018","journal-title":"Eur J Appl Physiol"},{"issue":"3","key":"pone.0345346.ref012","first-page":"341","article-title":"Copeptin, a stable peptide derived from the vasopressin precursor, correlates with the individual stress level","volume":"29","author":"M Katan","year":"2008","journal-title":"Neuro Endocrinol Lett"},{"issue":"6","key":"pone.0345346.ref013","doi-asserted-by":"crossref","DOI":"10.1152\/ajpregu.00215.2025","article-title":"Heat acclimation alters the relation between hyperthermia and biomarkers of kidney function during exercise heat stress","volume":"329","author":"KR Connor","year":"2025","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"pone.0345346.ref014","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jtherbio.2015.02.005","article-title":"Isothermic and fixed intensity heat acclimation methods induce similar heat adaptation following short and long-term timescales","author":"OR Gibson","year":"2015","journal-title":"J Therm Biol"},{"issue":"3","key":"pone.0345346.ref015","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s42978-023-00263-8","article-title":"Effects of Heat Adaptation on Physiology, Perception, and Exercise Performance in the Heat: An Updated Meta-Analysis","volume":"6","author":"CJ Tyler","year":"2024","journal-title":"J Sci In Sport and Exercise"},{"issue":"1","key":"pone.0345346.ref016","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s00421-019-04269-5","article-title":"Short-term isothermic heat acclimation elicits beneficial adaptations but medium-term elicits a more complete adaptation","volume":"120","author":"JN Moss","year":"2020","journal-title":"Eur J Appl Physiol"},{"issue":"2","key":"pone.0345346.ref017","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1123\/ijspp.8.2.111","article-title":"Guidelines to classify subject groups in sport-science research","volume":"8","author":"K De Pauw","year":"2013","journal-title":"Int J Sports Physiol Perform"},{"issue":"1","key":"pone.0345346.ref018","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s12199-017-0675-y","article-title":"Preventing heat illness in the anticipated hot climate of the Tokyo 2020 Summer Olympic Games","volume":"22","author":"T Kakamu","year":"2017","journal-title":"Environ Health Prev Med"},{"key":"pone.0345346.ref019","doi-asserted-by":"crossref","DOI":"10.4324\/9780203966846","volume-title":"Sport and exercise physiology testing guidelines: volume I\u2013sport testing: the British association of sport and exercise sciences guide","author":"EM Winter","year":"2006"},{"issue":"3","key":"pone.0345346.ref020","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1055\/a-1890-0993","article-title":"Reliability of Biomarkers of Physiological Stress at Rest and Post-exertional Heat Stress","volume":"44","author":"D Snape","year":"2023","journal-title":"Int J Sports Med"},{"key":"pone.0345346.ref021","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1152\/jappl.1964.19.3.531","article-title":"A New Weighting System For Mean Surface Temperature Of The Human Body","volume":"19","author":"NL Ramanathan","year":"1964","journal-title":"J Appl Physiol"},{"issue":"3","key":"pone.0345346.ref022","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1055\/s-2008-1026080","article-title":"Ratings of perceived exertion and heart rates during short-term cycle exercise and their use in a new cycling strength test","volume":"3","author":"G Borg","year":"1982","journal-title":"Int J Sports Med"},{"issue":"1","key":"pone.0345346.ref023","doi-asserted-by":"crossref","first-page":"211","DOI":"10.2466\/pms.1986.62.1.211","article-title":"Perceptual and physiological responses during exercise in cool and cold water","volume":"62","author":"MM Toner","year":"1986","journal-title":"Percept Mot Skills"},{"issue":"6","key":"pone.0345346.ref024","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1007\/s00421-004-1137-y","article-title":"Thermal sensation and comfort in transient non-uniform thermal environments","volume":"92","author":"H Zhang","year":"2004","journal-title":"Eur J Appl Physiol"},{"issue":"1","key":"pone.0345346.ref025","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1152\/jappl.1967.22.1.39","article-title":"Heat acclimatization by controlled hyperthermia in hot-dry and hot-wet climates","volume":"22","author":"RH Fox","year":"1967","journal-title":"J Appl Physiol"},{"issue":"2","key":"pone.0345346.ref026","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1152\/jappl.1974.37.2.247","article-title":"Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration","volume":"37","author":"DB Dill","year":"1974","journal-title":"J Appl Physiol"},{"key":"pone.0345346.ref027","doi-asserted-by":"crossref","first-page":"863","DOI":"10.3389\/fpsyg.2013.00863","article-title":"Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs","volume":"4","author":"D Lakens","year":"2013","journal-title":"Front Psychol"},{"issue":"11","key":"pone.0345346.ref028","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1007\/s40279-016-0538-5","article-title":"The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis","volume":"46","author":"CJ Tyler","year":"2016","journal-title":"Sports Med"},{"key":"pone.0345346.ref029","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.autneu.2016.02.002","article-title":"Cardiovascular adaptations supporting human exercise-heat acclimation","volume":"196","author":"JD P\u00e9riard","year":"2016","journal-title":"Auton Neurosci"},{"issue":"5","key":"pone.0345346.ref030","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1152\/jappl.1976.40.5.786","article-title":"Acclimatization in a hot, humid environment: body fluid adjustments","volume":"40","author":"LC Senay","year":"1976","journal-title":"J Appl Physiol"},{"issue":"2","key":"pone.0345346.ref031","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.autneu.2013.02.017","article-title":"Time course of the attenuation of sympathetic nervous activity during active heat acclimation","volume":"177","author":"D Hodge","year":"2013","journal-title":"Auton Neurosci"},{"key":"pone.0345346.ref032","doi-asserted-by":"crossref","first-page":"102705","DOI":"10.1016\/j.jtherbio.2020.102705","article-title":"Echocardiographic changes following active heat acclimation","volume":"93","author":"IT Parsons","year":"2020","journal-title":"J Therm Biol"},{"issue":"18","key":"pone.0345346.ref033","doi-asserted-by":"crossref","DOI":"10.14814\/phy2.13851","article-title":"Heat acclimatization blunts copeptin responses to hypertonicity from dehydrating exercise in humans","volume":"6","author":"MJ Stacey","year":"2018","journal-title":"Physiol Rep"},{"key":"pone.0345346.ref034","article-title":"Seven days of mixed\u2010method heat acclimation improved markers of cardiovascular and fluid\u2010regulatory strain during exercise\u2010heat stress","author":"D Snape","year":"2025","journal-title":"Exp Physiol"},{"key":"pone.0345346.ref035","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jtherbio.2018.03.002","article-title":"Inter-individual variation in the adaptive response to heat acclimation","volume":"74","author":"J Corbett","year":"2018","journal-title":"J Therm Biol"},{"issue":"3","key":"pone.0345346.ref036","doi-asserted-by":"crossref","DOI":"10.1152\/ajpregu.00359.2003","article-title":"Humid heat acclimation does not elicit a preferential sweat redistribution toward the limbs","volume":"286","author":"MJ Patterson","year":"2004","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"issue":"1","key":"pone.0345346.ref037","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1113\/EP088637","article-title":"Impact of passive heat acclimation on markers of kidney function during heat stress","volume":"106","author":"N Ravanelli","year":"2021","journal-title":"Exp Physiol"},{"issue":"9","key":"pone.0345346.ref038","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.jsams.2019.04.010","article-title":"Variation in renal responses to exercise in the heat with progressive acclimatisation","volume":"22","author":"J Omassoli","year":"2019","journal-title":"J Sci Med Sport"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345346","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:31:05Z","timestamp":1786469465000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345346"}},"subtitle":[],"editor":[{"given":"Hidenori","family":"Otani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":38,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0345346","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]}}}