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Article Title

SEX DIFFERENCES IN HYDRATION AND ACUTE KIDNEY INJURY BIOMARKERS AT THE 2019 B.A.A. BOSTON MARATHON

Abstract

Whitley C. Atkins1, Cory L. Butts2, Melani R. Kelly3, Chris Troyanos4, R. Mark Laursen5, Andrew Duckett5, Dawn M. Emerson3, Brendon P. McDermott1, FACSM

1University of Arkansas, Fayetteville, Arkansas; 2Weber State University, Ogden, Utah; 3University of Kansas, Lawrence, Kansas; 4Boston Athletic Association, Boston, Massachusetts; 5Boston University, Boston, Massachusetts

There are several studies demonstrating that acute kidney injury (AKI) is common immediately following marathon running. Many studies further suggest complete biomarker recovery within 24-hr. To date, however, sex differences in distance runners have received little investigation. Purpose: To evaluate sex differences on hydration and AKI biomarker changes surrounding running a marathon. Methods: Sixty-three participants (32 males and 31 females) in the Boston Athletic Association’s Boston Marathon (45.9 ± 9 y, 65.4 ± 10.8 kg, finishing time 3.78 ± 0.55 h) provided urine samples at three time points (pre-marathon, post-marathon and 24-hr postmarathon) for this study. Urine specific gravity (USG) was analyzed via refractometry and AKI biomarkers were evaluated using commercially available enzyme-linked immunosorbent assays. A 2 x 3 (sex x time) RM-ANOVA was used for statistical analysis post-hoc comparisons were completed with Bonferroni adjustments due to multiple time point comparisons. Results: Female USG (1.020 ± .001) was significantly greater post-marathon than male USG (1.016 ± .001; p = .028), yet male USG (1.024 ± .002) was significantly elevated 24-hr post-marathon compared to females (1.017 ± .002; p=.008). Female uCr values (186.91 ± 32.08 mg/dL) were significantly greater 24-hr post-marathon than males (59.24 ± 34.76 mg/dL, p ). Urinary neutrophil gelatinase-associated lipocalin (uNGAL) post-marathon was greater for both males (33.94 ± 10.84 ng/mL) and females (48.02 ± 10.00 ng/mL, p≤.001) compared to baseline (males: 4.27 ± 5.75 ng/mL, females: 22.68 ± 5.19 ng/mL). Twenty-four-hr post-marathon uNGAL was greater for both sexes (males: 65.76 ± 5.61 ng/mL, females: 60.16 ± 5.16 ng/mL, p=.004) compared to pre-marathon and post-marathon values but the effect of sex on uNGAL was not significant (p=.300). Conclusions: We identified persistent elevations in AKI biomarkers beyond 24-hr, regardless of sex. Further, this study highlights apparent sex differences in hydration and AKI outcomes of runners completing marathons. The need to further investigate sex differences and potential interactions between marathon running, hydration outcomes, hormone levels and AKI is warranted.

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