The metabolic syndrome following kidney transplantation.

The metabolic syndrome is a constellation of defined cardiovascular risk factors occurring simultaneously in a single individual. The result of dysregulated glucose and vascular metabolism, the syndrome has been identified as a significant risk factor for cardiovascular morbidity in the general population. More recently, a relatively high prevalence of the metabolic syndrome has been recognized among kidney transplant recipients. The prevalence, risk factors, pathophysiology, and potential consequences of the metabolic syndrome in the general population and in kidney transplant recipients are reviewed. The definitions and clinical utility of the metabolic syndrome as a medical condition continue to be debated. Nevertheless, the burden of risk increases with the presence of multiple components, including insulin resistance, abdominal obesity, and dysregulated lipid metabolism. Risk factors specific to transplant recipients include the duration of pretransplant dialysis and posttransplant immunosuppression and weight gain. The metabolic syndrome is emerging as a significant surveillance target following kidney transplantation. Control of body mass index, blood glucose and lipid levels, as well as blood pressure, is required to prevent the consequences of the metabolic syndrome, including cardiovascular events and cardiovascular death. Immunosuppressive regimens should be designed to limit exacerbation of components of the metabolic syndrome.