Acute Renal Failure in Four Comrades Marathon Runners Ingesting the Same Electrolyte Supplement: Coincidence Or Causation?(Original Articles) (Report)
The 89 km Comrades Marathon historically reports the highest incidence of acute renal failure (ARF) cases in any sporting event in the world (estimated at 2/10 000 runners). (1) The first 2 cases reported from the event (in 1967 and 1968) occurred in races with only ~600 runners. (2) An incidence as high as 10/10 000 runners was reported in the 1986 Comrades Marathon. (1) The spectrum of reported cases from this ultramarathon has ranged from unrecognised ARF that persisted for 10 days post-race (3) to significant renal damage requiring extended hospitalisation and peritoneal dialysis. (4) Aetiology factors proposed include dehydration secondary to inadequate fluid intake and/or diarrhoea or vomiting, (1,2,4,5) rhabdomyolysis (2,6) and analgesic use including paracetomol4 and non-steroidal anti-inflammatory drugs (NSAIDs). (5) Forty years after the first description of ARF in Comrades Marathon runners, (2) we report a cluster of 4 cases that occurred in the 2010 Comrades Marathon, and analyse possible causative factors.