Kidney Transplant and Cardiovascular-Kidney-Metabolic Health

Kidney transplantation (KT) is the treatment of choice for suitable candidates with advanced kidney disease, offering improved survival compared with chronic dialysis. However, KT recipients remain at high risk for cardiovascular mortality and complications. Cardiovascular-kidney-metabolic syndrome is commonly present, with high rates of obesity, diabetes, and dyslipidemia posttransplant. These risk factors are exacerbated by the metabolic effects of immunosuppression. Management includes utilizing standard pharmacologic therapy such as statins and antihypertensives, and newer agents such as glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter 2 inhibitors. Modification of the immunosuppressive regimen to reduce cardiometabolic effects should be weighed against other risks such as allograft rejection.