Awareness of post-transplant endocrine disorders among kidney transplant clinicians: results of an Italian survey

TL;DR

This study surveyed Italian kidney transplant clinicians about their awareness and management of endocrine disorders in patients, finding significant variability in practices.

Contribution

The study provides new insights into the current practices and gaps in managing endocrine disorders among kidney transplant recipients in Italy.

Findings

Over 50% of kidney transplant recipients have osteoporosis, but fracture prevalence is likely underestimated.

Adrenal function is not routinely assessed in most centers, with only 14% performing regular biochemical evaluations.

Many clinicians neglect gonadal function, with 20% not addressing it during clinical history taking.

Abstract

Endocrine disorders, which are commonly associated with End-Stage Kidney Disease, may either persist or emerge de novo in the post-transplant period. Despite their clinical relevance, the literature remains limited, and current guidelines offer only vague recommendations regarding the diagnosis and treatment.

A 44-item survey was sent via email to each kidney transplant center to assess transplant physicians’ interest in the endocrine disorders of kidney transplant recipients (KTRs) undergoing regular follow-up. The questionnaire was composed of 6 sections: general information; bone disease; thyroid disorders; pituitary disorders; adrenal disorders; gonadal disorders, fertility, and sexuality.

Out of the 41 centers, 29 transplant physicians participated in the study (70.7%). The prevalence of osteoporosis was greater than 50% in KTRs while the prevalence of fractures is likely underestimated, as most centers practice routine bone mineral density (BMD) screening through DEXA scan but do not routinely perform spinal radiography to detect vertebral deformities. The kidney transplant clinicians routinely assess thyroid hormone levels as part of clinical history although the timing varies widely among centers. Adrenal function is not routinely assessed during follow-up in a substantial number of centers, with only 14% conducting regular biochemical evaluations. Many centers show insufficient interest in investigating gonadal function, with 20% not addressing it during clinical history taking and 35% unaware of the incidence of menstrual irregularities or erectile dysfunction in their KTRs.

The survey revealed significant variability in the management of endocrine disorders across the Italian transplant centers. The development of guidelines for early detection and management would significantly improve the individualized care of this fragile patient population.

The online version contains supplementary material available at 10.1007/s40618-025-02741-y.

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