{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T15:44:40Z","timestamp":1792251880306,"version":"4.4.0"},"reference-count":101,"publisher":"Ovid Technologies (Wolters Kluwer Health)","funder":[{"name":"Mid-America Transplant","award":["Jane A. Beckman Endowed Chair"],"award-info":[{"award-number":["Jane A. Beckman Endowed Chair"]}]},{"name":"American Heart Association","award":["Career Development Award 24CDA1277194"],"award-info":[{"award-number":["Career Development Award 24CDA1277194"]}]},{"name":"National Institute of Diabetes and Digestive and Kidney Diseases","award":["R01DK120551, R01 DK137111-01, R01DK139339"],"award-info":[{"award-number":["R01DK120551, R01 DK137111-01, R01DK139339"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"abstract":"<jats:p>Pivotal clinical trials have heralded several new classes of pharmacologic agents focused on improving combined heart\u2013kidney outcomes among patients with cardiovascular\u2013kidney\u2013metabolic syndrome. This review compiles the current evidence pertaining to the use of these novel, exciting classes of agents among kidney transplant recipients (KTRs). Treatment with renin\u2013angiotensin\u2013aldosterone system inhibitors continues to remain the backbone of pharmacologic management among KTRs for several indications. Data from systematic reviews and meta-analyses support the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists with several comorbidities. However, evidence for both nonsteroidal and steroidal mineralocorticoid receptor antagonists and angiotensin receptor-neprilysin inhibitors is emerging and not adequate to support routine clinical use in KTRs. Finally, data from randomized controlled trials on statins serve as a reminder of their impact in the metabolic milieu following kidney transplantation. Using the recently introduced paradigm of cardiovascular\u2013kidney\u2013metabolic syndrome, this review proposes that four pharmacologic agents constitute the key pillars for improving downstream heart\u2013kidney outcomes on the basis of existing evidence: renin\u2013angiotensin\u2013aldosterone system inhibitors, statins, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists. Furthermore, this review highlights relevant practical drug interactions with immunosuppressants and considerations of tolerability of these agents among KTRs. Finally, this review discusses specific management considerations for coronary heart disease, heart failure, and atrial fibrillation with unique nuances applicable to KTRs. There remains a critical need for randomized trials in this vulnerable population focused on improvement in combined heart\u2013kidney outcomes.<\/jats:p>","DOI":"10.2215\/cjn.0000001195","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T16:01:48Z","timestamp":1784908908000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Evidence-Based Cardiovascular\u2013Kidney\u2013Metabolic Therapies in Kidney Transplant Recipients"],"prefix":"10.2215","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7614-9560","authenticated-orcid":false,"given":"Gautam R.","family":"Shroff","sequence":"first","affiliation":[{"name":"Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota"},{"name":"University of Minnesota Medical School, Minneapolis, 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