Rhabdomyolysis at the New York City Marathon: a rare death that exposes how much about the body we can't predict

By The Washington Post · November 3, 2026.

Rachel Apa, 24, a first-time marathoner and former college athlete, died on Sunday. According to The Washington Post, she collapsed near mile 24 (about 38.6 km) of the New York City Marathon. The cause was rhabdomyolysis.

Rhabdomyolysis, or "rhabdo," is a condition in which muscle breaks down and releases toxic amounts of proteins and electrolytes into the bloodstream. According to the paper, it causes acute kidney injury in up to 50% of cases and, in the most severe ones, kidney failure. About 26,000 people develop it each year in the US.

The causes cited in the article are overexertion, severe muscle injury, dehydration, overheating and certain medications. A 2026 study reviewed hospital records following the New York City Marathon between 2017 and 2023. It found 39 cases of rhabdo after the race, 24 of them in 2022, the hottest year on record for the event.

The symptoms require emergency care: muscle pain, weakness and swelling, dark urine and, sometimes, reduced urination, nausea and fainting. According to the article, most patients recover with intravenous fluids. A study of runners with rhabdo suggests that the rare cases of kidney failure reflect a "perfect storm": extreme exertion plus aggravating factors such as heat stress or a concurrent viral or bacterial infection.

Our take. The available data do not allow us to judge this specific case, and it is best not to speculate about it. What it does show is that a known risk remains hard to personalize. Heat and exertion raise the probability overall, but no one can tell a given runner whether today is their risky day.

That is where one of the reasonable long-term promises of health technology lies: continuous monitoring and models that combine temperature, hydration, medical history and biomarkers to warn before collapse. Broadly, these tools still need external validation before they have clinical impact, and they should not be marketed as if they already did.

In the short term, protection remains basic: recognize the symptoms, stop in time and seek medical care. Predictive medicine that prevents these deaths is a plausible horizon. Today, it does not yet exist.