Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.
Department of Computational Sciences, University of Colorado at Boulder, Boulder, Colorado, USA.
Emerg Med J. 2017 Oct;34(10):637-642. doi: 10.1136/emermed-2016-206353. Epub 2017 Jul 5.
Despite concerns that non-steroidal anti-inflammatory drugs (NSAIDs) contribute to acute kidney injury (AKI), up to 75% of ultramarathon runners ingest these during competition. The effect of NSAID on AKI incidence in ultramarathon runners is unclear.
Multisite randomised double-blind placebo-controlled trial in the Gobi, Atacama, Ecuador and Sri Lankan deserts to determine whether ibuprofen (400 mg every 4 hours) would be non-inferior to placebo during a 50-mile (80 km) foot race. The primary outcome was incidence of AKI defined as severity categories of 'risk' of injury of 1.5× baseline creatinine (Cr) or 'injury' as 2× Cr, combined to calculate total incidence at the finish line. Non-inferiority margin for difference in AKI rates was defined as 15%.
Eighty-nine participants (47% ibuprofen and 53% placebo) were enrolled with similar demographics between groups. The overall incidence of AKI was 44%. Intent-to-treat analysis found 22 (52%) ibuprofen versus 16 (34%) placebo users developed AKI (18% difference, 95% CI -4% to 41%; OR 2.1, 95% CI 0.9 to 5.1) with a number needed to harm of 5.5. Greater severity of AKI was seen with ibuprofen compared with placebo (risk=38% vs 26%; 95% CI -9% to 34%; injury=14% vs 9%; 95% CI -10% to 21%). Slower finishers were less likely to encounter AKI (OR 0.67, 95% CI 0.47 to 0.98) and greater weight loss (-1.3%) increased AKI (OR 1.24, 95% CI 1.00 to 1.63).
There were increased rates of AKI in those who took ibuprofen, and although not statistically inferior to placebo by a small margin, there was a number needed to harm of 5.5 people to cause 1 case of AKI. Consideration should therefore be taken before ingesting NSAID during endurance running as it could exacerbate renal injury.
NCT02272725.
尽管人们担心非甾体抗炎药（NSAIDs）会导致急性肾损伤（AKI），但多达 75%的超长马拉松跑者在比赛中会服用这些药物。NSAID 对超长马拉松跑者 AKI 发病率的影响尚不清楚。
在戈壁、阿塔卡马、厄瓜多尔和斯里兰卡沙漠进行的多地点随机双盲安慰剂对照试验，以确定在 50 英里（80 公里）的徒步比赛中，布洛芬（400mg 每 4 小时）是否不如安慰剂。主要结局是 AKI 的发生率，定义为损伤风险为 1.5×基线肌酐（Cr）或损伤为 2×Cr 的严重程度类别，结合计算终点处的总发生率。AKI 发生率差异的非劣效性边界定义为 15%。
89 名参与者（47%的布洛芬和 53%的安慰剂）入组，两组之间的人口统计学特征相似。AKI 的总体发生率为 44%。意向治疗分析发现，22 名（52%）布洛芬使用者和 16 名（34%）安慰剂使用者发生 AKI（18%的差异，95%CI-4%至 41%；OR 2.1，95%CI 0.9 至 5.1），需要治疗的人数为 5.5。与安慰剂相比，布洛芬使用者的 AKI 更严重（风险=38%比 26%；95%CI-9%至 34%；损伤=14%比 9%；95%CI-10%至 21%）。完成比赛较慢的人发生 AKI 的可能性较小（OR 0.67，95%CI 0.47 至 0.98），体重减轻较多（-1.3%）会增加 AKI（OR 1.24，95%CI 1.00 至 1.63）。
服用布洛芬的患者 AKI 发生率增加，尽管略低于安慰剂，但需要治疗的人数为 5.5 人才能导致 1 例 AKI。因此，在耐力跑步期间摄入 NSAID 之前应考虑到这一点，因为它可能会加重肾脏损伤。
NCT02272725。
