Background: Kidney transplantation (KTx) significantly improves survival and quality of life in patients with end-stage renal disease. However, post-transplant well-being is influenced by multiple factors, including healthcare accessibility, satisfaction with medical care, and psychological health. This study aimed to assess the well-being of post-KTx patients in Kazakhstan and examine its associations with healthcare access, satisfaction, and anxiety. Methods: A cross-sectional study was conducted among 223 post-KTx patients in Kazakhstan. Participants were recruited through online surveys and telephone interviews. Only patients who had undergone transplantation within Kazakhstan were included. The WHO-5 Well-Being Index was used to measure well-being, and additional surveys assessed healthcare access, satisfaction with post-KTx care, and treatment-related anxiety. Multiple linear regression was performed to identify predictors of well-being. Results: The mean WHO-5 well-being score was 66.1 (SD = 24.6), indicating moderate well-being. Satisfaction with post-transplant information (β = 0.287, p = 0.015) and educational level (β = 0.172, p = 0.019) were significant positive predictors of well-being. In contrast, post-KTx anxiety (β = −0.154, p = 0.024) and difficulties in accessing medical care (β = −0.216, p = 0.014) negatively affected well-being. Patients residing in rural areas reported greater barriers to post-transplant care compared to those in urban settings (χ² = 31.6, p = 0.002). Conclusions: Post-KTx well-being in Kazakhstan is influenced by educational level, access to healthcare, satisfaction with medical information, and anxiety levels. Targeted interventions to improve access to post-transplant care, enhance patient education, and address psychological distress may help improve outcomes for post-KTx patients.

Background: The Kidney Disease and Quality of Life Short Form (KDQOL-SF™ 1.3) is widely used to assess health-related quality of life (HRQoL) in patients with end-stage renal disease. However, no prior validation had been conducted in Kazakhstan, where both Kazakh and Russian are commonly spoken. This study aimed to validate the Kazakh and Russian versions of the KDQOL-SF™ 1.3 and to identify predictors of HRQoL among hemodialysis patients in Kazakhstan. Methods: A cross-sectional survey was conducted among 217 adult hemodialysis patients from February to April 2025 using a mixed-methods approach (in-person interviews and online data collection). Psychometric testing included Cronbach’s alpha, floor and ceiling effect analysis, and Pearson correlations with self-rated overall health. Multiple linear regression was used to identify predictors of the Kidney Disease Component Summary (KDCS), Physical Component Summary (PCS), and Mental Component Summary (MCS) scores. Results: Both language versions demonstrated acceptable to excellent internal consistency (Cronbach’s α = 0.692–0.939). Most subscales were significantly correlated with self-rated health, supporting construct validity. Regression analyses revealed that greater satisfaction with care, better economic well-being, and more positive dialysis experiences were significant predictors of higher KDCS and MCS scores. Lower PCS scores were associated with female gender, comorbidities, and financial burden. Importantly, financial hardship and access challenges emerged as strong negative influences on HRQoL, underscoring the role of socioeconomic and care-related factors in patient well-being. Conclusions: The KDQOL-SF™ 1.3 is a valid and reliable tool for assessing quality of life among Kazakh- and Russian-speaking hemodialysis patients in Kazakhstan. Integrating this instrument into routine clinical practice may facilitate more personalized, patient-centered care and help monitor outcomes beyond traditional clinical indicators. Addressing economic and access-related barriers has the potential to significantly improve both physical and mental health outcomes in this vulnerable population.

Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD), yet challenges persist in long-term graft survival and post-transplant complications. Genomic profiling, especially whole-exome sequencing (WES), offers new opportunities to personalize donor-recipient matching and predict transplant outcomes. This study aimed to explore the genetic landscape of both transplant recipients and donors using WES. This prospective cohort study included 64 kidney transplant recipients (51 adults, 13 pediatric) and 61 donors in Kazakhstan. WES was performed to identify monogenic causes of ESRD, evaluate rejection-associated immune polymorphisms (31 SNPs), and screen for post-transplant risk using a 355-gene Transplant Morbidity Panel. Variants were classified following ACMG/AMP guidelines, and allele frequencies were compared to global reference datasets. Among recipients, pathogenic/likely pathogenic variants were found in 15.4% of pediatric and 9.1% of adult cases, with additional variants of uncertain significance detected in 23.1% and 23.6%, respectively. WES identified monogenic nephropathies including Alport syndrome, cystinuria, and polycystic kidney disease. In donors, 13.1% carried variants associated with latent renal or systemic conditions despite no clinical manifestation at donation. The APOE p.Cys130Arg variant, linked to lipid dysregulation, was observed more frequently in recipients (allele frequency 0.17) than donors (0.09), though not statistically significant. Among the 31 SNPs evaluated, significant associations with acute rejection were observed for IL1B rs1143634 and TP53 rs1625895 under dominant models. IL1B carriers showed increased rejection risk (OR = 4.62, p = 0.039), whereas TP53 carriers appeared protected (OR = 0.058, p = 0.027). Given the limited number of rejection cases, these findings should be considered exploratory and require validation in larger cohorts. Additionally, 44.3% of recipients carried at least one pathogenic or likely pathogenic variant in the Transplant Morbidity Panel, particularly in genes related to malignancy, cardiomyopathy, and monogenic diabetes. This study provides one of the first applications of WES in a Central Asian kidney transplant population. Findings highlight the prevalence of monogenic and comorbid risk variants in both recipients and donors and support the use of genomic screening for improving pre- and post-transplant care. The identification of immune-related SNPs and extra-renal findings further underscores the utility of WES for personalized transplant management. Integration of genomics into transplant workflows may help address the ongoing gap between clinical need and transplant outcomes, particularly in low-resource settings.

Pediatric kidney transplantation (KTx) is a life-saving procedure for children with end-stage renal disease (ESRD), yet outcomes and risk factors remain underreported in Central Asia. We aimed to provide valuable insights into the long-term impact of KTx on pediatric patients. Materials and methods: This article presents a retrospective review of 12-year experience of pediatric KTx at the «University Medical Center» Corporate Fund (Astana, Kazakhstan). The analysis included the records of 146 patients under the age of 18. The characteristics of the patients included causes of chronic kidney disease (CKD), clinical features and transplantation outcomes: overall survival (OS), graft survival (GS), graft loss (GL), transplant rejection (TR) and complications. Results: Of 146 recipients (mean age 139 months, 56.8% male), the leading cause of ESRD was congenital anomalies of the kidney and urinary tract (CAKUT, 50.7%). Living donor KTx (LDKT) accounted for 73%, while Deceased donor KTx (DDKT). TR occurred in 18.5% of cases and was significantly associated with GL (OR = 7.19, 95% CI: 2.55-20.25, p < 0.001). GL occurred in 13.0% of patients, and mortality was 6.2%. Complications were reported in 43.8% of patients and were significantly associated with mortality (p = 0.034). No association between donor type (LDKT vs. DDKT) and rejection was found. Gender, diagnosis, BMI, age at transplantation, donor type were not significant predictors of GL or patient death. Conclusion: Pediatric KTx in Kazakhstan demonstrates promising outcomes, with relatively low mortality (6.2%) and GL (13.0%) rates. TR (occurred in 18.5% patients) significantly predicts GL, while post-Tx complications (occurred in43.8% of patients) are associated with decreased patient survival. These findings support the need for improved early monitoring and long-term management strategies to optimize outcomes. Keywords: kidney transplantation, child, graft loss, rejection, complication, survival analysis

Background: Kidney transplantation (KTx) is a life-saving intervention, but post-transplant psychological well-being and treatment adherence remain critical challenges. This study aimed to (1) develop and validate a Health and Treatment-Related Anxiety Scale in Kazakh- and Russian-languages, (2) identify predictors of such anxiety, and (3) examine its impact on adherence to treatment and well-being among kidney transplant recipients in Kazakhstan. Methods: A cross-sectional study was conducted among 223 adult kidney transplant recipients. The newly developed anxiety scale was tested for psychometric validity using exploratory and confirmatory factor analyses. Internal consistency and criterion-related validity were assessed through item-rest correlations and correlation with related outcomes. Multiple linear regression and mediation models were used to identify predictors of health and treatment-related anxiety and psychological mechanisms affecting treatment adherence and well-being. Results: The scale demonstrated strong psychometric properties with a one-factor structure and high internal consistency (Cronbach’s α=0.893). Anxiety negatively correlated with both treatment adherence (p<0.001). Regression analysis identified employment under disability status and perceived availability of post-KTx monitoring as protective factors. Emotional support and anxiety levels significantly predicted treatment adherence. Mediation analyses revealed that anxiety partially mediated the relationship between perceived post-KTx monitoring and both adherence and well-being (p<0.05). Conclusion: The validated anxiety scale is a reliable tool for assessing psychological vulnerability in kidney transplant recipients. Addressing treatment-related anxiety may enhance post-transplant care by improving both adherence and emotional well-being.