Journal of General Internal Medicine

, Volume 25, Issue 7, pp 731–740 | Cite as

Primary Care of the Renal Transplant Patient

  • Gaurav Gupta
  • Mark L. Unruh
  • Thomas D. Nolin
  • Peggy B. Hasley
Original Research

Abstract

There has been a remarkable rise in the number of kidney transplant recipients (KTR) in the US over the last decade. Increasing use of potent immunosuppressants, which are also potentially diabetogenic and atherogenic, can result in worsening of pre-existing medical conditions as well as development of post-transplant disease. This, coupled with improving long-term survival, is putting tremendous pressure on transplant centers that were not designed to deliver primary care to KTR. Thus, increasing numbers of KTR will present to their primary care physicians (PCP) post-transplant for routine medical care. Similar to native chronic kidney disease patients, KTRs are vulnerable to cardiovascular disease as well as a host of other problems including bone disease, infections and malignancies. Deaths related to complications of cardiovascular disease and malignancies account for 60–65% of long-term mortality among KTRs. Guidelines from the National Kidney Foundation and the European Best Practice Guidelines Expert Group on the management of hypertension, dyslipidemia, smoking, diabetes and bone disease should be incorporated into the long-term care plan of the KTR to improve outcomes. A number of transplant centers do not supply PCPs with protocols and guidelines, making the task of the PCP more difficult. Despite this, PCPs are expected to continue to provide general preventive medicine, vaccinations and management of chronic medical problems. In this narrative review, we examine the common medical problems seen in KTR from the PCP’s perspective. Medical management issues related to immunosuppressive medications are also briefly discussed.

Key words

renal transplantation kidney transplantation transplantation primary care primary care physicians 

Notes

Acknowledgements

We would like to thank Dr. Christine Wu for her help in the preparation of this manuscript.

Conflict of Interest

None disclosed.

References

  1. 1.
    Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med. 1994;331(6):365–76.PubMedCrossRefGoogle Scholar
  2. 2.
    Organ Procurement and Transplant Network/Scientific Registry of Transplant Recipients Annual Report. 2007 Donation and transplantation trends. accessed in March 2009 from www.unos.org.
  3. 3.
    Cecka JM. The OPTN/UNOS Renal Transplant Registry. Clin Transpl. 2005:1-16Google Scholar
  4. 4.
    Collins AJ, Kasiske B, Herzog C, et al. Excerpts from the United States Renal Data System 2006 Annual Data Report. Am J Kidney Dis. 2007;49(1 Suppl 1):A6–7–S1–296.Google Scholar
  5. 5.
    Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000;342(9):605–12.PubMedCrossRefGoogle Scholar
  6. 6.
    McCashland TM. Posttransplantation care: role of the primary care physician versus transplant center. Liver Transpl. 2001;7(11 Suppl 1):S2–S12.PubMedCrossRefGoogle Scholar
  7. 7.
    Aakhus S, Dahl K, Wideroe TE. Cardiovascular disease in stable renal transplant patients in Norway: morbidity and mortality during a 5-year follow-up. Clin Transplant. 2004;18(5):596–604.PubMedCrossRefGoogle Scholar
  8. 8.
    Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol. 1998;9(12 Suppl):S16–S23.PubMedGoogle Scholar
  9. 9.
    Aakhus S, Dahl K, Wideroe TE. Cardiovascular morbidity and risk factors in renal transplant patients. Nephrol Dial Transplant. 1999;14(3):648–54.PubMedCrossRefGoogle Scholar
  10. 10.
    Lentine KL, Schnitzler MA, Abbott KC, et al. De novo congestive heart failure after kidney transplantation: a common condition with poor prognostic implications. Am J Kidney Dis. 2005;46(4):720–33.PubMedCrossRefGoogle Scholar
  11. 11.
    Abbott KC, Hypolite IO, Hshieh P, Cruess D, Taylor AJ, Agodoa LY. Hospitalized congestive heart failure after renal transplantation in the United States. Ann Epidemiol. 2002;12(2):115–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Kasiske BL, Maclean JR, Snyder JJ. Acute myocardial infarction and kidney transplantation. J Am Soc Nephrol. 2006;17(3):900–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Ojo AO. Cardiovascular complications after renal transplantation and their prevention. Transplantation. 2006;82(5):603–11.PubMedCrossRefGoogle Scholar
  14. 14.
    Marcen R. Cardiovascular risk factors in renal transplantation-current controversies. Nephrol Dial Transplant. 2006;21:(Suppl 3):iii3–8PubMedCrossRefGoogle Scholar
  15. 15.
    Kasiske BL, Chakkera HA, Roel J. Explained and unexplained ischemic heart disease risk after renal transplantation. J Am Soc Nephrol. 2000;11(9):1735–43.PubMedGoogle Scholar
  16. 16.
    Ducloux D, Ruedin C, Gibey R, et al. Prevalence, determinants, and clinical significance of hyperhomocyst(e)inaemia in renal-transplant recipients. Nephrol Dial Transplant. 1998;13(11):2890–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Varagunam M, Finney H, Trevitt R, et al. Pretransplantation levels of C-reactive protein predict all-cause and cardiovascular mortality, but not graft outcome, in kidney transplant recipients. Am J Kidney Dis. 2004;43(3):502–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Fernandez-Fresnedo G, Escallada R, Rodrigo E, et al. The risk of cardiovascular disease associated with proteinuria in renal transplant patients. Transplantation. 2002;73(8):1345–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Lentine KL, Rocca-Rey LA. Bacchi G, et al. Obesity and cardiac risk after kidney transplantation: experience at one center and comprehensive literature review. Transplantation. 2008;86(2):303–12.Google Scholar
  20. 20.
    Friedman AN, Miskulin DC, Rosenberg IH, Levey AS. Demographics and trends in overweight and obesity in patients at time of kidney transplantation. Am J Kidney Dis. 2003;41(2):480–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Baum CL, Thielke K, Westin E, Kogan E, Cicalese L, Benedetti E. Predictors of weight gain and cardiovascular risk in a cohort of racially diverse kidney transplant recipients. Nutrition. 2002;18(2):139–46.PubMedCrossRefGoogle Scholar
  22. 22.
    Armstrong KA, Campbell SB, Hawley CM, Nicol DL, Johnson DW, Isbel NM. Obesity is associated with worsening cardiovascular risk factor profiles and proteinuria progression in renal transplant recipients. American J Transplantation. 2005;5(11):2710–8.CrossRefGoogle Scholar
  23. 23.
    Shah T, Kasravi A, Huang E, et al. Risk factors for development of new-onset diabetes mellitus after kidney transplantation. Transplantation. 2006;82(12):1673–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Modlin CS, Flechner SM, Goormastic M, et al. Should obese patients lose weight before receiving a kidney transplant? Transplantation. 1997;64(4):599–604.PubMedCrossRefGoogle Scholar
  25. 25.
    Gore JL, Pham PT, Danovitch GM, et al. Obesity and outcome following renal transplantation. Am J Transplant. 2006;6(2):357–63.PubMedCrossRefGoogle Scholar
  26. 26.
    Jindal RM, Zawada ET Jr. Obesity and kidney transplantation. Am J Kidney Dis. 2004;43(6):943–52.PubMedCrossRefGoogle Scholar
  27. 27.
    Lopes IM, Martin M, Errasti P, Martinez JA. Benefits of a dietary intervention on weight loss, body composition, and lipid profile after renal transplantation. Nutrition. 1999;15(1):7–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Painter PL, Hector L, Ray K, et al. Effects of exercise training on coronary heart disease risk factors in renal transplant recipients. Am J Kidney Dis. 2003;42(2):362–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Li Z, Maglione M, Tu W, et al. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005;142(7):532–46.PubMedGoogle Scholar
  30. 30.
    Barbaro D, Orsini P, Pallini S, Piazza F, Pasquini C. Obesity in transplant patients: case report showing interference of orlistat with absorption of cyclosporine and review of literature. Endocr Pract. Mar-Apr. 2002;8(2):124–6.Google Scholar
  31. 31.
    Modanlou KA, Muthyala U, Xiao H, et al. Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review. Transplantation. 2009;87(8):1167–73.PubMedCrossRefGoogle Scholar
  32. 32.
    Alexander JW, Goodman H. Gastric bypass in chronic renal failure and renal transplant. Nutr Clin Pract. 2007;22(1):16–21.PubMedCrossRefGoogle Scholar
  33. 33.
    Rogers CC, Alloway RR, Alexander JW, Cardi M, Trofe J, Vinks AA. Pharmacokinetics of mycophenolic acid, tacrolimus and sirolimus after gastric bypass surgery in end-stage renal disease and transplant patients: a pilot study. Clinical Transplantation. May-Jun. 2008;22(3):281–91.Google Scholar
  34. 34.
    Ablassmaier B, Klaua S, Jacobi CA, Muller JM. Laparoscopic gastric banding after heart transplantation. Obes Surg. 2002;12(3):412–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Koshy AN, Coombes JS, Wilkinson S, Fassett RG. Laparoscopic gastric banding surgery performed in obese dialysis patients prior to kidney transplantation. Am J Kidney Dis. 2008;52(4):e15–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Weiss H, Nehoda H, Labeck B, Oberwalder M, Konigsrainer A, Margreiter R. Organ transplantation and obesity: evaluation, risks and benefits of therapeutic strategies. Obes Surg. 2000;10(5):465–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Buch KE, El-Sabrout R, Butt KM. Complications of laparoscopic gastric banding in renal transplant recipients: a case study. Transplant Proc. 2006;38(9):3109–11.PubMedCrossRefGoogle Scholar
  38. 38.
    Olarte IG, Hawasli A. Kidney transplant complications and obesity. Am J Surg. 2009;197(3):424–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Duffey BG, Pedro RN, Makhlouf A, et al. Roux-en-Y gastric bypass is associated with early increased risk factors for development of calcium oxalate nephrolithiasis. J Am Coll Surg. 2008;206(3):1145–53.PubMedCrossRefGoogle Scholar
  40. 40.
    Lieske JC, Kumar R, Collazo-Clavell ML. Nephrolithiasis after bariatric surgery for obesity. Semin Nephrol. 2008;28(2):163–73.PubMedCrossRefGoogle Scholar
  41. 41.
    Sinha MK, Collazo-Clavell ML, Rule A, et al. Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery. Kidney Int. 2007;72(1):100–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Kasiske BL, Klinger D. Cigarette smoking in renal transplant recipients. J Am Soc Nephrol. 2000;11(4):753–9.PubMedGoogle Scholar
  43. 43.
    Sung RS, Althoen M, Howell TA, Ojo AO, Merion RM. Excess risk of renal allograft loss associated with cigarette smoking. Transplantation. 2001;71(12):1752–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Banas MC, Banas B, Wolf J, et al. Smoking behaviour of patients before and after renal transplantation. Nephrol Dial Transplant. 2008;23(4):1442–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Strategies for reducing exposure to environmental tobacco smoke, increasing tobacco-use cessation, and reducing initiation in communities and health-care systems. A report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep. Nov 10 2000;49(RR-12):1–11.Google Scholar
  46. 46.
    Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2004;(3):CD000146.Google Scholar
  47. 47.
    Lewis BR, Aoun SL, Bernstein GA, Crow SJ. Pharmacokinetic interactions between cyclosporine and bupropion or methylphenidate. J Child Adolesc Psychopharmacol. Summer. 2001;11(2):193–8.CrossRefGoogle Scholar
  48. 48.
    Jorenby DE, Hays JT, Rigotti NA, et al. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA. 2006;296(1):56–63.PubMedCrossRefGoogle Scholar
  49. 49.
    Shirali AC, Bia MJ. Management of cardiovascular disease in renal transplant recipients. Clin J Am Soc Nephrol. 2008;3(2):491–504.PubMedCrossRefGoogle Scholar
  50. 50.
    McIntyre RS. Varenicline and suicidality: a new era in medication safety surveillance. Expert Opin Drug Saf. 2008;7(5):511–4.PubMedCrossRefGoogle Scholar
  51. 51.
    McClure JB, Swan GE, Jack L, et al. Mood, side-effects and smoking outcomes among persons with and without probable lifetime depression taking varenicline. J Gen Intern Med. 2009;24(5):563–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure—The JNC 7 Report. JAMA. 2003;289(19):2560–72.PubMedCrossRefGoogle Scholar
  53. 53.
    Kasiske BL, Anjum S, Shah R, et al. Hypertension after kidney transplantation. Am J Kidney Dis. 2004;43(6):1071–81.PubMedCrossRefGoogle Scholar
  54. 54.
    Curtis JJ. Cyclosporine and Posttransplant Hypertension. J Am Soc Nephrol. 1992;2(12):S243–5.PubMedGoogle Scholar
  55. 55.
    Veenstra DL, Best JH, Hornberger J, Sullivan SD, Hricik DE. Incidence and long-term cost of steroid-related side effects after renal transplantation. Am J Kidney Dis. 1999;33(5):829–39.PubMedCrossRefGoogle Scholar
  56. 56.
    Mange KC, Cizman B, Joffe M, Feldman HI. Arterial hypertension and renal allograft survival. JAMA. 2000;283(5):633–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Opelz G, Wujciak T, Ritz E. Association of chronic kidney graft failure with recipient blood pressure. Collaborative Transplant Study. Kidney Int. Jan. 1998;53(1):217–22.CrossRefGoogle Scholar
  58. 58.
    K/DOQI. clinical practice guidelines on hypertension and anti hypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5):S14–S290.Google Scholar
  59. 59.
    European best practice guidelines for renal transplantation (2002) Section IV: Long-term management of the transplant recipient. IV.5.1. Cardiovascular risks. Cardiovascular disease after renal transplantation. Nephrol Dial Transplant. 17 Suppl 4:24–5.Google Scholar
  60. 60.
    Tomson CR. Ambulatory blood pressure measurement in kidney transplantation: an overview. Transplantation. 2003;76(11):1643–4.PubMedCrossRefGoogle Scholar
  61. 61.
    Kooman JP, Christiaans MH, Boots JM, van Der Sande FM, Leunissen KM, van Hooff JP. A comparison between office and ambulatory blood pressure measurements in renal transplant patients with chronic transplant nephropathy. Am J Kidney Dis. 2001;37(6):1170–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Lipkin GW, Tucker B, Giles M, Raine AE. Ambulatory blood pressure and left ventricular mass in cyclosporin-and non-cyclosporin-treated renal transplant recipients. J Hypertens. 1993;11(4):439–42.PubMedCrossRefGoogle Scholar
  63. 63.
    Covic A, Segall L, Goldsmith DJ. Ambulatory blood pressure monitoring in renal transplantation: should ABPM be routinely performed in renal transplant patients? Transplantation. 2003;76(11):1640–2.PubMedCrossRefGoogle Scholar
  64. 64.
    Premasathian NC, Muehrer R, Brazy PC, Pirsch JD, Becker BN. Blood pressure control in kidney transplantation: therapeutic implications. J Hum Hypertens. 2004;18(12):871–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Olyaei AJ, deMattos AM, Bennett WM. A practical guide to the management of hypertension in renal transplant recipients. Drugs. 1999;58(6):1011–27.PubMedCrossRefGoogle Scholar
  66. 66.
    Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients. American Journal of Transplantation. 2009;9(s3):S1–55.Google Scholar
  67. 67.
    KDOQI. Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis. 2007;49(2 Suppl 2):S12–54.Google Scholar
  68. 68.
    Midtvedt K, Hartmann A, Holdaas H, Fauchald P. Efficacy of nifedipine or lisinopril in the treatment of hypertension after renal transplantation: a double-blind randomised comparative trial. Clin Transplant. 2001;15(6):426–31.PubMedCrossRefGoogle Scholar
  69. 69.
    Ladefoged SD, Andersen CB. Calcium channel blockers in kidney transplantation. Clin Transplant. 1994;8(2 Pt 1):128–33.PubMedGoogle Scholar
  70. 70.
    European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. Nephrol Dial Transplant. 2002;17(Suppl 4):1–67.Google Scholar
  71. 71.
    Kothari J, Nash M, Zaltzman J, Ramesh, Prasad GV. Diltiazem use in tacrolimus-treated renal transplant recipients. J Clin Pharm Ther. Oct. 2004;29(5):425–30.CrossRefGoogle Scholar
  72. 72.
    Djamali A, Samaniego M, Muth B, et al. Medical care of kidney transplant recipients after the first posttransplant year. Clin J Am Soc Nephrol. 2006;1(4):623–40.PubMedCrossRefGoogle Scholar
  73. 73.
    Buturovic-Ponikvar J. Renal transplant artery stenosis. Nephrol Dial Transplant. 2003;18(Suppl 5):v74–7.PubMedCrossRefGoogle Scholar
  74. 74.
    Valpreda S, Messina M, Rabbia C. Stenting of transplant renal artery stenosis: outcome in a single center study. J Cardiovasc Surg (Torino). 2008;49(5):565–70.Google Scholar
  75. 75.
    Voiculescu A, Hollenbeck M, Plum J, et al. Iliac artery stenosis proximal to a kidney transplant: clinical findings, duplex-sonographic criteria, treatment, and outcome. Transplantation. 2003;76(2):332–9.PubMedCrossRefGoogle Scholar
  76. 76.
    Voiculescu A, Schmitz M, Hollenbeck M, et al. Management of arterial stenosis affecting kidney graft perfusion: a single-centre study in 53 patients. Am J Transplant. 2005;5(7):1731–8.PubMedCrossRefGoogle Scholar
  77. 77.
    Kasiske B, Cosio FG, Beto J, et al. Clinical practice guidelines for managing dyslipidemias in kidney transplant patients: a report from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Am J Transplant. 2004;4:13–53.PubMedCrossRefGoogle Scholar
  78. 78.
    Chueh SCJ, Kahan BD. Dyslipidemia in renal transplant recipients treated with a sirolimus and cyclosporine-based immunosuppressive regimen: Incidence, risk factors, progression, and prognosis. Transplantation. 2003;76(2):375–82.PubMedCrossRefGoogle Scholar
  79. 79.
    Kobashigawa JA, Kasiske BL. Hyperlipidemia in solid organ transplantation. Transplantation. 1997;63(3):331–8.PubMedCrossRefGoogle Scholar
  80. 80.
    Legendre C, Campistol JM, Squifflet JP, Burke JT. Cardiovascular risk factors of sirolimus compared with cyclosporine: early experience from two randomized trials in renal transplantation. Transplant Proc. 2003;35(3 Suppl):151S–3S.PubMedCrossRefGoogle Scholar
  81. 81.
    Fellstrom B. Risk factors for and management of post-transplantation cardiovascular disease. BioDrugs. 2001;15(4):261–78.PubMedCrossRefGoogle Scholar
  82. 82.
    Brattstrom C, Wilczek H, Tyden G, Bottiger Y, Sawe J, Groth CG. Hyperlipidemia in renal transplant recipients treated with sirolimus (rapamycin). Transplantation. 1998;65(9):1272–4.PubMedCrossRefGoogle Scholar
  83. 83.
    Kasiske BL. Risk factors for accelerated atherosclerosis in renal transplant recipients. Am J Med. 1988;84(6):985–92.PubMedCrossRefGoogle Scholar
  84. 84.
    Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.Google Scholar
  85. 85.
    Holdaas H, Fellstrom B, Jardine AG, et al. Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo-controlled trial. Lancet. 2003;361(9374):2024–31.PubMedCrossRefGoogle Scholar
  86. 86.
    Asberg A. Interactions between cyclosporin and lipid-lowering drugs: implications for organ transplant recipients. Drugs. 2003;63(4):367–78.PubMedCrossRefGoogle Scholar
  87. 87.
    Lemahieu WP, Hermann M, Asberg A, et al. Combined therapy with atorvastatin and calcineurin inhibitors: no interactions with tacrolimus. Am J Transplant. 2005;5(9):2236–43.PubMedCrossRefGoogle Scholar
  88. 88.
    Nogueira J, Weir M. The unique character of cardiovascular disease in chronic kidney disease and its implications for treatment with lipid-lowering drugs. Clin J Am Soc Nephrol. 2007;2(4):766–85.PubMedCrossRefGoogle Scholar
  89. 89.
    Kastelein JJ, Akdim F, Stroes ES, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008;358(14):1431–43.PubMedCrossRefGoogle Scholar
  90. 90.
    Langone AJ, Chuang P. Ezetimibe in renal transplant patients with hyperlipidemia resistant to HMG-CoA reductase inhibitors. Transplantation. 2006;81(5):804–7.PubMedCrossRefGoogle Scholar
  91. 91.
    Lim AK, Manley KJ, Roberts MA, Fraenkel MB. Fish oil treatment for kidney transplant recipients: a meta-analysis of randomized controlled trials. Transplantation. 2007;83(7):831–8.PubMedCrossRefGoogle Scholar
  92. 92.
    Ballantyne CM, Corsini A, Davidson MH, et al. Risk for myopathy with statin therapy in high-risk patients. Arch Intern Med. 2003;163(5):553–64.PubMedCrossRefGoogle Scholar
  93. 93.
    Celik S, Doesch A, Erbel C, et al. Beneficial effect of omega-3 fatty acids on sirolimus-or everolimus-induced hypertriglyceridemia in heart transplant recipients. Transplantation. 2008;86(2):245–50.PubMedCrossRefGoogle Scholar
  94. 94.
    Kasiske BL. Clinical practice guidelines for managing dyslipidemias in kidney transplant patients. Am J Transplant. 2005;5(6):1576.PubMedCrossRefGoogle Scholar
  95. 95.
    Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003;3(2):178–85.PubMedCrossRefGoogle Scholar
  96. 96.
    Chuang P, Gibney EM, Chan L, Ho PM, Parikh CR. Predictors of cardiovascular events and associated mortality within two years of kidney transplantation. Transplant Proc. 2004;36(5):1387–91.PubMedCrossRefGoogle Scholar
  97. 97.
    Fernandez-Fresnedo G, Escallada R, de Francisco ALM, et al. Posttransplant diabetes is a cardiovascular risk factor in renal transplant patients. Transplant Proc. 2003;35(2):700.PubMedCrossRefGoogle Scholar
  98. 98.
    Miles AM, Sumrani N, Horowitz R, et al. Diabetes mellitus after renal transplantation: as deleterious as non-transplant-associated diabetes? Transplantation. 1998;65(3):380–4.PubMedCrossRefGoogle Scholar
  99. 99.
    Wilkinson A, Davidson J, Dotta F, et al. Guidelines for the treatment and management of new-onset diabetes after transplantation. Clin Transplant. 2005;19(3):291–8.PubMedCrossRefGoogle Scholar
  100. 100.
    Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. Jan 2003;26 Suppl 1:S5–20.Google Scholar
  101. 101.
    Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: a position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Cardiol. 2009;53(3):298–304.PubMedCrossRefGoogle Scholar
  102. 102.
    Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–2559.PubMedCrossRefGoogle Scholar
  103. 103.
    Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta–analysis of controlled clinical trials. JAMA. 2001;286(10):1218–27.PubMedCrossRefGoogle Scholar
  104. 104.
    Seliger SL, Gillen DL, Longstreth WT Jr, Kestenbaum B, Stehman-Breen CO. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int. 2003;64(2):603–9.PubMedCrossRefGoogle Scholar
  105. 105.
    Oliveras A, Roquer J, Puig JM, et al. Stroke in renal transplant recipients: epidemiology, predictive risk factors and outcome. Clin Transplant. 2003;17(1):1–8.PubMedCrossRefGoogle Scholar
  106. 106.
    Abedini S, Holme I, Fellstrom B, et al. Cerebrovascular events in renal transplant recipients. Transplantation. 2009;87(1):112–7.PubMedCrossRefGoogle Scholar
  107. 107.
    Khella S, Bleicher MB. Stroke and its prevention in chronic kidney disease. Clin J Am Soc Nephrol. 2007;2(6):1343–51.PubMedCrossRefGoogle Scholar
  108. 108.
    Shah N, Al-Khoury S, Afzali B, et al. Posttransplantation anemia in adult renal allograft recipients: prevalence and predictors. Transplantation. 2006;81(8):1112–8.PubMedCrossRefGoogle Scholar
  109. 109.
    Vanrenterghem Y. Anaemia after renal transplantation. Nephrology Dialysis Transplantation. 2004;19:54–8.CrossRefGoogle Scholar
  110. 110.
    Rigatto C, Foley R, Jeffery J, Negrijn C, Tribula C, Parfrey P. Electrocardiographic left ventricular hypertrophy in renal transplant recipients: Prognostic value and impact of blood pressure and anemia. J Am Soc Nephrol. 2003;14(2):462–8.PubMedCrossRefGoogle Scholar
  111. 111.
    Winkelmayer WC, Chandraker A. Pottransplantation anemia: management and rationale. Clin J Am Soc Nephrol. 2008;3(Suppl 2):S49–55.PubMedCrossRefGoogle Scholar
  112. 112.
    Vanrenterghem Y, Ponticelli C, Morales JM, et al. Prevalence and management of anemia in renal transplant recipients: a European survey. Am J Transplant. 2003;3(7):835–45.PubMedCrossRefGoogle Scholar
  113. 113.
    Lorenz M, Kletzmayr J, Perschl A, Furrer A, Horl WH, Sunder-Plassmann G. Anemia and iron deficiencies among long-term renal transplant recipients. J Am Soc Nephrol. 2002;13(3):794–7.PubMedGoogle Scholar
  114. 114.
    Afzali B, Al-Khoury S, Shah N, Mikhail A, Covic A, Goldsmith D. Anemia after renal transplantation. Am J Kidney Dis. 2006;48(4):519–36.PubMedCrossRefGoogle Scholar
  115. 115.
    Pamidi S, Friedman K, Kampalath B, Eshoa C, Hariharan S. Human parvovirus B19 infection presenting as persistent anemia in renal transplant recipients. Transplantation. 2000;69(12):2666–9.PubMedCrossRefGoogle Scholar
  116. 116.
    Kasiske BL, Vazquez MA, Harmon WE, et al. Recommendations for the outpatient surveillance of renal transplant recipients. J Am Soc Nephrol. 2000;11(10):S1–86.PubMedGoogle Scholar
  117. 117.
    II. Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults. Am J Kidney Dis. May 2006;47(5 Suppl 3):S16–85.Google Scholar
  118. 118.
    KDOQI. Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007;50(3):471–530.CrossRefGoogle Scholar
  119. 119.
    Abbott KC, Kimmel PL, Dharnidharka V, Oglesby RJ, Agodoa LY, Caillard S. New-onset gout after kidney transplantation: incidence, risk factors and implications. Transplantation. 2005;80(10):1383–91.PubMedCrossRefGoogle Scholar
  120. 120.
    Lin HY, Rocher LL, McQuillan MA, Schmaltz S, Palella TD, Fox IH. Cyclosporine-induced hyperuricemia and gout. N Engl J Med. 1989;321(5):287–92.PubMedCrossRefGoogle Scholar
  121. 121.
    Braun WE. Modification of the treatment of gout in renal transplant recipients. Transplant Proc. 2000;32(1):199.PubMedCrossRefGoogle Scholar
  122. 122.
    Stamp L, Searle M, O’Donnell J, Chapman P. Gout in solid organ transplantation: a challenging clinical problem. Drugs. 2005;65(18):2593–611.PubMedCrossRefGoogle Scholar
  123. 123.
    Dupont P, Hunt I, Goldberg L, Warrens A. Colchicine myoneuropathy in a renal transplant patient. Transpl Int. 2002;15(7):374–6.PubMedCrossRefGoogle Scholar
  124. 124.
    Kuncl RW, Duncan G, Watson D, Alderson K, Rogawski MA. Peper M. Colchicine myopathy and neuropathy. N Engl J Med. 1987;316(25):1562–8.PubMedCrossRefGoogle Scholar
  125. 125.
    Alloway JA, Moriarty MJ, Hoogland YT, Nashel DJ. Comparison of triamcinolone acetonide with indomethacin in the treatment of acute gouty arthritis. J Rheumatol. 1993;20(1):111–3.PubMedGoogle Scholar
  126. 126.
    Rosenthal AK, Ryan LM. Treatment of refractory crystal-associated arthritis. Rheum Dis Clin North Am. 1995;21(1):151–61.PubMedGoogle Scholar
  127. 127.
    Dalbeth N, Stamp L. Allopurinol dosing in renal impairment: walking the tightrope between adequate urate lowering and adverse events. Semin Dial. Sep-Oct. 2007;20(5):391–5.CrossRefGoogle Scholar
  128. 128.
    Cummins D, Sekar M, Halil O, Banner N. Myelosuppression associated with azathioprine-allopurinol interaction after heart and lung transplantation. Transplantation. 1996;61(11):1661–2.PubMedCrossRefGoogle Scholar
  129. 129.
    Arapaslan B, Soykan A, Soykan C, Kumbasar H. Cross-sectional assessment of psychiatric disorders in renal transplantation patients in Turkey: a preliminary study. Transplant Proc. 2004;36(5):1419–21.PubMedCrossRefGoogle Scholar
  130. 130.
    Butler JA, Peveler RC, Roderick P, Smith PW, Horne R, Mason JC. Modifiable risk factors for non-adherence to immunosuppressants in renal transplant recipients: a cross-sectional study. Nephrol Dial Transplant. 2004;19(12):3144–9.PubMedCrossRefGoogle Scholar
  131. 131.
    Dobbels F, Skeans MA, Snyder JJ, Tuomari AV, Maclean JR, Kasiske BL. Depressive disorder in renal transplantation: an analysis of Medicare claims. Am J Kidney Dis. 2008;51(5):819–28.PubMedCrossRefGoogle Scholar
  132. 132.
    Cukor D, Rosenthal DS, Jindal RM, Brown CD, Kimmel PL. Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney Int. 2009.Google Scholar
  133. 133.
    Liston HL, Markowitz JS, Hunt N, DeVane CL, Boulton DW, Ashcraft E. Lack of citalopram effect on the pharmacokinetics of cyclosporine. Psychosomatics. Jul-Aug. 2001;42(4):370–2.CrossRefGoogle Scholar
  134. 134.
    Baines LS, Joseph JT, Jindal RM. Prospective randomized study of individual and group psychotherapy versus controls in recipients of renal transplants. Kidney Int. 2004;65(5):1937–42.PubMedCrossRefGoogle Scholar
  135. 135.
    Kunzendorf U, Kramer BK, Arns W, et al. Bone disease after renal transplantation. Nephrol Dial Transplant. 2008;23(2):450–8.PubMedCrossRefGoogle Scholar
  136. 136.
    Patel S, Kwan JT, McCloskey E, et al. Prevalence and causes of low bone density and fractures in kidney transplant patients. J Bone Miner Res. 2001;16(10):1863–70.PubMedCrossRefGoogle Scholar
  137. 137.
    Grotz WH, Mundinger FA, Gugel B, Exner V, Kirste G, Schollmeyer PJ. Bone fracture and osteodensitometry with dual energy X-ray absorptiometry in kidney transplant recipients. Transplantation. 1994;58(8):912–5.PubMedCrossRefGoogle Scholar
  138. 138.
    Weisinger JR, Carlini RG, Rojas E, Bellorin-Font E. Bone disease after renal transplantation. Clin J Am Soc Nephrol. 2006;1(6):1300–13.PubMedCrossRefGoogle Scholar
  139. 139.
    K/DOQI. clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(4 Suppl 3):S1–201.Google Scholar
  140. 140.
    Hariharan S. Recommendations for outpatient monitoring of kidney transplant recipients. Am J Kidney Dis. 2006;47(4 Suppl 2):S22–36.PubMedCrossRefGoogle Scholar
  141. 141.
    Palmer SC, McGregor DO, Strippoli GF Interventions for preventing bone disease in kidney transplant recipients. Cochrane Database Syst Rev. 2007;(3):CD005015.Google Scholar
  142. 142.
    Cruz DN, Brickel HM, Wysolmerski JJ, et al. Treatment of osteoporosis and osteopenia in long-term renal transplant patients with alendronate. Am J Transplant. 2002;2(1):62–7.PubMedCrossRefGoogle Scholar
  143. 143.
    Jeffery JR, Leslie WD, Karpinski ME, Nickerson PW, Rush DN. Prevalence and treatment of decreased bone density in renal transplant recipients: a randomized prospective trial of calcitriol versus alendronate. Transplantation. 2003;76(10):1498–502.PubMedCrossRefGoogle Scholar
  144. 144.
    Kasiske BL, Snyder JJ, Gilbertson DT, Wang C. Cancer after kidney transplantation in the United States. Am J Transplant. 2004;4(6):905–13.PubMedCrossRefGoogle Scholar
  145. 145.
    Vajdic CM, McDonald SP, McCredie MR, et al. Cancer incidence before and after kidney transplantation. JAMA. 2006;296(23):2823–31.PubMedCrossRefGoogle Scholar
  146. 146.
    Wimmer CD, Rentsch M, Crispin A, et al. The janus face of immunosuppression-de novo malignancy after renal transplantation: the experience of the Transplantation Center Munich. Kidney Int. 2007;71(12):1271–8.PubMedCrossRefGoogle Scholar
  147. 147.
    Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370(9581):59–67.PubMedCrossRefGoogle Scholar
  148. 148.
    Serraino D, Piselli P, Busnach G, et al. Risk of cancer following immunosuppression in organ transplant recipients and in HIV-positive individuals in southern Europe. Eur J Cancer. 2007;43(14):2117–23.PubMedCrossRefGoogle Scholar
  149. 149.
    Morath C, Mueller M, Goldschmidt H, Schwenger V, Opelz G, Zeier M. Malignancy in renal transplantation. J Am Soc Nephrol. 2004;15(6):1582–8.PubMedCrossRefGoogle Scholar
  150. 150.
    Fischereder M. Cancer in patients on dialysis and after renal transplantation. Nephrol Dial Transplant. 2008;23(8):2457–60.PubMedCrossRefGoogle Scholar
  151. 151.
    Dantal J, Pohanka E. Malignancies in renal transplantation: an unmet medical need. Nephrol Dial Transplant. 2007;22(Suppl 1):i4–i10.PubMedCrossRefGoogle Scholar
  152. 152.
    European best practice guidelines for renal transplantation Section IV: Long-term management of the transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin cancers: prevention and treatment. Nephrol Dial Transplant. 2002;17(Suppl)4:31–6.Google Scholar
  153. 153.
    Knoll G. Trends in kidney transplantation over the past decade. Drugs. 2008;68(Suppl 1):3–10.PubMedCrossRefGoogle Scholar
  154. 154.
    Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601–14.PubMedCrossRefGoogle Scholar
  155. 155.
    Padiyar A, Akoum FH, Hricik DE Management of the kidney transplant recipient. Prim Care. 2008;35(3):433–450, v.PubMedGoogle Scholar
  156. 156.
    Abbott KC, Swanson SJ, Richter ER, et al. Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis. 2004;44(2):353–62.PubMedCrossRefGoogle Scholar
  157. 157.
    Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643–54.PubMedCrossRefGoogle Scholar
  158. 158.
    Grekas D, Thanos V, Dioudis C, Alivanis P, Tourkantonis A. Treatment of urinary tract infections with ciprofloxacin after renal transplantation. Int J Clin Pharmacol Ther Toxicol. 1993;31(6):309–11.PubMedGoogle Scholar
  159. 159.
    de Souza RM, Olsburgh J. Urinary tract infection in the renal transplant patient. Nat Clin Pract Nephrol. 2008;4(5):252–64.PubMedCrossRefGoogle Scholar
  160. 160.
    Guidelines for vaccination of solid organ transplant candidates and recipients. Am J Transplant. Nov 2004;4 Suppl 10:160–3.Google Scholar
  161. 161.
    Duchini A, Goss JA, Karpen S, Pockros PJ. Vaccinations for adult solid-organ transplant recipients: current recommendations and protocols. Clin Microbiol Rev. 2003;16(3):357–64.PubMedCrossRefGoogle Scholar
  162. 162.
    Avery RK, Michaels M. Update on immunizations in solid organ transplant recipients: what clinicians need to know. Am J Transplant. 2008;8(1):9–14.PubMedCrossRefGoogle Scholar
  163. 163.
    Tan HP, Kaczorowski DJ, Basu A, et al. Living donor renal transplantation using alemtuzumab induction and tacrolimus monotherapy. Am J Transplant. 2006;6(10):2409–2417.PubMedCrossRefGoogle Scholar
  164. 164.
    Meier-Kriesche HU, Li S, Gruessner RW, et al. Immunosuppression: evolution in practice and trends, 1994–2004. Am J Transplant. 2006;6(5 Pt 2):1111–31.PubMedCrossRefGoogle Scholar
  165. 165.
    Arend SM, Mallat MJ, Westendorp RJ, van der Woude FJ, van Es LA. Patient survival after renal transplantation; more than 25 years follow-up. Nephrol Dial Transplant. 1997;12(8):1672–9.PubMedCrossRefGoogle Scholar
  166. 166.
    Rao PS, Schaubel DE, Jia X, Li S, Port FK, Saran R. Survival on dialysis post-kidney transplant failure: results from the Scientific Registry of Transplant Recipients. Am J Kidney Dis. 2007;49(2):294–300.PubMedCrossRefGoogle Scholar
  167. 167.
    Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK. Long-term survival in renal transplant recipients with graft function. Kidney Int. 2000;57(1):307–313.PubMedCrossRefGoogle Scholar
  168. 168.
    Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004. Hypertension. 2008;52(5):818–27.PubMedCrossRefGoogle Scholar
  169. 169.
    From the Centers for Disease Control and Prevention, Physician and other health care professional counseling of smokers to quit-United States, 1991. JAMA. Dec 1 1993;270(21):2536–7.Google Scholar
  170. 170.
    Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038–47.PubMedCrossRefGoogle Scholar
  171. 171.
    CDC. State-Specific Prevalence of Obesity Among Adults—United States, 2005. Morbidity and Mortality Weekly Report. 2006;55(36):985–8.Google Scholar
  172. 172.
    Goff DC Jr, Bertoni AG, Kramer H, et al. Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA): gender, ethnicity, and coronary artery calcium. Circulation. 2006;113(5):647–56.PubMedCrossRefGoogle Scholar
  173. 173.
    National Health and Nutrition Examination Survey (NHANES) 2004–2006. accessed in March, 2009 from http://www.cdc.gov/nchs/about/major/nhanes/nhanes2005–2006/nhanes05_06.htm.
  174. 174.
    Foley RN, Murray AM, Li S, et al. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol. 2005;16(2):489–95.PubMedCrossRefGoogle Scholar
  175. 175.
    Kasiske BL. Cardiovascular disease after renal transplantation. Semin Nephrol. 2000;20(2):176–87.PubMedGoogle Scholar
  176. 176.
    First MR, Neylan JF, Rocher LL, Tejani A. Hypertension after renal transplantation. J Am Soc Nephrol. 1994;4(8 Suppl):S30–6.PubMedGoogle Scholar
  177. 177.
    Lincoff AM, Wolski K, Nicholls SJ, Nissen SE. Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus: a meta-analysis of randomized trials. JAMA. 2007;298(10):1180–8.PubMedCrossRefGoogle Scholar
  178. 178.
    Lago RM, Singh PP, Nesto RW. Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomised clinical trials. Lancet. 2007;370(9593):1129–36.PubMedCrossRefGoogle Scholar
  179. 179.
    Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356(24):2457–1.PubMedCrossRefGoogle Scholar
  180. 180.
    Chan JC, Scott R. Arjona Ferreira JC, et al. Safety and efficacy of sitagliptin in patients with type 2 diabetes and chronic renal insufficiency. Diabetes Obes Metab. 2008;10(7):545–55.PubMedCrossRefGoogle Scholar
  181. 181.
    Djamali A. Can the renal transplant patient be really considered as a patient with chronic renal insufficiency? Nephrol Ther. 2008;4(Suppl 1):S36–9.PubMedGoogle Scholar
  182. 182.
    Schwarz A, Vatandaslar S, Merkel S, Haller H. Renal cell carcinoma in transplant recipients with acquired cystic kidney disease. Clin J Am Soc Nephrol. 2007;2(4):750–6.PubMedCrossRefGoogle Scholar
  183. 183.
    Birdwell KA, Ikizler MR, Sannella EC, et al. Decreased antibody response to influenza vaccination in kidney transplant recipients: a prospective cohort study. Am J Kidney Dis. 2009;54(1):112–21.PubMedCrossRefGoogle Scholar
  184. 184.
    Sanchez-Fructuoso AI, Prats D, Naranjo P, et al. Influenza virus immunization effectivity in kidney transplant patients subjected to two different triple-drug therapy immunosuppression protocols: mycophenolate versus azathioprine. Transplantation. 2000;69(3):436–9.PubMedCrossRefGoogle Scholar
  185. 185.
    Bernardo JF, McCauley J. Drug therapy in transplant recipients: special considerations in the elderly with comorbid conditions. Drugs Aging. 2004;21(5):323–48.PubMedCrossRefGoogle Scholar
  186. 186.
    Augustine JJ, Bodziak KA, Hricik DE. Use of sirolimus in solid organ transplantation. Drugs. 2007;67(3):369–91.PubMedCrossRefGoogle Scholar
  187. 187.
    Staatz CE, Tett SE. Clinical pharmacokinetics and pharmacodynamics of mycophenolate in solid organ transplant recipients. Clin Pharmacokinet. 2007;46(1):13–58.PubMedCrossRefGoogle Scholar
  188. 188.
    Kuypers DR. Immunotherapy in elderly transplant recipients: a guide to clinically significant drug interactions. Drugs Aging. 2009;26(9):715–37.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Gaurav Gupta
    • 1
  • Mark L. Unruh
    • 2
    • 3
  • Thomas D. Nolin
    • 2
    • 3
    • 4
  • Peggy B. Hasley
    • 2
    • 5
  1. 1.Nephrology Division, Department of MedicineJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Renal-Electrolyte DivisionUniversity of Pittsburgh Medical CenterPittsburghUSA
  4. 4.Department of Pharmacy and TherapeuticsUniversity of Pittsburgh Medical CenterPittsburghUSA
  5. 5.Division of General Internal MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA

Personalised recommendations