A recent study conducted through Stanford University School of Medicine suggests that endurance athletes taking ibuprofen could be doubling their risk of acute kidney injury.1
Acute Kidney Injury Common in High Endurance Athletes
Acute kidney injury is fairly common in high endurance athletes, as dehydration leads to a decrease in renal blood flow coupled by rhabdomyolisis (tissue breakdown, which releases proteins into the blood and increase kidney burden). The study at hand specifically looked at ultra-marathon runners, who at baseline experienced a 34-85 percent risk of developing acute kidney injury according to the study. Taking ibuprofen was shown to tip that scale to the upper end of the spectrum. Most of the time this acute kidney injury is self resolving, however, runners have been hospitalized for renal failure, and this current research does support cautioning ultra-endurance athletes against the use of ibuprofen for pain management.
Ibuprofen Reduces Renal Blood Flow
Ibuprofen decreases blood flow to the kidneys, and though this has been a theoretical concern for athletes, research hasn’t shown a correlated negative effect with its use. However, for ultra-endurance athletes who are pushing their renal system well-beyond what even many professional athletes would experience, this decrease in renal blood flow could be a serious problem. This was the first randomly controlled trial of ultra-marathon runners looking at renal function.
Study of 155-mile Ultra-Marathon Runners
Eighty-nine participants were enrolled in the study. All were 155-mile ultra-marathon runners, competing in either China, Chile, Ecuador or Sri Lanka. Participants were divided into 2 groups, either taking 400 mg ibuprofen or placebo, during a 50-mile section of 1 of 4 different 7-day ultra-marathons. The morning of the 50-mile section, the runners were given a baggie at the medical tent with either the placebo or the ibuprofen. Between 12 and 36 hours later, when at the next medical tent, their electrolytes and renal function were measured.
Many of the participants, from both groups, had acute renal injury, but there was an 18% higher rate of kidney injury in the ibuprofen group.
The conclusions for this study were that caution should be taken with ibuprofen use for high endurance athletes, and acetaminophen may be a safer option if pharmaceutical pain relief is needed. However, the study is specifically addressing a concern in endurance athletes, and these cautions should not be extended to the general population, where ibuprofen use is typically well tolerated.
- Lipman GS, Shea K, Christensen M, et al. Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial. Emerg Med J. 2017
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Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine among the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend camp out where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.