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Primary Care of the Renal Transplant Patient

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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.

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Acknowledgements

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

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Authors and Affiliations

  1. Nephrology Division, Department of Medicine, Johns Hopkins University, Suite 416, 1830 East Monument St, Baltimore, MD, 21205, USA

    Gaurav Gupta MD

  2. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

    Mark L. Unruh MD, Thomas D. Nolin PharmD, PhD & Peggy B. Hasley MD

  3. Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

    Mark L. Unruh MD & Thomas D. Nolin PharmD, PhD

  4. Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

    Thomas D. Nolin PharmD, PhD

  5. Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

    Peggy B. Hasley MD

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Gupta, G., Unruh, M.L., Nolin, T.D. et al. Primary Care of the Renal Transplant Patient. J GEN INTERN MED 25, 731–740 (2010). https://doi.org/10.1007/s11606-010-1354-5

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