Metabolic Disorders with Kidney Transplant
| Autor: | Renata Belfort de Aguiar, Glenda G. Callender, Danielle J. Haakinson, Maria Korah, Elizabeth Cohen |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Pediatrics Epidemiology Population 030232 urology & nephrology Reviews 030230 surgery Critical Care and Intensive Care Medicine Risk Assessment Organ transplantation 03 medical and health sciences 0302 clinical medicine Metabolic Diseases Risk Factors Diabetes management Diabetes mellitus medicine Humans Renal Insufficiency Chronic education Kidney transplantation Transplantation Hyperparathyroidism education.field_of_study business.industry medicine.disease Kidney Transplantation Treatment Outcome surgical procedures operative Nephrology Secondary hyperparathyroidism business |
| Zdroj: | Clin J Am Soc Nephrol |
| ISSN: | 1555-905X 1555-9041 |
| DOI: | 10.2215/cjn.09310819 |
| Popis: | Metabolic disorders are highly prevalent in kidney transplant candidates and recipients and can adversely affect post-transplant graft outcomes. Management of diabetes, hyperparathyroidism, and obesity presents distinct opportunities to optimize patients both before and after transplant as well as the ability to track objective data over time to assess a patient's ability to partner effectively with the health care team and adhere to complex treatment regimens. Optimization of these particular disorders can most dramatically decrease the risk of surgical and cardiovascular complications post-transplant. Approximately 60% of nondiabetic patients experience hyperglycemia in the immediate post-transplant phase. Multiple risk factors have been identified related to development of new onset diabetes after transplant, and it is estimated that upward of 7%-30% of patients will develop new onset diabetes within the first year post-transplant. There are a number of medications studied in the kidney transplant population for diabetes management, and recent data and the risks and benefits of each regimen should be optimized. Secondary hyperparathyroidism occurs in most patients with CKD and can persist after kidney transplant in up to 66% of patients, despite an initial decrease in parathyroid hormone levels. Parathyroidectomy and medical management are the options for treatment of secondary hyperparathyroidism, but there is no randomized, controlled trial providing clear recommendations for optimal management, and patient-specific factors should be considered. Obesity is the most common metabolic disorder affecting the transplant population in both the pre- and post-transplant phases of care. Not only does obesity have associations and interactions with comorbid illnesses, such as diabetes, dyslipidemia, and cardiovascular disease, all of which increase morbidity and mortality post-transplant, but it also is intimately inter-related with access to transplantation for patients with kidney failure. We review these metabolic disorders and their management, including data in patients with kidney transplants. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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