Background and Objectives: Post-transplant diabetes mellitus (PTDM) is a significant risk factor for the survival of graft recipients and occurs in 10–30% of patients after kidney transplant (KT). PTDM is associated with premature cardiovascular morbidity and mortality. Weight gain, obesity, and dyslipidemia are strong predictors of PTDM, and by modifying them with an active lifestyle it is possible to reduce the incidence of PTDM and affect the long-term survival of patients and grafts. The aim of our study was to determine the effect of regular physical activity on the development of PTDM and its risk factors in patients after KT. Materials and Methods: Participants in the study had to achieve at least 150 min of moderate-intensity physical exertion per week. The study group (n = 22) performed aerobic or combined (aerobic + strength) types of sports activities. Monitoring was provided by the sports tracker (Xiaomi Mi Band 4 compatible with the Mi Fit mobile application). The control group consisted of 22 stable patients after KT. Each patient underwent an oral glucose tolerance test (oGTT) at the end of the follow-up. The patients in both groups have the same immunosuppressive protocol. The total duration of the study was 6 months. Results: The patients in the study group had significantly more normal oGTT results at 6 months compared to the control group (p < 0.0001). In the control group, there were significantly more patients diagnosed with PTDM (p = 0.0212) and with pre-diabetic conditions (impaired plasma glucose and impaired glucose tolerance) at 6 months (p = 0.0078). Conclusions: Regular physical activity after KT provides significant prevention against the development of pre-diabetic conditions and PTDM.

Background: Protein–energy wasting (PEW) is a major predictor of morbidity and mortality in patients with chronic kidney disease (CKD), even before the initiation of dialysis. Its multifactorial pathogenesis includes reduced dietary intake, chronic inflammation, metabolic acidosis, hormonal disturbances, and dysbiosis of the gut microbiota. Early recognition and targeted management are crucial for preventing muscle loss, functional decline, and adverse outcomes. Methods: This narrative review summarises and integrates current evidence from the literature on nutritional and metabolic interventions to prevent and treat protein–energy wasting in patients with nondialysis chronic kidney disease. Relevant clinical trials, meta-analyses, and experimental studies published up to date were evaluated, focusing on dietary strategies, metabolic modulation, physical exercise, and gut microbiome-targeted therapies. Results: Adequate energy and protein intake remain the cornerstone of PEW management, based on available clinical and observational evidence. Individualised diets emphasising high-quality and plant-based proteins, oral nutritional supplements, and ketoanalogues can attenuate muscle wasting. Correction of metabolic acidosis and inflammation enhances protein anabolism and nitrogen balance. Physical exercise acts synergistically with dietary interventions to preserve muscle mass and function. Novel approaches—such as modulating the gut–kidney axis with pre-, pro-, and postbiotics or supplementing with short-chain fatty acids—show promise in improving metabolic and inflammatory profiles. Conclusions: The management of PEW in nondialysis CKD requires a personalised approach that integrates nutrition, physical activity, metabolic correction and microbiome modulation. Early, coordinated intervention may help to slow the progression of CKD and improve patient survival and quality of life.

Background: Keto analogues in combination with a (very) low-protein diet significantly reduces the progression to end-stage kidney disease. The question of their benefit and safety for kidney transplant recipients remains. This study aimed to show the renoprotective effect and safety of the use of this method in patients with chronic kidney disease and a kidney transplantation. Materials: This was a retrospective monocentric study conducted by the transplant nephrology department in Martin, in which patients with chronic kidney disease, with or without kidney transplant therapy, who received a low-protein diet and supplementation with keto analogues were included (n = 59). The changes in their glomerular filtration rate, proteinemia, calcaemia, weight, and glycaemia and the side effects associated with a low-protein diet and keto analogue use were studied in the patients with chronic kidney disease with or without kidney transplantation. Results: The kidney transplant recipients had a significantly more advanced stage of chronic kidney disease (p = 0.0001) than the non-transplanted patients at the time of the prescription of the keto analogues (p = 0.0001). Furthermore, the kidney transplant recipients had a significantly longer follow-up period (p = 0.0001), with a difference of 27 months within subgroups. During the observed period, we recorded a decrease in glomerular filtration, but without statistical significance. In our group, we did not confirm a significant occurrence of adverse effects associated with a low-protein diet and keto analogues. Conclusion: Keto analogues reduce the progression of chronic kidney disease and stabilise glomerular filtration in patients with chronic kidney disease. Based on our analysis, treatment with keto analogues is effective and safe for kidney transplant recipients after kidney transplantation.

Kidney transplantation is the best therapeutic option for patients with end-stage kidney disease. Despite advances in surgical techniques, the surgical procedure itself is associated with a risk of postoperative complications, with an incidence rate of 5–25%. The aim of this retrospective analysis was to identify risk factors for surgical complications after kidney transplantation. The study included 283 patients who underwent kidney transplantation at our center over an 11-year period (2013–2023). Baseline characteristics of the recipients (age, sex, and type of donor) and factors influencing the development of surgical complications (type of induction therapy, diabetes mellitus, BK positivity) were recorded. Patients who developed a surgical complication (bleeding, lymphocele, ureteral stenosis) were identified and analyzed in relation to potential independent risk factors. Surgical complications occurred in 15.8% of patients (n=45), with ureteral stenosis comprising 60% of all surgical complications. The average time to surgical complication onset ranged from 5.4 to 8.6 months. By using Cox proportional-hazard regression multivariate analysis, none of the parameters that were looked at were found to be independent risk factors for the development of surgical complications (endpoints: surgical complications itself, bleeding, ureteral stenosis, lymphocele/lymphorrhea). Kidney transplantation significantly improves quality of life and survival in patients with end-stage kidney disease. Surgical complications remain a significant post-transplant challenge, with urological, vascular, and parietal complications being most common. While we found no independent risk factors among the parameters studied, minimizing these complications is essential to reduce the need for reinterventions and to improve outcomes.

Background and Objectives: It has been confirmed that adiponectin/leptin (A/L) ratio correlates better with cardiometabolic risk factors than hormone levels alone. The aim of our study was to determine the risk of developing post-transplant diabetes mellitus (PTDM) and other metabolic conditions depending on A/L ratio after kidney transplantation (KT). Material and Methods: In a prospective analysis, the studied samples were divided into three groups: control group, prediabetes and PTDM group. Pre-transplantation, at 3, 6 and 12 months after KT, we recorded basic characteristics of donor and recipient. We also monitored levels of adipocytokines and calculated A/L ratio. Results: During observed period, we recorded significant increase in A/L ratio in control group (p = 0.0013), on the contrary, a significant decrease in PTDM group (p = 0.0003). Using Cox regression Hazard model, we identified age at time of KT (HR 2.8226, p = 0.0225), triglycerides at 1 year (HR 3.5735, p = 0.0174) and A/L ratio < 0.5 as independent risk factors for prediabetes and PTDM 1-year post-transplant (HR 3.1724, p = 0.0114). Conclusions: This is the first study to evaluate the relationship between A/L and risk of PTDM and associated metabolic states after KT. We found out that A/L ratio <0.5 is independent risk factor for prediabetes and PTDM 1 year post-transplant.

Liver transplantation is the only curative treatment for terminal liver failure. Advances in immunosuppressive therapy and improvements in surgical techniques have improved patient survival in the post-transplant period. At the same time, however, the incidence of late complications is increasing, which has been contributed to by the broadening of the indication criteria in liver allocation. The most common complications include chronic kidney disease, the aetiology of which is multifactorial with a predominance of calcineurin inhibitor toxicity in the post-transplant period. The prevalence ranges from 30% to 90% depending on the definition used and the methodology used to measure renal function. Early detection of risk factors and early intervention lead to a significant improvement in the quality of life of recipients in the post-transplant period.