Jessica Omassoli1, Neil E Hill1, David R Woods2, Simon K Delves3, Joanne L Fallowfield3, Stephen J Brett4, Duncan Wilson5, Richard W Corbett1, Adrian J Allsopp3, Michael J Stacey6. 1. Department of Medicine, Imperial College London, United Kingdom. 2. Department of Military Medicine, Royal Centre for Defence Medicine, United Kingdom; Carnegie Research Institute, Leeds Beckett University, United Kingdom. 3. Environmental Medicine and Science Division, Institute of Naval Medicine, United Kingdom. 4. Department of Surgery and Cancer, Imperial College London, United Kingdom; General intensive Care Unit, Hammersmith Hospital, London, United Kingdom. 5. Department of Military Medicine, Royal Centre for Defence Medicine, United Kingdom. 6. Department of Military Medicine, Royal Centre for Defence Medicine, United Kingdom; Department of Surgery and Cancer, Imperial College London, United Kingdom. Electronic address: m.stacey13@imperial.ac.uk.
Abstract
OBJECTIVES: To investigate changes in renal status from exercise in the heat with acclimatisation and to evaluate surrogates markers of Acute Kidney Injury. DESIGN: Prospective observational cohort study. METHODS: 20 male volunteers performed 60 min standardised exercise in the heat, at baseline and on four subsequent occasions during a 23-day acclimatisation regimen. Blood was sampled before and after exercise for serum creatinine, copeptin, interleukin-6, normetanephrine and cortisol. Fractional excretion of sodium was calculated for corresponding urine samples. Ratings of Perceived Exertion were reported every 5 min during exercise. Acute Kidney Injury was defined as serum creatinine rise ≥26.5 μmol L-1 or fall in estimated glomerular filtration rate >25%. Predictive values of each candidate marker for developing Acute Kidney Injury were determined by ROC analysis. RESULTS: From baseline to Day 23, serum creatinine did not vary at rest, but showed a significant (P<0.05) reduction post-exercise (120 [102, 139] versus 102 [91, 112] μmol L-1). Acute Kidney Injury was common (26/100 exposures) and occurred most frequently in the unacclimatised state. Log-normalised fractional excretion of sodium showed a significant interaction (exercise by acclimatization day), with post-exercise values tending to rise with acclimatisation. Ratings of Perceived Exertion predicted AKI (AUC 0.76, 95% confidence interval 0.65-0.88), performing at least as well as biochemical markers. CONCLUSIONS: Heat acclimatization is associated with reduced markers of renal stress and AKI incidence, perhaps due to improved regional perfusion. Acclimatisation and monitoring Ratings of Perceived Exertion are practical, non-invasive measures that could help to reduce renal injury from exercise in the heat. Crown
OBJECTIVES: To investigate changes in renal status from exercise in the heat with acclimatisation and to evaluate surrogates markers of Acute Kidney Injury. DESIGN: Prospective observational cohort study. METHODS: 20 male volunteers performed 60 min standardised exercise in the heat, at baseline and on four subsequent occasions during a 23-day acclimatisation regimen. Blood was sampled before and after exercise for serum creatinine, copeptin, interleukin-6, normetanephrine and cortisol. Fractional excretion of sodium was calculated for corresponding urine samples. Ratings of Perceived Exertion were reported every 5 min during exercise. Acute Kidney Injury was defined as serum creatinine rise ≥26.5 μmol L-1 or fall in estimated glomerular filtration rate >25%. Predictive values of each candidate marker for developing Acute Kidney Injury were determined by ROC analysis. RESULTS: From baseline to Day 23, serum creatinine did not vary at rest, but showed a significant (P<0.05) reduction post-exercise (120 [102, 139] versus 102 [91, 112] μmol L-1). Acute Kidney Injury was common (26/100 exposures) and occurred most frequently in the unacclimatised state. Log-normalised fractional excretion of sodium showed a significant interaction (exercise by acclimatization day), with post-exercise values tending to rise with acclimatisation. Ratings of Perceived Exertion predicted AKI (AUC 0.76, 95% confidence interval 0.65-0.88), performing at least as well as biochemical markers. CONCLUSIONS: Heat acclimatization is associated with reduced markers of renal stress and AKI incidence, perhaps due to improved regional perfusion. Acclimatisation and monitoring Ratings of Perceived Exertion are practical, non-invasive measures that could help to reduce renal injury from exercise in the heat. Crown
Authors: Zachary J Schlader; David Hostler; Mark D Parker; Riana R Pryor; James W Lohr; Blair D Johnson; Christopher L Chapman Journal: Nutrients Date: 2019-09-04 Impact factor: 5.717
Authors: Michael J Stacey; Neil E Hill; Iain T Parsons; Jenny Wallace; Natalie Taylor; Rachael Grimaldi; Nishma Shah; Anna Marshall; Carol House; John P O'Hara; Stephen J Brett; David R Woods Journal: PLoS One Date: 2022-02-17 Impact factor: 3.240
Authors: Louisa Samuels; Britt Nakstad; Nathalie Roos; Ana Bonell; Matthew Chersich; George Havenith; Stanley Luchters; Louise-Tina Day; Jane E Hirst; Tanya Singh; Kirsty Elliott-Sale; Robyn Hetem; Cherie Part; Shobna Sawry; Jean Le Roux; Sari Kovats Journal: Int J Biometeorol Date: 2022-05-12 Impact factor: 3.738