Patient after kidney transplantation in outpatient internal clinic

Czech version

Authors: Tomáš Rohá
Authors‘ workplace: Klinika nefrologie, Transplantcentrum, IKEM Praha
Published in: Vnitř Lék 2020; 66(4): 42-46
Category:

Overview

Kidney transplantation is the first-choice treatment of the end-stage kidney disease. By increasing the number of kidney transplants and by improving the care for these patients, there is increasing number of patients with a functional graft, who need adequate follow-up and treatment. It is advisable to feasibly transfer some portion of the care to the doctors based outside transplant centres and so it is necessary to make them familiar with these issues. That is also the purpose of this article, which is focused on some of those frequent medical problems associated with kidney transplantations, which are in competence of internal medicine doctors. These are namely arterial hypertension, present in majority of patients after transplantation, frequently caused by persisting renal dysfunction of various degree and effect of immunosuppressants, post transplant diabetes mellitus, dyslipidaemia, which is our focus because chronic kidney disease is considered a coronary heart disease risk equivalent, and anaemia.

Keywords:

arterial hypertension – diabetes mellitus – anaemia – dyslipidaemia – kidney transplantation – PTDM

Sources

1. Statistická ročenka dialyzační léčby v České republice v roce 2016. Česká nefrologická společnost. (cit. 2018–09–25). Dostupné z WWW: .

2. Vella J, Brennan DC. Hypertension after renal transplantation. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. (cit. 2018–09–25). Dostupné z WWW: .

3. Kasiske BL, Anjum S, Shah R, et al. Hypertension after kidney transplantation. Am J Kid‑ ney Dis 2004; 43: 1071–1081.

4. Takeda Y, Miyamori I, Furukawa K, et al. Mechanisms of FK 506-induced hypertension in the rat. Hypertension 1999; 33: 130–136.

5. Curtis JJ, Luke RG, Jones P, et al. Hypertension in cyclosporine‑treated renal transplant recipients is sodium dependent. Am J Med. 1988; 85: 134–138.

6. Audard V, Matignon M, Hemery F, et al. Risk factors and long‑term outcome of transplant renal artery stenosis in adult recipients after treatment by percutaneous transluminal angioplasty. Am J Transplant 2006; 6: 95–99.

7. Opelz G, Dohler B. Improved Long‑Term Outcomes After Renal Transplantation Associated with Blood Pressure Control. Am J Transplant 2005; 5: 2725–2731.

8. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDI‑ GO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int Suppl 2012; 2: 337–414.

9. Cross NB, Webster AC, Masson P, et al. Antihypertensive treatment for kidney transplant recipients. Cochrane Database Syst Rev 2009; 3.

10. Knoll GA, Fergusson D, Chassé M, et al. Ramipril versus placebo in kidney transplant patients with proteinuria: a multicentre, double‑blind, randomised controlled trial. Lancet Diabetes Endocrinol 2016; 4: 318–326.

11. Chakkera HA, Weil EJ, Castro J, et al. Hyperglycemia during the immediate period after kidney transplantation. Clin J Am Soc Nephrol 2009; 4: 853–859.

12. Sharif A, Hecking M, de Vries APJ, et al. Proceedings From an International Consensus Meeting on Posttransplantation Diabetes Mellitus: Recommendations and Future Directions. Am J Transplant 2014; 14: 1992–2000.

13. Tobin GS, Klein CL, Brennan DC. New‑onset diabetes after transplant (NODAT) in renal transplant recipients. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. (cit. 2018–09– 25). Dostupné z WWW: .

14. Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR 2013 Annual Data Report: Kidney. Am J Transplant 2015; 15: 1–34.

15. Shivaswamy V, Boerner B, Larsen J. Post‑transplant diabetes mellitus: Causes, Treatment, and Impact on Outcomes. Endocr Rev 2016; 37: 37–61.

16. Pirsch JD, Henning AK, First MR, et al. New‑onset diabetes after transplantation: Results from a double‑blind early corticosteroid withdrawal trial. Am J Transplant 2015; 15: 1982–1990.

17. Wauters RP, Cosio FG, Suarez Fernandez ML, et al. Cardiovascular consequences of new‑onset hyperglycemia after kidney transplantation. Transplantation 2012; 94: 377–382.

18. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009; 9: (Suppl. 3): S1-S157.

19. Gonyea JE, Anderson CF. Weight Change and Serum Lipoproteins in Recipients of Renal Allografts. Mayo Clin Proc 1992; 67: 653–657.

20. Gaston RS, Kasiske BL, Fieberg AM, et al. Use of cardioprotective medications in kidney transplant recipients. Am J Transplant 2009; 9: 1811–1815.

21. Brennan DC, Lentine KL. Lipid abnormalities after renal transplantation. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. (cit. 2018–09–26). Dostupné z WWW: .

22. Agarwal A, Prasad GVR. Post‑transplant dyslipidemia: Mechanisms, diagnosis and management. World J Transplant 2016; 6: 125.

23. Kasiske BL, De Mattos A, Flechner SM, et al. Mammalian target of rapamycin inhibitor dyslipidemia in kidney transplant recipients. Am J Transplant 2008; 8: 1384–1392.

24. Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work Group. KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease. Kidney Int Suppl 2013; 3: 259–305.

25. Knoll GA, Blydt‑Hansen TD, Campbell P, et al. Canadian Society of Transplantation and Canadian Society of Nephrology commentary on the 2009 KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Kidney Dis 2010; 56: 219–246.

26. Kidney Disease Outcomes Quality Initiative (K/DOQI) Group: K/DOQI clinical practice guidelines for management of dyslipidemias in patients with kidney disease. Am J Kidney Dis 2003; 41: S11-S91.

27. Holdaas H, Fellström B, Ag J, et al. Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo‑controlled trial. Lancet 2003; 361: 2024–2031.

28. Yabu JM, Winkelmayer WC. Posttransplantation anemia: Mechanisms and management. Clin J Am Soc Nephrol 2011; 6: 1794–1801.

29. Mix TCH, Kazmi W, Khan S, et al. Anemia: A Continuing Problem Following Kidney Transplantation. Am J Transplant 2003; 3: 1426–1433.

30. Coyne DW, Brennan DC. Anemia and the renal transplant recipient. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. (cit. 2018–09–28). Dostupné z WWW: .

31. Lorenz M, Kletzmayr J, Perschl A, et al. Anemia and iron deficiencies among long‑term renal transplant recipients. J Am Soc Nephrol 2002; 13: 794–797.