Abstract: TH-PO0700
Urinary Liver-Type Fatty Acid-Binding Protein Dynamics and Heat-Related Illness in Thai Military Recruits Undergoing Tropical Basic Combat Training: A Prospective Observational Study
Session Information
- AKI: Prevention, Diagnostics, and Management
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Siriwattanasit, Narongrit, Phramongkutklao Hospital, Bangkok, Thailand
- Satirapoj, Bancha, Phramongkutklao Hospital, Bangkok, Thailand
- Srisawat, Nattachai, Chulalongkorn University, Bangkok, Thailand
- Kaewput, Wisit, Phramongkutklao Hospital, Bangkok, Thailand
- Nata, Naowanit, Phramongkutklao Hospital, Bangkok, Thailand
- Supasyndh, Ouppatham, Phramongkutklao Hospital, Bangkok, Thailand
Background
Heat stress–induced kidney injury is an increasing concern in heat-exposed occupational and military populations, yet evidence on early biomarker detection in tropical Southeast Asian cohorts is limited. Urinary liver-type fatty acid–binding protein (L-FABP) is a proximal tubular biomarker of oxidative stress and hypoxia. We aimed to characterize longitudinal urinary L-FABP dynamics and their association with heat-related clinical events in Thai military recruits under tropical basic combat training.
Methods
This prospective observational study enrolled 158 male Thai military recruits undergoing 7-day basic combat training under tropical heat conditions (heat index >32°C). Urinary L-FABP was measured by quantitative ELISA on Days 1, 2, 3, and 7. Participants were classified as uL-FABP positive (>=5 ng/mL on any post-training measurement: Day 2, 3, or 7) or L-FABP-negative. Pre-training predictors and associations with heat-related illness events were evaluated using logistic regression and multilevel mixed-effects modeling.
Results
Urinary L-FABP rose progressively from Day 1 (0.71 ± 1.71 ng/mL) to Day 7 (2.69 ± 3.96 ng/mL; P < 0.001). Forty-one recruits (26%) were uL-FABP positive; none developed KDIGO-defined AKI. After adjustment for age, body mass index, and serum creatinine, uL-FABP positive status was independently associated with heat cramps (adjusted OR 8.10; 95% CI, 3.52–18.63; P < 0.001) and heat edema (adjusted OR 6.22; 95% CI, 1.08–35.66; P = 0.04), but not with exertional rhabdomyolysis (adjusted OR 1.44; P = 0.635). Baseline alkaline phosphatase independently predicted subsequent positivity (adjusted OR 1.02; P = 0.042).
Conclusion
Urinary L-FABP rose progressively during tropical military training despite absence of clinical AKI and was selectively associated with heat cramps and heat edema — suggesting that the proximal tubule may serve as a sensitive sentinel for systemic thermal-exertional stress, with urinary L-FABP capturing this response prior to the onset of functional kidney injury. These hypothesis-generating findings warrant independent validation in multi-biomarker cohorts.
Funding
- Private Foundation Support