Regular exercise confers multifaceted and well-established health benefits. Yet, transient and asymptomatic increases in markers of cardio-renal injury are commonly observed in ultra-endurance athletes during and after competition. This has raised concerns that chronic recurring insults could cause long-term cardiac and/or renal damage. Indeed, extreme endurance exercise (EEE) over decades has sometimes been linked with untoward cardiac effects, but a causal relation with acute injury markers has not yet been established. Here, we summarize the current knowledge on markers of cardiac and/or renal injury in EEE athletes, outline the possible interplay between cardiac and kidney damage, and explore the roles of various factors in the development of potential exercise-related cardiac damage, including underlying diseases, medication, sex, training, competition, regeneration, mitochondrial dysfunction, oxidative stress, and inflammation. In conclusion, despite the undisputed health benefits of regular exercise, we speculate, based on the intimate link between heart and kidney diseases, that in rare cases excessive endurance sport may induce adverse cardio-renal interactions that under specific, hitherto undefined conditions could result in persistent cardiac damage. We highlight future research priorities and provide decision support for athletes and clinical consultants who are seeking safe strategies for participation in EEE training and competition.

定期锻炼可以带来多方面和公认的健康益处。然而，在超耐力运动员比赛期间和比赛后，通常会观察到心肾损伤标志物的短暂和无症状增加。这引起了人们对慢性反复发作可能导致长期心脏和/或肾脏损害的担忧。事实上，几十年来的极度耐力运动 (EEE) 有时与心脏不良反应有关，但与急性损伤标志物的因果关系尚未确定。在这里，我们总结了当前关于 EEE 运动员心脏和/或肾脏损伤标志物的知识，概述了心脏和肾脏损伤之间可能的相互作用，并探讨了各种因素在潜在运动相关心脏损伤发展中的作用，包括潜在的疾病、药物、性、训练、竞争、再生、线粒体功能障碍、氧化应激和炎症。总之，尽管定期锻炼对健康的好处无可争议，但我们推测，基于心脏和肾脏疾病之间的密切联系，在极少数情况下，过度的耐力运动可能会导致心肾相互作用不良，而这种相互作用在特定的、迄今未定义的条件下可能会导致持续性心脏损伤。我们强调未来的研究重点，并为正在寻求安全策略以参与 EEE 训练和比赛的运动员和临床顾问提供决策支持。在极少数情况下，过度的耐力运动可能会引起不良的心肾相互作用，在特定的、迄今未定义的条件下可能导致持续性心脏损伤。我们强调未来的研究重点，并为正在寻求安全策略以参与 EEE 训练和比赛的运动员和临床顾问提供决策支持。在极少数情况下，过度的耐力运动可能会引起不良的心肾相互作用，在特定的、迄今未定义的条件下可能导致持续性心脏损伤。我们强调未来的研究重点，并为正在寻求安全策略以参与 EEE 训练和比赛的运动员和临床顾问提供决策支持。