Abstract
Background/Objectives: Accurate hydration assessment is critical for optimizing performance and preventing heat-related complications in ultra-endurance athletes. This study evaluated the agreement and reliability between urine reagent strips and refractometry for field-based hydration assessment via urine-specific gravity (USG) in ultra-trail runners. Methods: Thirty-four ultra-trail runners (22 males, 12 females; mean age 43.71 ± 11.50 years) participated during The Coastal Challenge, a 241-km multi-stage ultra-trail competition. Urine samples were collected before and after the first two stages (Stage 1: 41 km, 1071 m elevation; Stage 2: 40 km, 1828 m elevation). USG was measured using semi-quantitative urine reagent strips (Combur10Test M) and a handheld digital refractometer (Palm Abbe™). Agreement was assessed via paired t-tests, Pearson and Spearman correlations, intraclass correlation coefficients, and Bland-Altman plots across four measurement time points. Results: Strong agreement existed between methods with correlation coefficients of 0.92-0.99 (p < 0.01) within the hydration range typical of well-prepared ultra-endurance athletes (USG 1.010-1.020). No significant differences were found between devices at any time point (all p > 0.05). Bland-Altman analyses revealed minimal mean bias (range: -0.002 to +0.001 g/mL) and narrow limits of agreement, with fewer than 5% of values falling outside limits. Both methods detected significant increases in USG from pre- to post-stage (p < 0.01), indicating exercise-induced hypohydration. Conclusions: Semi-quantitative urine reagent strips and handheld refractometers demonstrate strong agreement for hydration assessment in ultra-trail runners under field conditions when not severely hypohydrated, supporting their interchangeable use for practical monitoring.