Endocrine disorders linked to chronic kidney disease: Mechanisms and clinical implications

Table 1 Major Endocrine disorders in chronic kidney disease

Disorder	Prevalence in CKD	Pathophysiological mechanism	Key complications	Clinical management
CKD-MBD	High (> 40%-80%)	Phosphate retention, ↓ Klotho, ↑ FGF-23, ↓ calcitriol	Bone fragility, vascular calcification, fractures	Non-calcium binders, vitamin D analogs, calcimimetics, parathyroidectomy
Vitamin D deficiency	Frequent in all CKD stages	↓ 1-α hydroxylase activity, impaired calcitriol synthesis	↑ PTH, ↓ calcium absorption, chronic inflammation	Active vitamin D analogs, calcifediol, monitor Ca/Pi
Hypogonadism	40%-60% in dialysis patients	HPG axis suppression, ↓ TT/FT, ↑ prolactin	Sexual dysfunction, anemia, fatigue	TRT if symptomatic, risk-benefit evaluation
Thyroid dysfunction	Up to 70% in ESRD	↓ T4→T3 conversion, ↑ TSH due to altered renal clearance	Fatigue, ↓ GFR, cardiovascular risk	Levothyroxine for overt/symptomatic hypothyroidism
Hyperprolactinemia	About 66% in dialysis	↓ Renal clearance, ↑ pituitary secretion, ↓ dopamine tone	Galactorrhea, libido loss, GnRH suppression	Dopamine agonists if symptomatic
Insulin resistance	Near-universal in advanced CKD	Inflammation, oxidative stress, ↓ insulin degradation	Hypoglycemia, CKD progression, ↑ CV risk	SGLT2 inhibitors, insulin dose adjustment

CKD: Chronic kidney disease; MBD: Mineral and bone disorders; FGF-23: Fibroblast growth factor 23; PTH: Parathyroid hormone; HPG: Hypothalamic-pituitary-gonadal axis; TT: Total testosterone; FT: Free testosterone; ESRD: End-stage renal disease; T4: Thyroxine; T3: Triiodothyronine; TSH: Thyroid-stimulating hormone; GnRH: Gonadotropin-releasing hormone; CV: Cardiovascular; Ca/Pi: Calcium/phosphorus product; TRT: Testosterone replacement therapy; GFR: Glomerular filtration rate; SGLT2: Sodium-glucose co-transporter type 2.