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My concern with the prophylactic use of NSAIDs occurs in endurance athletes. My anecdotal experience is that endurance runners attempting distances categorised as ultra races (ie longer than a marathon) may regularly take NSAIDs during an event in a misguided attempt to delay muscle fatigue. I have even seen NSAIDs being referred to as “Vitamin I” in some running literature.

Acute renal failure with NSAID therapy is mediated hemodynamically as a result of decreased renal perfusion after inhibition of prostacyclin synthesis. Decreased renal perfusion in ultra distance events can be caused by dehydration. Factor into the equation the muscle breakdown that occurs in these events and possible rhabdomyolysis.

This triple insult to the kidneys can lead to renal failure and dialysis, if not death. I suspect that many ultra endurance athletes, whether this be running or triathlon, are unaware of the possibility of renal failure that may occur when prophylactically taking NSAIDs during an event.

Stephen H. Boyce
Consultant Emergency Medicine
Wishaw General Hospital, North Lanarkshire, Scotland