Exercise and Sports After Kidney Transplantation

After a kidney transplant, exercise is particularly important. It contributes to the preservation of your new kidney.

Before the transplant, exercise may have been difficult or even impossible. Now you have the opportunity to resume your activities step by step.

Build up your physical activity slowly

In the period after the kidney transplant, go outside every day. Just after discharge from hospital, this may only be possible for a short time. Try to build it up slowly. Listen to your body.

After a while you can start moving more. And also start exercising. You probably haven’t been able to exercise for a long time, because of your illness and the operation. Therefore, start quietly. Build up movement slowly. A physiotherapist can help you with this.

Exciting? Question guidance

Many people find it scary to start moving again after a transplant. They are afraid that their bodies cannot handle it. That is another reason why it is wise to start moving under the supervision of a physiotherapist. The physical therapist helps you to get to know your own limits. You will then move in a safe and responsible manner. This way you regain confidence in your body. Exercise is good for you. But sufficient exercise can be difficult after a kidney transplant.

How much to move?

Preferably move every day. Try to exercise moderately intensively for at least 2.5 hours a week. For example, you can walk or cycle. Moving more and more intensively is even better. This gives you extra health benefits.

Tips for sports after a transplant

When exercising, take the following into account:

• Avoid contact sports such as rugby, judo, karate and taekwondo. The transplanted kidney is less deep in your body than your own kidneys, and is therefore more vulnerable. Football or other team sports are possible. You can wear a protective kidney belt.
• Tell your trainer or supervisor that you have been kidney transplanted. They can then take this into account. Does the trainer ask questions that you cannot answer? Then consult with your urologist.
• After transplantation you should take anti-rejection medicines. These medicines reduce your resistance. Therefore, do not overdo sports. If you have sport as a hobby or if you exercise to stay in good shape, there is nothing wrong. But if you want to exercise at a high level, it is better to consult your urology doctor first. You will then need expert guidance.
• Do not exercise if you do not feel well or if you have a fever. Wait a few days until you recover and then pick up your training again.
• Stop exercising if you feel dizzy or light in your head. Or if you have chest, neck or arm pain. Contact your urology doctor.

Why is exercise after transplantation important?

There are many different reasons to get more exercise.

Good for heart and blood vessels

Because of the kidney damage and its treatment you have a higher risk of cardiovascular disease. Exercise is good for your heart and blood vessels. This allows you to keep your heart and blood vessels in the best possible condition.

Keeps the blood pressure at the right level

Anti-rejection drugs can cause high blood pressure. High blood pressure is harmful to your kidney. By exercising enough, you can keep your blood pressure under control.

Healthy weight

Many transplant patients arrive in the year after transplantation. Overweight and high body fat give an increased risk of kidney damage. And also to other diseases, such as diabetes and cardiovascular diseases. Exercise helps you to reach a healthy weight and to stay at a good weight. Exercise also ensures a good balance between body fat and muscles.

A more favorable cholesterol level

There are 2 types of cholesterol: a good and a bad one. The bad cholesterol (LDL-cholesterol) contributes to arterial calcification. The good cholesterol (HDL-cholesterol) takes care of the removal of the bad cholesterol. When you exercise enough, your good cholesterol rises. Your body will then be better able to remove the bad cholesterol.
Stronger bones

The anti-rejection drugs can cause osteoporosis (osteoporosis). This is a side effect of some of these medicines. Exercise and sports ensure that your bones remain strong.

More energy and a better condition

People who exercise regularly generally feel better and more energetic, can relax more easily and are more resistant to stress.
Better quality of life

Sufficient exercise contributes in many ways to a healthier and more vital body. Regular exercise increases the quality of life. All daily things go easier if you feel fit and healthy.

Preferably go outside to move. You will get a lot of daylight, and that helps against sombre feelings. Daylight is also needed for vitamin D. This vitamin helps to keep the bones strong.

End of the stalemate: Cardiologists and neurologists recommend umbrellas to protect against stroke

“We knew that many patients under the age of 60 were particularly at risk from this short-circuit between the right and left atrium if they had suffered a stroke,” says Hans-Christoph Diener, senior professor at the Medical Faculty of the University of Duisburg-Essen, who was the first author of the new guideline for DGN. “The proof that the interventional closure of the PFO can prevent secondary events in persons at risk, however, has only been successful in the past two years”. After years of uncertainty for neurologists and cardiologists, this guideline formulates clear treatment recommendations for patients with cryptogenic stroke,” states DGK first author Professor Stephan Baldus, Director of the Clinic for Cardiology at the Heart Centre of the University Hospital of Cologne.

The previous DGN PFO guideline on secondary prevention of stroke was published in 2012. The current studies on the interventional closure of an open foramen oval were not yet included. The new guideline closes this gap and is addressed not only to neurologists but also to cardiologists who treat PFO patients who have suffered a cryptogenic stroke between the ages of 16 and 60. In 25 percent of all people, the foramen oval does not close completely after birth, and at the same time the stroke causes a high morbidity. The recommendations are of great practical relevance.

A PFO is one of the risk factors for a stroke in younger people without other causes. These insults, which by definition cannot be assigned a clear other cause, account for about 20 percent of all strokes. Standard treatment for patients after a cryptogenic stroke is the administration of anticoagulant drugs, which can reduce the rate of recurrence.

Medication or intervention? For a long time a clear “yes”.

Studies have repeatedly attempted to seal the passage between the two atria by means of an umbrella-shaped closure (“occluder”) as part of an intervention with a catheter advanced from the groin. However, three older studies (CLOSURE I, PC study, RESPECT) had shown no clear advantage of this stroke prevention method. Four further studies then initiated a turnaround: REDUCE, CLOSE, RESPECT extended follow up and most recently the DEFENSE-PFO study have shown that PFO occlusion can significantly reduce the rate of stroke recurrence. The majority of recurrences were mild, non-disabling strokes. Atrial fibrillation may occur during the intervention, but in most cases it stopped spontaneously.

The evidence from these studies is discussed and evaluated in detail in the new guideline. “It is noteworthy that it reaches the second highest quality level (S2e) of a guideline and was prepared by the participants on a voluntary basis in a very short time. We were therefore able to dispense with external financing,” says Baldus.

Five recommendations

The evaluation of 22 publications and a multi-stage consensus process by the 13-member editorial committee finally led to five recommendations, four of which were adopted unanimously and one of which only abstained once. The most important suggestion is probably recommendation level A and evidence level I. It reads: “In patients between 16 and 60 years of age with a cryptogenic ischaemic stroke (after neurological and cardiological clarification) and open foramen ovale with a moderate or pronounced right-left shunt, an interventional PFO occlusion is to be performed. Ten experts were in favor of this. Three experts were in favor of an attenuated version of this recommendation, according to which such an intervention should be “considered”.

Peri- and postoperative risks include atrial fibrillation, pericardial tamponades and pulmonary embolisms, but these are so rare that they should not stand in the way of the implantation of an occluder, according to another recommendation. In addition, the experts have looked into the ideal design of the occluder. They come to the conclusion that so-called disc occlusions are to be preferred. And they give advice on medication after the operation as well as for patients who reject the operation.

Guideline does not release from meticulous search for causes

“It is a step forward that the benefit of PFO closure in younger patients with an unexplained stroke is now better proven,” says Professor Armin Grau of the German Stroke Society (DSG). “However, it is important that there is always a detailed search for other causes and that an experienced neurologist checks the indication. Not every younger stroke patient with a PFO needs a closure of the foramen ovale,” said the director of the Neurological Clinic at the Park Hospital In Delhi.

“Much also depends on neurologists and cardiologists working well together in this indication,” said Diener. If we do everything right and select the right patients, the PFO closure can reduce the risk of stroke by 75 percent.

Choice aids treatment kidney failure

Choosing from different treatments for kidney failure is a process. There are several decision aids that can help. The experiences of others can also be helpful.

Would you like to know what the different kidney failure treatments involve? Or what the consequences of the kidney failure treatments are for your body and your daily life? Then read detailed information.

Choice help: consultation card

A consultation card is a decision aid for patients and urology doctors. There are 2 consultation cards for people who have to deal with kidney failure. 1 to compare and discuss the different renal function replacement treatments. And 1 to discuss the choice between renal function replacement treatment or conservative treatment.

• The consultation cards show all possible treatment options.
• You use the consultation card together with your urology doctor. Your urology doctor will indicate which options are medically possible. You can then compare these treatment options together.
• For each treatment, the most common questions and answers are listed in a schedule. The answers are based on medical guidelines, other scientific literature and expert experience.

Experiences of others: Park Hospital

On Park Hospital you will find videos of people who have already made a choice of treatments for kidney failure. In short fragments they tell about their experience. How they feel about it, and what advantages and disadvantages they experience. For example in the field of work and school, sleep, relationships and holidays.

Then discuss your wishes, doubts and ideas with your care providers.

Park Hospital give you a more complete picture of what a treatment can mean for you.

Compare dialysis centers: Comparison help

Are you considering dialysis? Then use the Comparison Tool Dialysis Centers to see which dialysis centers are near you and what types of dialysis they offer. You can also compare facilities such as opening hours on Sundays, training options and single rooms for night dialysis.

Selection scheme for renal function replacement treatments

The Kidney Function Replacement Treatments Selection Chart helps compare treatments that take over kidney function. It involves transplantation and various forms of dialysis. The selection scheme contains the characteristics of these treatments. For example, you can compare the physical effects of treatments. Or the effect of the different treatments on your freedom of movement.

When reading this diagram, it is good to think of the following:

• Your urologist will discuss with you which treatments are possible.
• The schedule only shows the broad outlines. In practice, something may turn out differently from what is stated in the schedule, for example due to your personal circumstances.
• How you experience a treatment also depends on what you expect from it. Also plays a role how you felt in the period before. Suppose that someone first dialyses, and then gets a kidney transplant. This person will probably experience a greater improvement in the period after the transplant than someone who receives a transplant and did not dialysis before that.
• Some of the complaints in this schedule are unclear whether they are caused by kidney damage, treatment, or even a completely different condition.