The use and effect of ibuprofen, a common ingredient in many pain-relieving medications, among ultramarathon runners was studied by Stanford researchers in the department of emergency medicine, whose findings suggested high consumption increased risk of acute kidney disease and potentially kidney problems later in life.

The study, published in July 5, 2017, examined a cohort of long distance runners who took ibuprofen to deal with muscle pain and soreness. It found that these runners had doubled their risk of kidney problems compared to subjects who didn’t consume as much ibuprofen.

Lipman explains that one of his driving points to conduct the study was to examine the effect of taking ibuprofen during an ultramarathon after noticing that over 75 percent of participants reported doing so. They then found a link between the ibuprofen and acute kidney injury.

“We really wanted to see if there was causation [for acute kidney injury],” Lipman said. “And we could only look at that through a head to head comparison of a sugar pill, or placebo, to ibuprofen.”

Dr. Patrick Burns, a clinical instructor for Emergency Medicine and a co-author of the study, explains that the research drew upon established science correlating ibuprofen with increased levels of creatinine in the kidney. These increased levels can lead to acute kidney injury.  

“We knew that it was an unanswered question that theoretically could be a problem,” he said. “But in reality, [people] didn’t really have any clinical problems, so we didn’t know what was going on at the physiological level.”

Lipman explains the recent findings about the long-term risks of ibuprofen pose much concern for the ultramarathon community because of the high rate of people taking ibuprofen to alleviate symptoms. The particular runners in the study were competing in 150-mile weeklong races, often over rugged terrain, according to an interview with Lipman in the Stanford Scope Blog. Lipman notes that runners are typically surprised when they find out it is the ibuprofen itself that is inducing harm. He explains that though acute kidney injury cures itself after around a day, there are cases of devastating outcomes, such as hospitalization after renal failure and even an Ironman athlete who died from kidney dysfunction.

“Our concern is that we know it can get worse,” Lipman said. “We know it can lead to hospitalization and even death in some cases, so what we want to say is that this drug could increase people’s risk of having a bad outcome.”

Burns explained that the study followed a group of ultramarathoners, who complete almost a marathon everyday for seven days as part of the ultramarathon. On the fifth day of the ultra marathon, the runners run the longest portion. In the study, the cohort of 89 runners were split into two groups:one received ibuprofen while the other received a sugar pill, which served as the placebo. Burns explained that they observed that around 44 percent of the whole group came back with acute kidney injury.

“It was seen that there was an 18 percent higher chance of somebody who was taking ibuprofen as opposed to the placebo to have acute kidney injury,” Burns said. “For every 5.5 people taking ibuprofen, doing this race, one person had acute kidney injury.”

Lipman explains that with this result, it is important to be aware of the possibility that acute kidney injury can get worse. These runners need to make sure that the medicine they’re taking isn’t hurting them more than it may be helping.

“I think moderation should be preached,” Lipman said. “If someone is hurting and they need to take a pain medicine to help them reach the finish line, moderate use of acetaminophen [is a] wise choice, and often after a race … if [people] are hurting, I’d recommend an ice bath rather than any drug at all.”

Contact Mallika Singh at mallika12 ‘at’ gmail.com.