Endocrine-metabolic pathophysiologic conditions and treatment approaches after kidney transplantation

To review pathophysiologic conditions and diagnostic and therapeutic approaches in the management of endocrine-metabolic disorders after kidney transplantation (KT).

We discuss the assessment of diabetes mellitus (DM), hyperlipidemia, hypertension, and disturbances of bone and mineral metabolism after KT.

KT offers patients with end-stage kidney disease substantial improvement in life expectancy and quality of life. Despite amelioration of renal dysfunction, however, these patients are at risk for the deterioration of existing and the development of new endocrine pathologic conditions. Pretransplant DM and new-onset diabetes after transplantation are associated with worse patient and graft survival. Little is known about preventing new-onset diabetes after transplantation and managing DM shortly after KT. In addition to glycemic control in patients with diabetes, management of cardiovascular risk factors includes appropriate recognition and treatment of hypertension and dyslipidemia. After KT, patients are at considerable risk for derangements in calcium and vitamin D metabolism. Immunosuppressive medications may cause compromised glucose and lipid metabolism, which may, in turn, contribute to the progression of preexisting and the development of new posttransplant endocrinopathies.

Clinical care of kidney transplant patients should include a comprehensive endocrine assessment before and after KT in close collaboration with transplant nephrology providers. A referral to an endocrinologist should be initiated early during the pretransplant stage, and collaborative management should be maintained in kidney transplant patients to improve clinical outcomes.