A rare but potentially fatal condition known as rhabdomyolysis has been linked to the death of 24-year-old Rachel Apa, who collapsed during Sunday’s New York City Marathon, just short of the finish line.
The young American, a former collegiate athlete, was taking part in her first marathon when she collapsed at approximately the 39-kilometre mark. According to her family, her death was attributed to rhabdomyolysis, although the official medical examiner’s findings have yet to be made public.
As the Washington Post explains, rhabdomyolysis occurs when muscle cells break down, releasing substances including myoglobin and electrolytes into the bloodstream. In severe cases, the condition can cause acute kidney injury and even kidney failure, while electrolyte imbalances can trigger dangerous cardiac arrhythmias.
According to available figures, approximately 26,000 people develop rhabdomyolysis in the United States each year. The condition can be triggered by excessive physical exertion, serious muscle injuries, overheating and certain medications, while dehydration can increase the risk of complications.
Depending on the severity of the condition, up to 50% of cases may develop acute kidney injury.
The main symptoms include severe muscle pain, weakness, muscle swelling and dark-coloured urine. Reduced urine output, nausea and fainting may also occur. Anyone experiencing these symptoms should seek immediate medical assessment.
Most patients recover with prompt treatment, which frequently involves the administration of intravenous fluids.
Why marathon runners may be at risk
A 2026 study examining hospital data from the New York City Marathons held between 2017 and 2023 identified a total of 39 cases of rhabdomyolysis following the races.
Notably, 24 of those cases occurred in 2022, when the event was held in the highest temperatures recorded in its history.
Researchers believe that the rare cases of severe kidney failure among runners are likely caused by a combination of factors, including extreme physical exertion, heat stress and the simultaneous presence of a viral or bacterial infection.
The findings highlight how prolonged endurance exercise, particularly in hot conditions, can place significant strain on the body’s muscles and kidneys.
‘When she set her mind to something, she pursued it with all her heart’
Rachel Apa’s work ethic, determination and competitive spirit were remembered by Isabella Pavlidis, a 23-year-old pre-medical student from New Jersey, who spoke to the New York Post about her late friend.
Pavlidis first met Apa at a field hockey camp in 2018, before the two went on to study together at Bucknell University.
“I always admired Rachel’s work ethic and the way she approached almost everything, especially field hockey,” she said.
“She was competitive, and when she set her mind to something, when she wanted to achieve something, she put her whole heart into it and genuinely believed she could do it,” Pavlidis added, describing the young athlete who lost her life during her first marathon.
Pavlidis described her friend as “extremely passionate and determined”, emphasising that she “always believed in herself”.
“She always radiated confidence. If you could choose one person to get something done, it would be Rachel. She always found a way, and she was one of the most determined people I know,” her devastated friend added.
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