title: Implementation of guidelines for metabolic syndrome control in kidney transplant recipients: results at a single center.
abstract: BACKGROUND
  Cardiovascular disease is a leading cause of death among kidney transplant recipients. Metabolic syndrome increases the risk for cardiovascular events and decreases graft survival. Lately, guidelines for management of the metabolic syndrome, primarily hypertension, diabetes mellitus (DM) and hypercholesterolemia have dramatically changed in an attempt to decrease cardiovascular risks among kidney transplant recipients. In the present study we examined whether these guideline changes had impact on our management of post-transplantation patients and the subsequent treatment outcomes for these diseases.
  
  
  METHODS
  Data were obtained from kidney transplant clinic files from two follow-up (FU) periods-between 1994-1997 and between 2008-2011. Demographic data, monitoring and screening frequency for cardiovascular risk factors, immunosuppression regimen, treatment for hypertension, diabetes and hyperlipidemia, treatment outcomes and graft function changes were compared between the two follow-up periods.
  
  
  RESULTS
  There was a significant increase in the percentage of patients undergoing transplantation due to renal failure secondary to diabetes and/or hypertension. Patient monitoring and screening during the second FU period were less frequent, but more targeted, reflecting changes in clinic routines. Blood pressure was better controlled in the second FU period (p < 0.01), as was hypercholesterolemia (p < 0.001). High fasting glucose levels were more prevalent among patients in the second group (p < 0.005), although more patients received treatment for DM (p < 0.001). Significantly, fewer patients experienced deterioration of kidney functions during the second FU period (p < 0.001).
  
  
  CONCLUSIONS
  We found that guideline changes had impact on clinical practice, which translated to better control of the metabolic syndrome. DM control is challenging. Overall, stability of kidney function improved.
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Houri
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Keren
authors.initials: K
authors.lastname: Tzukert
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Irit Mor-Yosef
authors.initials: IM
authors.lastname: Levi
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Aharon
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Aharon
authors.initials: A
authors.lastname: Bloch
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Olga
authors.initials: O
authors.lastname: Gotsman
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Backenroth
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Levi
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Iddo Ben
authors.initials: IB
authors.lastname: Dov
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Dvora
authors.initials: D
authors.lastname: Rubinger
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Michal Dranitzki
authors.initials: MD
authors.lastname: Elhalel
keywords: Kidney transplantation; Metabolic syndrome; Treatment practice