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

Chronic kidney disease (CKD) is a progressive condition that disrupts multiple endocrine axes, contributing to a broad range of hormonal imbalances, including mineral and bone disorder, gonadal dysfunction, thyroid abnormalities, insulin resistance, and elevated prolactin levels. These disturbances not only exacerbate comorbidities such as cardiovascular disease, anemia, diabetes, and sarcopenia, but may also accelerate the decline of renal function. This article aims to provide a comprehensive overview of the pathophysiology, clinical impact, and management strategies for endocrine disorders in CKD. A narrative literature search was conducted using PubMed, EMBASE, the Cochrane Library, and Scielo through July 2025, focusing on 141 studies addressing endocrine complications in CKD. The prevalence of hormonal dysfunction increases with CKD progression, affecting over 70% of patients in advanced stages. Disruptions in calcium and phosphate homeostasis lead to secondary hyperparathyroidism, vascular calcification, and bone fragility. Thyroid hormone alterations and testosterone deficiency contribute to reduced muscle mass, fatigue, and cardiovascular risk. Impaired glucose metabolism complicates glycemic control, particularly in dialysis and post-transplant populations. Diagnostic interpretation is often challenged by altered hormone clearance and protein binding. Therapeutic approaches require individualized strategies, including dietary and pharmacological correction of mineral imbalances, cautious hormone replacement, and use of agents such as dopamine agonists or sodium-glucose cotransporter-2 inhibitors. A multidisciplinary approach integrating nephrology and endocrinology is essential to improve outcomes and quality of life in this population.