Geschatte leestijd: 8 minutenBryan van Bentum was suddenly told at a young age that his kidneys were barely functioning. A kidney transplant would need to be scheduled within a few weeks, along with the possibility of dialysis. However, with medication, fitness, and adapted nutrition, this ultimately proved unnecessary. Nevertheless, he will likely have reduced kidney function for the rest of his life and must live accordingly.
Decreased muscle mass is often a consequence of reduced kidney function due to numerous catabolic (tissue-breaking) processes associated with it [1]. This means that an average kidney patient of 30 years old is physically less active than a 70-year-old leading a sedentary lifestyle [1]. A correlation has been demonstrated between this reduced physical activity and survival rates [2]. The more active you remain and the more you use your muscles, the better.
Leave that to Bryan….
Fitness after Kidney Failure
Kenneth: Twenty years old is a young age to be confronted with something like this. How did you find out about it, and under what circumstances?
Bryan: I was playing tennis at a high level when I thought I had pulled something in my back. Eventually, the pain wasn’t too bad, so I went on vacation in August 2013. There I noticed that I was moving less and less smoothly. I started experiencing a lot of pain in my back. During the day, I was okay and could swim and do everything normally. However, in the evenings, if we were out, for example, after an hour, I had to be picked up by a taxi and taken back to the hotel because I couldn’t stand the pain anymore.
This went on all week, and even on the plane, I could barely sit because of the pain. When I got home, I went straight to the hospital. There, they did blood tests, which quickly showed that my kidneys were functioning poorly, although the cause was unclear. I was allowed to go home while further tests were done in the hospital. However, the next morning, I was called early and told that I needed to return to the hospital urgently because it turned out to be serious after all. It turned out that I had cysts on my kidneys, one of which had become infected. As a result, my right kidney was not functioning at all, while the function of the left kidney was barely above 10%.
I spent five days in the hospital and was told that I would need a kidney transplant within three weeks. First, the infection needed to be treated. I was given antibiotics, which did not improve kidney function. After those five days, I was allowed to go home. After a week at home, the pain decreased, and I could move again. I wanted to see how I could pick up my life again. I started playing tennis again and joined a gym. I noticed that I was getting fitter.
After two and a half weeks, I went back to the hospital, where kidney function was measured again. It had increased to 13%, and two weeks later, it was even 17%. It was decided to postpone the transplant for the time being and to continue monitoring closely to intervene if necessary.
I continued training, felt myself getting stronger, and felt that this somewhat compensated for the weakness of my kidneys. Three weeks later, kidney function had increased to 20%.
Kenneth: Well, that’s uplifting!
“Low-Salt Diet and No Shakes”
Bryan: Yes, although I did encounter a problem with the strict diet I was given. For example, I was no longer allowed to eat salt and ate a lot of fresh fish, roast beef, and dry chicken breast. However, I didn’t know that I wasn’t allowed [ed. protein] shakes. As I continued training, I felt better and thought that protein shakes would make me even better. When I went back to the hospital three weeks later, kidney function had dropped again to 17%.
Kenneth: That’s not good news!
Bryan: No. When asked, I admitted that I had used shakes for training, and apparently, my kidneys couldn’t handle that amount of protein. I had to stop using them in the hope that this would improve kidney function again. Three weeks after stopping the protein, kidney function was back to 20%, where it has been for the past year.
Kenneth: So, it’s been relatively stable for about a year. Do the doctors expect a further upward trend, or will you have to live with this for the rest of your life?
“Kidneys Never Functioned Optimally”
Bryan: I’ll probably always have to take nutrition into account. They now think that this is the maximum my kidneys have ever
been able to do, that I’ve never been above 20%. Otherwise, I would have to feel tired every day and wouldn’t be as active as I am.
Kenneth: Your body has probably already adapted to this reduced kidney function over all those years?
Bryan: They think so, yes. They can never really determine that anymore, but everything seems to indicate that this is indeed the case.
Kenneth: And if an inflammation occurs in such a situation, it can probably deteriorate very quickly because your kidneys can handle much less, I suppose.
Bryan: Yes, normally you can easily handle that, but this time, it was really the drop that made it go downhill quickly.
Kenneth: But even in terms of diet and training, it’s very difficult. For example, if you’re not allowed (extra) protein.
Bryan: Yes and no. I already ate quite healthy, but now even more so because I eat much less salt. In that respect, it actually goes well with training. Because I saw the progress so quickly despite my situation, I wanted to share my story. Show that you shouldn’t just sit back and do nothing, but do everything you can to get fit again.
“No Excuses!”
Kenneth: It’s one thing to say that and another to actually do it. Not many people will be in your situation, let alone at your age. So, it’s very impressive to look at it with such a perspective. Especially when you initially had the prospect of a kidney transplant, which I think must have been very shocking.
Bryan: Yes, at that moment, my world completely collapsed, and I didn’t see it in a positive light anymore. Until I realized that I wouldn’t benefit from giving in to this feeling. I just had to try to make the most of it.
Kenneth: I can imagine it was also a huge shock for your family.
Bryan: Yes, that hit them hard. Especially since I am an only child, and for my parents, everything has often revolved around me, they may have had an even harder time with it than I did.
Kenneth: How did they experience those weeks then? I can imagine mostly in fear.
Bryan: Yes, but my mother always remained optimistic. My father is always a bit more down-to-earth and realistic, and even when things were getting better, he kept emphasizing that I need to stay well-controlled. ‘You may feel fine, but you don’t know what’s happening inside.’
Kenneth: Which is good advice, especially as it quickly became apparent that those protein shakes weren’t a good idea in your case.
Bryan: No. When this became clear, and I returned home from the hospital, my father had already thrown away that jar of protein.
(“What a waste!” cries the average reader who spends several tens of euros on protein every month. However, as a father, I can understand and appreciate such an action)
Fitness vs. Tennis
Kenneth: You play tennis alongside fitness. How does that combination work for you in terms of scheduling, but also training method and things like recovery?
Bryan: At one point, I noticed that my strength distribution became very different due to strength training. When things were going poorly, I put tennis on the back burner for a while. When I picked it up again, I had already done strength training and felt the difference from the 4-5 kilos of muscle mass I had gained. Because I still had to get used to this, the control and ball feeling were a bit less. However, at the same time, I became much faster and felt much stronger. So, I recommend this combination with strength training for youth players.
Kenneth: Where do your priorities lie? Is your fitness supportive of tennis?
Bryan: No, definitely not. Before I got sick, I was ranked 216th in the Netherlands. However, I noticed that I was too old to make the leap to pro. Especially when I had been out for a while and already had to doubt whether I could still reach my old level, I accepted that. I still love doing it and as a distraction, but fitness now comes first.
Kenneth: I asked because when you specialize in one of the two, the other must be adjusted. For example, if the focus is mainly on improving your tennis, I would recommend plyometric training (focused on explosive power) instead of training focused on muscle mass or maximal training (see also strength training for martial arts).
Bryan: Yes, that’s right, the way I do fitness now would indeed not be compatible with the level of tennis I would be at if I hadn’t gotten sick. Then I would indeed have done more core exercises and explosive training while now I opt for muscle mass and strength. I have accepted that I won’t be at Wimbledon. My body is more important now, and I notice that with more muscle mass, I can just handle more.
Kenneth: To what extent do you still fear a relapse (in kidney function)?
Bryan: Honestly? Six out of seven days, I don’t think about it at all. It’s just that I have to take it into account regarding nutrition, so I’m constantly confronted with it, but otherwise, you get used to it. As long as I don’t suffer from it and don’t have a relapse, and the better my body gets, the easier it becomes.
Kenneth: You talk about it very lightly, but I can imagine it takes a certain character to deal with it like that.
Bryan: Definitely. I’ve heard from various people who have experienced something similar that they dealt with it very differently. People who, five or six years after the problems started, are still thinking about it every day and are afraid of a relapse. I see it a bit like skiing: If you’re afraid to fall and start being overly cautious, you fall
.
Reduced Kidney Function, Muscle Mass, Protein, and Anabolics
From the research, it appears to be very difficult to counteract muscle breakdown due to kidney failure or reduced kidney function. Increased breakdown processes cause protein stores in the muscles to decrease rapidly [1]. From the above interview, but also from the article I wrote about the influence protein has on kidney function, it appears that you cannot simply solve this by eating more protein because that could be too much of a burden on the kidneys. Any diet aimed at counteracting muscle breakdown must therefore be evaluated by looking at the effect on the kidneys.
Two studies found that anabolic steroids (nandrolone decanoate in this case) led to more muscle mass [3], while strength training only led to more muscle strength but not more muscle mass [3,4]. As a natural bodybuilder, I have always said that I have seen older age and thus reduced testosterone as a legitimate reason for using anabolics (to get this level back to that of a young man). Various studies into the effects of aging therefore also look at to what extent anabolics can limit this. However, a lot of research is also done among patients who experience muscle breakdown due to diseases such as HIV and cancer. Kidney patients with muscle breakdown thus also fall into the group for whom anabolic steroids could improve the quality of life. In addition, nandrolone could also have a direct effect on the consequences of reduced kidney function. The kidneys produce red blood cells. The production of these is decreased with reduced kidney function. Nandrolone would inhibit this decrease [5].
Nandrolone decanoate expresses an anabolic effect on LBM* without altering the renal function and thus would provide nutritional benefit in predialysis patients with CKD**.
S. Eiam-Ong, Chulalongkorn University Hospital, Bangkok, Thailand
(*Lean Body Mass, **Cronic Kidney Disease)
However, Austrian researchers add that they advise against prescribing nandrolone to women because of its masculinizing effect [5].
References
- Ikizler TA, Himmelfarb J. Muscle wasting in kidney disease: Let’s get physical. J Am Soc Nephrol. 2006 Aug;17(8):2097-8. Epub 2006 Jul 12. PubMed PMID: 16837638.
- Sietsema KE, Amato A, Adler SG, Brass EP: Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney Int 65: 719–724, 2004
- Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T: Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: A randomized, controlled trial. J Am Soc Nephrol 17,2307–2314, 2006
- Pupim LB, Flakoll PJ, Levenhagen DK, Ikizler TA: Exercise augments the acute anabolic effects of intradialytic parenteral nutrition in chronic hemodialysis patients. Am J Physiol Endocrinol Metab 286: E589–E597, 2004
- Eiam-Ong S, Buranaosot S, Eiam-Ong S, Wathanavaha A, Pansin P. Nutritional effect of nandrolone decanoate in predialysis patients with chronic kidney disease. J Ren Nutr. 2007 May;17(3):173-8. PubMed PMID: 17462549.
