Diabetes and Cardiovascular Disease Following Kidney Transplantation

Brian      P. Boerner; Vijay      Shivaswamy; Cyrus      V. Desouza; Jennifer      L. Larsen

Abstract

Kidney transplantation is being performed more frequently for individuals with end stage renal disease (ESRD) due to improved survival and quality of life compared to long-term dialysis. Though rates decrease after transplant, cardiovascular disease (CVD) remains the most common cause of death after kidney transplant. New-onset diabetes after transplant (NODAT), a common complication following kidney transplantation, and pre-transplant diabetes both significantly increase the risk for CVD. Several other risk factors for CVD in kidney transplant recipients have been identified; however, optimal therapy for controlling the risk factors of CVD after kidney transplantation, including NODAT and pretransplant diabetes, is not well defined. In the following review we will discuss the role of traditional and non-traditional risk factors in CVD after kidney transplant and the mechanisms involved therein. We will also examine the current literature regarding treatment of these risk factors for the prevention of CVD. Finally, we will review the current recommendations for pre- and post-transplant cardiovascular evaluation and management.

Keywords: Diabetes, Hypertension, Dyslipidemia, Obesity, Cardiovascular disease, Kidney transplant, End stage renal disease, New-onset diabetes after transplant, Chronic kidney disease (CKD), Hyperparathyroidism, Hyperhomocysteinemia, Hyperuricemia