Are you a kidney donor and are contemplating signing up for an IronMan? Or are you considering donating your kidney and want to know what that means for your IronMan goals? This is the article for you!

We have three amazing Kidney Donor Athletes that have given their first-hand advice for those of you aspiring to become a living kidney donor IronMan!

Disclaimer: This is not a source of medical advice. This is solely an account of people’s experiences and advice they would give from their experience. For medical guidance you should always contact your transplant team.

Michael Koetting

Bellevue, Washington

Completing a full Ironman distance (140.6) triathlon after donating a kidney is a great goal and one which motivated me to be in the best possible physical condition before my donation and to be diligent in my recovery and post-donation training. I made my non-directed donation in December 2014 and completed Ironman Florida in November 2015; here a few things I learned along the way which you might helpful.

The best way to prepare for a post-donation Ironman is to do a pre-donation Ironman! 

I doubt you’ll see ‘Complete an Ironman’ on any pre-donation surgery checklists from your hospital or donor advocate but I can’t think of a better way to get in the best shape of your life and give yourself the best possible chance at an uneventful, speedy recovery from the surgery.

Ironman training is a months-long odyssey in adapting your body to an exercise workload that you likely previously thought was impossible (and which your family and friends may think is unwise). As your body adapts, your eating habits and diet will change, your hydration needs will change, your sleep habits will change; even your bathroom habits will change – and all of this is normal and to be expected. If you have the experience of having trained for Ironman before your donation, you’ll know what changes to expect and what’s ‘normal’. You won’t worry about trying to discern whether your physical adaptations are a consequence of your training or your donation.

Well, what if I forgot to do an Ironman before my donation. What now?

Fear not! Completing your first full Ironman after donating is still a goal within reach, but I’d recommend starting with a few intermediate distances as you work your way up to the full IM. Attempting a full IM requires self-confidence, race strategy, and experience as well as physical training. Nothing helps build self-confidence like completing a few marathons and half-IM distance triathlons. Building a foundation with shorter races will also give your body plenty of time to adapt and will help you learn to differentiate between normal training fatigue and more serious issues that may require the advice of a trainer or physician.

How about some practical training and race-day advice?

Every Ironman training program includes plenty of advice about nutrition and how to prepare by practicing your race-day nutrition during your long brick workouts. As a kidney donor, however, you should obviously pay special attention to hydration.

1. Look at the weather history for the event and identify the worst-case heat index.
2. Determine your sweat rate on a training day with a long brick workout (>4-5 hours) and a heat index like the worst case for your event. You will do this by weighing yourself naked before and after your workout and keeping track of how much you drank during your workout. If you urinate during the workout, estimate that too. If you were dehydrated after your workout, keep track of how much hydration you required after your workout.
3. DO THE MATH. Figure out how much hydration you require every 30 minutes on a hot day.
4. DO THE MATH. Figure out how much salt you require every hour on a hot day. I’m a heavy- sweater, even Gatorade Endurance isn’t enough for me and I had to supplement with The Right Stuff.
5. EXPERIMENT. Read the race information; understand what brand of sports drink/electrolyte is going to be available and use that for your training. Test your calculations about hydration and salt requirements in addition to glucose needs on a long training day.

During my last IM, which was on a hot day, I drank at least two gallons of Gatorade, two gallons of water, and 3 cups of chicken broth. I took 4 Right Stuff pouches and probably could have used one more. Each pouch contains 1,780 mg of sodium. I didn’t urinate until 90 minutes after the race.

Last but not least…remember, you’re already a hero.

I completed 6 Ironman races before my donation (including one just 6 weeks prior to my donation) and completed my 7th Ironman 11 months after my donation. In the races before my donation, I think I was rather cavalier about how much I suffered during a race. For most mortals, an IM distance race is like the frog in the pot of boiling water. The training is as much about becoming accustomed to the boiling water (the suffering) as it is improving your conditioning. Suffering is expected and perhaps part of the appeal. Fortunately, I never had any serious consequences, but I spent time in the finish line medical tent on a few occasions.

My family was wonderfully supportive of my decision to give a kidney to a stranger; in exchange, I promised them (and myself) that I would take care of myself and stay out of the medical tent. As a result, I don’t push myself to the absolute limit anymore. I’ve purposely set my pain and suffering threshold a bit lower.

During my post-donation IM I wore a shirt designed by my daughter which tells the world that you can be an IronMan athlete AND a kidney donor. I know it can be done and I believe you can do it too.

AIMEE JAHNKE MUELLER

Green Bay, Wisconsin

Training for and competing in an IronMan is an incredible undertaking, and an amazing achievement! Here are three things from my experience that will help get you through the process to the finish line as a kidney donor.

Having supporting people in your life is important while you strive for this goal. Find the tribe: 

If you can afford it, get a coach. Based on your finishing goals, they understand how much, and what work you should do so you build at the right pace. If they have a group ride or swim, do it! During the group workouts, listen to the stories of why they do it and share your own, feel the love in the stories and tap into it. Do not be afraid of a group that is faster than you. I was the slowest in my group, and being last in a group of committed people makes you faster! Let them push you. Seeing them on the course during the race raised my spirits and energy, one even gave me the best advice right near the end when I needed it most. Drink the broth! 

Reach out to KDA and find a pal to talk about your why. Doing this not only helped me find someone willing to talk about hydration and training load, but reduced my overall fears. She was passionate about my success and shared her story of why she donated and what her own big athletic goals and accomplishments were. I am so grateful for her time.

Build a personal tribe. Talk about your training with people in your world and ask them to support you. One month before the race I put up a fundraiser and asked people to pledge support per mile. This raised money for National Kidney Foundation, and it built support for me on the day of the race both in person and virtually. I shared my estimated times for different points in the race, and I later found out there was a string of people following me online. One person noticed I was falling behind, got out of bed, called another friend, and met me on the run! It was so good to see them and feel their love! 

Find online support groups and with their help, find supported long bike rides. I did five supported long rides. Three were different local century rides, and two were supported loops on the IM course. This made long rides more fun! 

Eat and Drink: 

Eat enough and drink water! I was not aware of just how much I would have to eat to sustain my training. My husband finally started to make extra meals for me, pasta, meat, and veggies. I ate this three times a day, in addition to my normal food load. Also, consider adding in liquid nutrition. I tried to eat all solids for nutrition and drinking water and electrolytes for hydration. Near the end, I was doing meal replacement liquids before my swims and then moved to only liquids on the bike for long rides and race day. This liquid included protein, caffeine, and other electrolytes. Also, check-in with your labs. I checked in the middle of my training and found I had to up my water intake. When in doubt, check in with the transplant nutritionist. They are happy to consult with you! 

Enjoy the day: 

Remember you get to do this, enjoy the training, and enjoy the day! You will run into so many beautiful people, see them, and appreciate the small moments. Give thanks for the sunrises of the early morning workouts, the sunsets of the last run of the day, even the summer storm during your long weekend ride. Enjoy the kids who wave at you and give you high fives and soak in the love of the midnight finish line. What a display of love and kindness, cheering people they have never met, in a goal of a lifetime!

JOHN FRANKLIN MARTIN JR.

Alexandria, Ohio

Overall, no real reason a KDA can’t do an IronMan. You’ve got to be careful, particularly about hydration. With a single kidney, you just can’t mistreat it!

First off, I assume that a KDA considering an Ironman distance event has not done one before. So, I believe a coach is essential. Getting to the start line is more than just putting in the time to get you there, it is doing it in the most responsible way possible and always having consideration for the fact that you are doing this on one kidney. 

That is the physical side of the training, and if you have not done it before, then you need a coach as a guide. There was an article several years ago that attempted to identify the key factors that contribute to success at IM distances, and having a coach was at the top of the list. Another way to look at it is simply as insurance. You will spend a significant amount on an entry fee, bike, additional equipment, travel, etc. Now, include your time and effort. When you total it all up it is a considerable amount. Easily an outlay of over $5,000. If you fail in your attempt to finish it is most likely due to having made amateur mistakes. Suppose I tell you that for 20% of the total you will spend, I can guarantee you that you will not only finish but will finish strong? Interested? You don’t need dedicated one on one coaching. If you can afford it, then go for it, but there are many virtual training programs available at reasonable costs.

Secondly, in addition to being a physical contest, there is a significant mental element to IM racing. At shorter distances, it is possible to sneak through with minimal training. You can apply maximum effort for a short period, finish an Olympic or sprint distance event, and not be overly concerned about adverse effects. IM is all about risk vs reward. Or, when and where to invest large increases in an effort for maximum return. It is a thinking person’s game. You have to determine, based upon conditions and situations that may be unknown until race day (temperature, wind, waves, equipment failure, etc.) how you will approach each portion of the event, analyze how you are doing throughout the event, and then make decisions about how to proceed. 

For most of us, swimming is simply getting it done and staying alive while in the water. However, once you get on the bike, the thinking has to start. How hard do I go? When do I go hard? Go hard enough but not so hard that you have nothing left for the run. Ironman really does not begin until mile 90 on the bike – it is then that you will know if you have correctly invested the correct amount of effort so you can be off the bike and have a successful run. And, having a coach who has been there and done it is invaluable.

This is a link is to an article that appeared in October 2019. The author makes some good points about why we do these crazy things. He also believes there is a major mental aspect.

Advice from a coach (thanks John for talking with her and sharing her thoughts with our community!):

Here is what a good friend and experienced IM coach would say to any KDA who might ask her to coach them through an IM. Her approach is different from many other coaches that I know. For any KDA considering an IM with the help of a coach, the key question to ask any coach during the interview process (yes, interview your prospective employee!) is “What will be different about the way you train me as opposed to an athlete that has not been a kidney donor?” Her thoughts:

If an athlete asked me to coach them for an Ironman and they shared they had one kidney, there would be a series of questions and considerations that as a professional coach I would discuss:

1. Do you have medical clearance from both your nephrologist and primary care doctor to participate in a strenuous physical activity routine? I say strenuous because training for an Ironman can take 15-20 hours per week depending on your goals, current fitness level, and athletic ability.
2. Do you have medical clearance for the specific race you are planning to race? For example, 140.6 miles in the heat and humidity of Kona are vastly different than the usually windy and cooler conditions of a race like Ironman Florida. Though the weather cannot be predicted, understanding the typical environment for a specific race is important.
3. If you do have medical clearance, is your doctor willing to be in communication with the coach when or if there are any concerns about kidney function or health? Is the athlete willing to legally allow for this communication to occur?
4. Get details and establish the athletic history and experience of the future ironman in question. A novice athlete with no or little athletic background will have less body awareness than a veteran, life-long athlete. As a coach, part of my responsibility is to guide an athlete through this process of body awareness as they develop skills and fitness in multisport. Someone who has been a life-long athlete will likely have a higher familiarity with pain, discomfort, and understand the nuance between “injury” pain and daily training discomfort. Being attuned to one’s body becomes an essential skill when preparing for an Ironman
5. Develop rapport and trust with my athlete. The coach-athlete relationship is just that, a relationship. It requires trust for it to function properly. Something I see lacking in many of my coaching colleagues is a misunderstanding of what coaching is. Coaching is not just writing a progressive program of training that takes an athlete from point A to the IronMan finish line. That is PART of the job, but the bigger part of the job is tending to the specific needs of an athlete in body and mind. This means that a coach must be a keen observer, deep listener, and intentional communicator. The coach has to be able to develop enough trust so that an athlete with one kidney, for example, knows when they need to push themselves and when, for safety reasons, they need to call it a day. The coach must be able to communicate a clear and thoughtful nutrition and hydration program that effectively the athlete can easily and repeatedly adhere to. The coach must also be able to reflect when the athlete is not demonstrating the discipline necessary to not only go the distance for 140.6 miles but also do it safely and responsibly.
6. I would also set up a series of daily monitoring tests such as urinalysis strips to monitor hydration first thing in the AM, before and after training sessions, and before bed. Sweat rate testing is something else that can be considered.
7. When looking for a coach to assist you in your pursuit of the Ironman finish line, it is important to interview several coaches. Ask tough questions and be honest about what you want in a coach. Also know that you get what you pay for and skimping on price could leave you in a scary situation on race day.
8. Do not be afraid of doing an Ironman with one kidney, but do be responsible and hire a coach with years of proven experience and one who has shown responsibility to the health and well being of their athletes. COVID-19 has been a great way to see how a coach takes care of their athletes – does a coach have group training sessions, does a coach have their athletes swimming indoors? Asking questions like this will demonstrate how a coach orients his or herself to tending to the long term health of their athletes.

Are you still inspired to train for an IronMan with one kidney? We hope so!

As always, please seek medical advice from your transplant team, and join us in our Kidney Donor Athletes Private Facebook Group for more discussion with fellow KDA IronMan finishers!

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