{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:09:21Z","timestamp":1792613361349,"version":"4.5.0"},"reference-count":177,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T00:00:00Z","timestamp":1671062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Increasingly popular, ultra-endurance participation exposes athletes to extremely high levels of functional and structural damage. Ultra-endurance athletes commonly develop acute kidney injury (AKI) and other pathologies harmful to kidney health. There is strong evidence that non-steroidal anti-inflammatory drugs, common amongst ultra-athletes, is linked to increased risk and severity of AKI and potentially ischaemic renal injury, i.e., acute tubular necrosis. Ultra-endurance participation also increases the risk of exertional rhabdomyolysis, exercise-associated hyponatremia, and gastrointestinal symptoms, interlinked pathologies all with potential to increase the risk of AKI. Hydration and fuelling both also play a role with the development of multiple pathologies and ultimately AKI, highlighting the need for individualised nutritional and hydration plans to promote athlete health. Faster athletes, supplementing nitrates, and being female also increase the risk of developing AKI in this setting. Serum creatinine criteria do not provide the best indicator for AKI for ultra-athletes therefore further investigations are needed to assess the practicality and accuracy of new renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL). The potential of recurring episodes of AKI provide need for further research to assess the longitudinal renal health impact of ultra-participation to provide appropriate advice to athletes, coaches, medical staff, and event organisers.<\/jats:p>","DOI":"10.3390\/ijerph192416887","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T01:46:51Z","timestamp":1671155211000},"page":"16887","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review"],"prefix":"10.3390","volume":"19","author":[{"given":"Victoria","family":"Tidmas","sequence":"first","affiliation":[{"name":"Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4104-9447","authenticated-orcid":false,"given":"Jon","family":"Brazier","sequence":"additional","affiliation":[{"name":"Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4632-3764","authenticated-orcid":false,"given":"Lindsay","family":"Bottoms","sequence":"additional","affiliation":[{"name":"Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6748-9870","authenticated-orcid":false,"given":"Daniel","family":"Muniz","sequence":"additional","affiliation":[{"name":"Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8606-0458","authenticated-orcid":false,"given":"Terun","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3390-9590","authenticated-orcid":false,"given":"Sivakumar","family":"Sridharan","sequence":"additional","affiliation":[{"name":"Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK"},{"name":"Renal Unit, Lister Hospital, East and North Herts Trust, Stevenage SG1 4AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Farrington","sequence":"additional","affiliation":[{"name":"Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK"},{"name":"Renal Unit, Lister Hospital, East and North Herts Trust, Stevenage SG1 4AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1007\/s40279-021-01561-3","article-title":"Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review","volume":"52","author":"Scheer","year":"2021","journal-title":"Sport Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.physbeh.2018.10.002","article-title":"Muscle damage and inflammation biomarkers after two ultra-endurance mountain races of different distances: 54 km vs 111 km","volume":"205","author":"Alcaraz","year":"2019","journal-title":"Physiol. 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