Mortality In Renal Transplant Recipients Research Articles

#2504 Histopathological findings and cardiovascular events in kidney transplantation

Abstract Background and Aims Despite offering superior outcomes for patients with end-stage kidney disease, kidney transplantation poses significant cardiovascular risks. Recently, histopathological findings in chronic kidney disease patients have been associated with all-cause mortality and cardiovascular events, but there is scant data on this subject in kidney transplant recipients. This study assesses the relationship between histopathological findings in protocol biopsies of kidney grafts and cardiovascular events, graft loss, and mortality in renal transplant recipients. Method A prospective observational study included 530 renal transplant recipients at the Hospital Clínic de Barcelona from March 2015 to 2019, with follow-up until March 2023. Data included demographics, comorbidities, laboratory tests, and protocol allograft biopsies at 3 and 12 months post-transplant. Associations between histopathological findings and outcomes (cardiovascular events, graft loss, mortality) were analyzed. Results Chronic vascular lesions (CV) were significantly correlated with cardiovascular death and major adverse cardiovascular events (MACE) (OR 10.4 (1.6–66.4); p 0.002). Arteriolar hyalinosis and interstitial fibrosis were independently associated with all-cause mortality (OR 4.9 (1.1-21.4); p 0.02, and 1.2 (1.03-1.3), p 0.005; respectively) regardless of the estimated glomerular filtration rate (eGFR). Associations were also found between pre-transplant factors (diabetes, hypertension, hyperphosphatemia), active smoking, and deceased donors. Notably, post-transplant hypophosphatemia was related to MACE, suggesting a potential association with malnutrition though, this subject requires further investigation. Conclusion Histopathological findings in early protocol biopsies of kidney grafts, especially chronic vascular lesions, arteriolar hyalinosis, and interstitial fibrosis, have a potential predictive value for cardiovascular events, mortality, and graft outcomes in transplant recipients, irrespective of eGFR. These insights emphasize the importance of timely post-transplant histological assessments for risk stratification and personalized interventions. Prospective studies are imperative to validate these findings and improve customized care strategies in this population.

Analysis of COVID-19 Infection in Kidney Transplant Recipients

BackgroundThe Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was responsible for higher morbidity and mortality in renal transplant recipients (RTx). The objective of the study was to evaluate the impact of COVID-19 infection on RTx in a single center in Brazil. MethodsA cohort of 135 RTx was evaluated between December 2019 to June 202l and demographics, clinical and, laboratory profiles were analyzed from deceased donors with COVID-19. ResultsDiabetic and RTx from extended criterion donors presented more frequently the severe form of the disease. Serum creatinine (sCr) after 3 months of diagnosis of COVID-19 varied according to the severity of infection. The lethality rate was higher in the group with severe symptoms (65%) compared with those with mild infection (1.5%). ConclusionThe increase in sCr was associated with disease severity. The lethality rate for COVID-19 was 26.6%. These rates are 10 to 20 times higher than those reported in the general population and suggest that rigorous observation, early diagnosis, and disease prevention measures are crucial in RTx.

Infective complications in the renal transplant recipients

Infections remain a common complication of solid-organ transplantation and are a major factor of morbidity and mortality in renal transplant recipients. The incidence of infection in renal transplant patients is directly related to the net immunosuppressive effect achieved and the duration of the administration of immunosuppressive therapy. The major types of infections can be categorized according to the time post-transplant during which they occur: in the first month after transplantation post-surgical bacterial infections and in the period from one to four months post-transplant opportunistic infections, overall cytomegalovirus; late infections, beyond 6-12 months, are community-acquired infections. Opportunistic infections (like Pneumocystis carini, Listeria monocytogenes, and Aspergillus fumigatus) most frequently occur in the first 12 months post-transplant and can be modulated by prior exposures and the use of prophylaxis.

Spectrum of Pneumonia in Renal Transplant Recipients: An Indian Experience.

Respiratory tract infections are life-threatening infections in solid-organ transplant recipients that pose risk to the graft and to the patient. This study was undertaken to examine the clinical and microbiological spectrum of pneumonia in renal transplant recipients. Of 400 consecutive renal transplant recipients, 87 recipients (21.8%) were hospitalized between November 2014 and October 2016 with pneumonia. We examined demographic profiles and clinical investigations. The median age of patients was 38 years (range, 19-72 y). The mean time of presentation after renal transplant was 18 months (range, 1-174 mo). Most patients (80.5%) were on maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and steroids; 34% of patients had an induction agent. Chronic hepatitis C and hepatitis B infections were found in 12.6% and 2.2% of patients, respectively, and new-onset diabetes in 19.5% of patients. Fever (88%), cough (87%), shortness of breath (68%), and hypotension (33%) were common presenting symptoms. Diarrhea was the most frequent accompanying symptom, found in 9.2% of patients. Cytopenia and graft dysfunction were present in 38.7% and 80.4% of patients. Among infections, fungal infections were the most frequent (30%) followed by mixed infections (20.7%), tuberculosis (12.6%), bacterial (12.6%), and viral (3.5%) infections. Etiology could not be found in 27.6% patients. Mortality rate was 24.1%, with the highest rates for fungal infections (44%), followed by bacterial (25%) and mixed infections (18%). Presence of hypoxia and hypotension at presentation was associated with increased risk of death, whereas use of induction agents, new-onset diabetes posttransplant, diabetes mellitus, and acute kidney injury were not correlated with death or increased duration of hospital stay. Pneumonia carries high risk of mortality in renal transplant recipients. Fungal and bacterial infections carry high risk of mortality. Despite invasive investigations, a substantial number of patients had unidentified etiology.

Impact of an ultrasensitive Cytomegalovirus quantitative nucleic acid test on Cytomegalovirus detection and therapy in renal transplant recipients.

Cytomegalovirus (CMV) infection has broad implications for morbidity and mortality in renal transplant recipients (RTR). Routine surveillance for CMV replication with PCR-based quantitative nucleic acid testing (qNAT) assays is standard practice in most transplant centers, but the impact of assay sensitivity on antiviral decision-making and virologic outcomes has not been studied. We investigated the effects of an ultrasensitive CMV qNAT assay on multiple clinical outcomes, including time to detection and duration of CMV DNAemia. We conducted a single-center cohort study contrasting RTRs monitored with a qNAT with a higher lower limit of quantification (LLOQ >300IU/mL) with those monitored with a more sensitive qNAT (LLOQ >35IU/mL). Patients were stratified by donor (D)/recipient (R) CMV serostatus (D+/R-: high risk; any R+: moderate risk). CMV viral load monitoring was performed monthly post transplantation, with the primary outcomes being time to CMV DNAemia and its duration. Total 1382 patients were analyzed from 2014 to 2016 and 2019 to 2021. Moderate-risk RTRs monitored with the more sensitive assay experienced a greater hazard for the development of a first episode of CMV DNAemia (aHR: 1.95, 95% confidence interval [CI]: 1.55-2.46) and an average of 24 (95% CI: 16.40-31.98) additional days of DNAemia. There was no difference in CMV end-organ disease or 1-year all-cause mortality between moderate-risk RTRs. The more sensitive assay was associated with earlier detection and extended durations of CMV DNAemia in moderate-risk RTRs, without altering clinical outcomes. These findings inform optimal use of these assays and antiviral stewardship in RTRs. The use of ultrasensitive CMV qNAT assays in moderate-risk CMV renal transplant recipients is associated with earlier detection and longer durations of CMV DNAemia without impacting CMV end-organ disease or 1-year mortality.

Relationship Between Physical Activity and Estimated Glomerular Filtration Rate in Renal Transplant Recipients: A Cross-sectional Study Analyzing Isotemporal Substitution Model

Successful renal transplantation reduces mortality rates. However, the decline in the estimated glomerular filtration rate (eGFR) after transplantation is strongly associated with premature mortality in renal transplant recipients (RTRs). Physical activity (PA) is a modifiable lifestyle factor with the potential to maintain or improve eGFR. However, the effects of the type or intensity of PA and sedentary behavior (SB) on eGFR in RTRs remain unclear. The purpose of this study was to clarify the association between accelerometry-measured PA and SB and eGFR in RTRs using isotemporal substitution (IS) analysis. A total of 82 renal transplant outpatients participated in this cross-sectional study, among which 65 (average age, 56.9 years; average time post-transplant, 83.0 months) were finally analyzed. All RTRs wore a triaxial accelerometer to measure PA for seven consecutive days. The measured PA was classified based on intensity into light PA (LPA), moderate-to-vigorous PA (MVPA), and SB. The association of each type of PA with eGFR was examined using multi-regression analyses of single-factor, partition, and IS models. The IS model was applied to examine the estimated effects of substituting 30 min of SB with an equal amount of time of LPA or MVPA on eGFR. The partition model showed that MVPA was an independent explanatory variable for eGFR (β = 5.503, p < 0.05), and the IS model identified that the substitution of time spent in SB with MVPA led to improvements in eGFR (β = 5.902, p < 0.05). The present study suggests that MVPA has an independent and positive association with eGFR, and replacing 30 min of SB with MVPA after renal transplantation might lead to the maintenance or improvement of eGFR in RTRs.

N1-Methylnicotinamide: The Mysterious Anti-aging Actor in Renal Transplantation.

The fast global aging of people worldwide is a crucial demographic trend. According to evidence, Americans aged 65 and above will compose 21.6% of the population by 2040. During the aging process, the kidney undergoes gradual functional decrease, which turned out to be a forthcoming problem in clinical practice. Age-related decrease in renal function, evaluated by total glomerular filtration rate (GFR), which has been shown to drop by approximately 5-10% per decade after the age of 35. The sustaining extended period renal homeostasis is the main purpose of any therapeutic options intended for delaying or even reversing the aging kidney. The renal transplant has been regarded as the common alternative for kidney replacement therapy for elderly patients with end-stage renal disease (ESRD). In the last few years, considerable progress has been made to find novel therapeutic options for alleviating renal aging, in particular, calorie restriction and pharmacologic therapy. Nicotinamide N-methyltransferase is an enzyme responsible for generating N1-Methylnicotinamide (MNAM), notorious for its anti-diabetic, anti-thrombotic, and anti-inflammatory activity. MNAM is one of the important factors regarded as in vivo probes for evaluating the activity of some renal drug transporters. Furthermore, it has been shown to have therapeutic potential in the pathogenesis of proximal tubular cell damage and tubulointerstitial fibrosis. In this article, in addition to addressing the role of MNAM in renal function, we also explained its anti-aging effects. We conducted an in-depth investigation of the urinary excretion of MNAM and its metabolites, especially N1-methyl-2-pyridone-5- carboxamide (2py) in RTR. The excretion of MNAM and its metabolite, 2py, was inversely correlated with the risk of all-cause mortality in renal transplant recipients (RTR), independent of possible confounders. Therefore, we have shown that the reason for the lower mortality rate in RTR who had higher urinary excretion of MNAM and 2py may be related to the anti- aging effects of MNAM through transiently generating low levels of reactive oxygen species, stress resistance and the activation of antioxidant defense pathways.

Abstract 14756: Outcomes of Cardiac Co-Morbidities in Renal Transplantation: A National Population-Based Cohort Study

Background Cardiovascular disease (CVD) is common and associated with higher mortality in end-stage renal disease patients, but its impact on mortality from renal transplantation has not been studied formally. Our aim was to investigate the impact of CVD on the mortality of renal transplant recipients at the time of transplantation. Methods The National Inpatient Sample 2016-2019 was analyzed to identify a patient cohort admitted for renal transplantation with a diagnosis of a cardiovascular diseases using ICD-10 codes. The prevalence of various cardiac co-morbidities and their effect on mortality in renal transplant recipients were evaluated. A multivariate logistic regression model was used to analyze the in-hospital mortality rates. Results Analysis of 142,333,352 patients revealed that 84,525 (0.059%) were admitted for renal transplantation, of whom 32.5% had cardiac co-morbidities. Mean age of these patients was 57 years, and 66% were males. 19% of these patients had ischemic heart disease, 15.9% had heart block, 8.1% had heart failure, 7.1% had atrial fibrillation, 7.6% had congenital heart disease (CHD), 3.4% had pulmonary hypertension, 2.7% had ventricular arrhythmia, 2.5% had non-rheumatic valvular heart disease (NRVHD), 1.3% had chronic rheumatic heart disease (CRHD), 0.05% had pericarditis, and 0.018% had infective endocarditis. In patients undergoing renal transplant, CVD was associated with more than four times higher likelihood of mortality (OR 4.77, CI 2.84-8.03, p=0.00). Pericarditis (OR 31.56), ventricular arrhythmia (OR 13.9), heart failure (OR 5.4), heart block (OR 5.0), atrial fibrillation (OR 2.64), pulmonary hypertension (OR 2.54), and ischemic heart disease (OR 1.7) were also associated with significantly higher mortality (p&lt;0.05). CHD, NRVHD, CRHD, and infective endocarditis had no significant association with mortality. Conclusions The prevalence of CVD in renal transplant recipients is 32.5%, and it is associated with over four-fold higher odds of mortality. Other cardiac co-morbidities associated with increased mortality following renal transplantation are ischemic heart disease, heart failure, atrial fibrillation, ventricular arrhythmia, heart block, pericarditis, and pulmonary hypertension

POS-094 INFECTIONS IN KIDNEY TRANSPLANT RECIPIENTS :SINGLE CENTER EXPERIENCE FROM TERTIARY CARE CENTER IN SOUTH INDIA

Infections occurring in the post transplant period are the major cause of morbidity and mortality in renal transplant recipients. Early infections (within the first month) are more likely to be due to nosocomially acquired pathogens, surgical issues, and donor-derived infections. Opportunistic pathogens occur after 6 months, reflects the greater impact of immunosuppressive therapies. Late infections may be secondary to opportunistic pathogens or conventional ones.

POS-108 POST-TRANSPLANT INFECTIONS AND LONG TERM OUTCOMES IN RENAL TRANSPLANT RECIPIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA

Infections are a significant cause of morbidity in the form of graft loss and mortality in Renal Transplant Recipients (RTR). Several factors in the pre and peri-transplant period increase the susceptibility to Post Transplant Infections (PTI), affecting the overall graft and patient survival.

Ultra-processed foods and risk of all-cause mortality in renal transplant recipients

ABSTRACTBackgroundRenal transplant recipients (RTRs) have a 6-fold higher risk of mortality than age- and sex-matched controls. Whether high consumption of ultra-processed foods is associated with survival in RTRs is unknown.ObjectivesWe aimed to study the association between high consumption of ultra-processed foods and all-cause mortality in stable RTRs.MethodsWe conducted a prospective cohort study in adult RTRs with a stable graft. Dietary intake was assessed using a validated 177-item FFQ. Food items were categorized according to the NOVA classification system and the proportion ultra-processed foods comprised of total food weight per day was calculated.ResultsWe included 632 stable RTRs (mean ± SD age: 53.0 ± 12.7 y, 57% men). Mean ± SD consumption of ultra-processed foods was 721 ± 341 g/d (28% of total weight of food intake), whereas the intake of unprocessed and minimally processed foods, processed culinary ingredients, and processed foods accounted for 57%, 1%, and 14%, respectively. During median follow-up of 5.4 y [IQR: 4.9–6.0 y], 129 (20%) RTRs died. In Cox regression analyses, ultra-processed foods were associated with all-cause mortality (HR per doubling of percentage of total weight: 2.13; 95% CI: 1.46, 3.10; P < 0.001), independently of potential confounders. This association was independent from the quality of the overall dietary pattern, expressed by the Mediterranean Diet Score (MDS) or Dietary Approaches to Stop Hypertension (DASH) score. When analyzing ultra-processed foods by groups, only sugar-sweetened beverages (HR: 1.21; 95% CI: 1.05, 1.39; P = 0.007), desserts (HR: 1.24; 95% CI: 1.02, 1.49; P = 0.03), and processed meats (HR: 1.87; 95% CI: 1.22, 2.86; P = 0.004) were associated with all-cause mortality.ConclusionsConsumption of ultra-processed foods, in particular sugar-sweetened beverages, desserts, and processed meats, is associated with a higher risk of all-cause mortality after renal transplantation, independently of low adherence to high-quality dietary patterns, such as the Mediterranean diet and the DASH diet.This trial was registered at clinicaltrials.gov as NCT02811835.

Does the cytomegalovirus infection cause kidney transplant rejection in Erbil city patients, Kurdistan region of Iraq?

Does the cytomegalovirus infection cause kidney transplant rejection in Erbil city patients, Kurdistan region of Iraq?

POS-812 FACTORS PREDICTING POST RENAL TRANSPLANT TUBERCULOSIS: A TERTIARY CARE CENTRE EXPERIENCE

Tuberculosis (TB) is one of the most common causes of morbidity and mortality in renal transplant recipients in India. We studied factors predicting tuberculosis in post renal transplant period and its impact on graft and patient outcomes.

Aetiology, management, and outcome of lower respiratory tract infection in renal allograft recipients - A report from a tropical country.

Lower respiratory tract infections (LRTIs) among renal transplant recipients (RTRs) are a significant cause of morbidity and mortality. This study aimed to analyse the aetiology, outcome, and risk factors associated with mortality. We analysed baseline transplant characteristics, symptoms, hospital course, laboratory, serological and microbial results, and their association with the outcome of all RTRs between January 2011 and December 2019. A total of 206 LRTI patients out of 1051 RTRs were analysed. The incidence proportion was nearly 22 episodes per 1000 patients per year. The mean age was 39.3 years, with male predominance. Bacterial was the most common aetiology (53%), and staphylococcus was the most common species. Among the fungal causes (14%), 68% had aspergillus infection. More than one-third RTRs died during the hospital course mainly because of bacterial causes (42.6%). The aspergillus infection was the most common fungus associated with 50% mortality. On multi-variate analysis, sepsis, septic shock, and the need for mechanical ventilation independently predicted mortality. Bacterial aetiology was the most common cause; though the fungal aetiology was seen less, it was associated with higher mortality. Mortality in RTR with LRTI was associated with sepsis, septic shock, and the need for mechanical ventilation.

Statin use and incident cardiovascular events in renal transplant recipients.

BackgroundStatins achieve potent LDL lowering in the general population leading to a significant cardiovascular (CV) risk reduction. In renal transplant recipients (RTR) statins are included in treatment guidelines, however, conclusive evidence of improved cardiovascular outcomes has not been uniformly provided and concerns have been raised about simultaneous use of statins and the immunosuppressant cyclosporine. This study aimed to elucidate the effect of statins on a compound CV endpoint, comprised of ischaemic CV events and CV mortality in RTR, with subgroup analysis focussing on cyclosporine users.Method622 included RTR (follow‐up 5.4 years) were matched based on propensity scores and dichotomized by statin use. Survival analysis was conducted.ResultsCox regression showed that statin use was not significantly associated with the compound CV endpoint in a fully adjusted model (HR = 0.81, 95% CI = 0.53‐1.24, P = .33). Subgroup analyses in RTR using cyclosporine revealed a strong positive association of statin use with the CV compound outcome in a fully adjusted model (HR = 6.60, 95% CI 1.75‐24.9, P = .005). Furthermore, statin use was positively correlated with cyclosporine trough levels (correlation coefficient 0.11, P = .04).ConclusionIn conclusion, statin use does not significantly decrease incident CV events in an overall RTR cohort, but is independently associated with CV‐specific mortality and events in cyclosporine using RTR, possibly due to a bilateral pharmacological interaction.

POS-742 LONG TERM OUTCOMES OF POST-TRANSPLANT INFECTIONS IN ADULT RENAL TRANSPLANT RECIPIENTS

Infections are a major cause of morbidity in the form of graft loss and mortality in renal transplant recipients (RTR). A number of factors in pre and peri transplant period increase the susceptibility to post-transplant infections (PTI) affecting the overall graft and patient survival.

POS-740 “BECAUSE IT'S RARE DOESN’T MEAN IT DOESN’T EXIST”: PHAEOHYPHOMYCOSIS IN RENAL TRANSPLANT RECIPIENTS - A 10-YEAR EXPERIENCE FROM A TERTIARY CARE CENTRE IN SOUTH INDIA.

Invasive fungal infections are an important cause of morbidity and mortality in renal transplant recipients. Common invasive fungal infections include candidiasis, aspergillosis and mucormycosis. Dematiaceous fungi (containing pigment in their walls) are rare pathogens in renal transplant recipients and may cause phaeohyphomycosis, mycetoma or chromoblastomycosis. The most common presentation is with invasive cutaneous lesions but deep seated organ involvement like pulmonary infection, cerebral abscess, sinusitis and blood stream infection can also occur.

Pulmonary infections after renal transplantation: a prospective study from a tropical country.

Pulmonary infection is a leading cause of morbidity and mortality in renal transplant recipients. In a prospective study, we characterized their epidemiology in a tropical country with high infectious disease burden. Adult renal transplant recipients presenting with pulmonary infections from 2015 to 2017 were evaluated using a specific diagnostic algorithm. 102 pulmonary infections occurred in 88 patients. 32.3% infections presented in the first year, 31.4% between 1 and 5, and 36.3% beyond 5years after transplantation. Microbiological diagnosis was established in 69.6%, and 102 microorganisms were identified. Bacterial infection (29.4%) was most common followed by tuberculosis (23.5%), fungal (20.6%), Pneumocystis jiroveci (10.8%), viral (8.8%), and nocardial (6.9%) infections. Tuberculosis(TB) and bacterial infections presented throughout the post-transplant period, while Pneumocystis (72.7%), cytomegalovirus (87.5%) and nocardia (85.7%) predominantly presented after >12months. Fungal infections had a bimodal presentation, between 2 and 6months (33.3%) and after 12months (66.7%). Four patients had multi-drug resistant(MDR) TB. In 16.7% cases, plain radiograph was normal and infection was diagnosed by a computed tomography imaging. Mortality due to pulmonary infections was 22.7%. On multivariate Cox regression analysis, use of ATG (HR-2.39, 95% CI: 1.20-4.78, P=0.013), fungal infection (HR-2.14, 95% CI: 1.19-3.84, P=0.011) and need for mechanical ventilation (9.68, 95% CI: 1.34-69.82, P=0.024) were significant predictors of mortality in our patients. To conclude, community-acquired and endemic pulmonary infections predominate with no specific timeline and opportunistic infections usually present late. Nocardiosis and MDR-TB are emerging challenges.

Early changes in renal resistive index and mortality in diabetic and nondiabetic kidney transplant recipients: a cohort study

BackgroundRenal resistive index (RI) predicts mortality in renal transplant recipients (RTR). However, its predictive value may be different according to the time of measurement. We analysed RI changes between 1 month and 3 months after transplantation and its predictive value for death with a functioning graft (DWFG).MethodsWe conducted a retrospective study in 1685 RTR between 1985 and 2017. The long-term predictive value of changes in RI value from 1 month to 3 months was assessed in diabetic and non-diabetic RTR.ResultsBest survival was observed in RTR with RI < 0.70 both at 1 and 3 months, and the worst survival was found in RTR with RI ≥ 0.70 both at 1 and 3 months (HR = 3.77, [2.71–5.24], p < 0.001). The risk of DWFG was intermediate when RI was < 0.70 at 1 month and ≥ 0.70 at 3 months (HR = 2.15 [1.29–3.60], p = 0.003) and when RI was ≥0.70 at 1 month and < 0.70 at 3 months (HR = 1.90 [1.20–3.03], p = 0.006).In diabetic RTR, RI was significantly associated with an increased risk of death only in those with RI < 0.70 at 1 month and ≥ 0.70 at 3 months (HR = 4.69 [1.07–20.52], p = 0.040). RI considered as a continuous variable at 1 and 3 months was significantly associated with the risk of DWFG in nondiabetic but not in diabetic RTR.ConclusionRI changes overtime and this impacts differently diabetic and nondiabetic RTR. RI short-term changes have a strong prognosis value and refines the risk of DWFG associated with RI.

Uremic Toxins, Oxidative Stress, Atherosclerosis in Chronic Kidney Disease, and Kidney Transplantation.

Patients with chronic kidney disease (CKD) are at a high risk for cardiovascular disease (CVD), and approximately half of all deaths among patients with CKD are a direct result of CVD. The premature cardiovascular disease extends from mild to moderate CKD stages, and the severity of CVD and the risk of death increase with a decline in kidney function. Successful kidney transplantation significantly decreases the risk of death relative to long-term dialysis treatment; nevertheless, the prevalence of CVD remains high and is responsible for approximately 20-35% of mortality in renal transplant recipients. The prevalence of traditional and nontraditional risk factors for CVD is higher in patients with CKD and transplant recipients compared with the general population; however, it can only partly explain the highly increased cardiovascular burden in CKD patients. Nontraditional risk factors, unique to CKD patients, include proteinuria, disturbed calcium, and phosphate metabolism, anemia, fluid overload, and accumulation of uremic toxins. This accumulation of uremic toxins is associated with systemic alterations including inflammation and oxidative stress which are considered crucial in CKD progression and CKD-related CVD. Kidney transplantation can mitigate the impact of some of these nontraditional factors, but they typically persist to some degree following transplantation. Taking into consideration the scarcity of data on uremic waste products, oxidative stress, and their relation to atherosclerosis in renal transplantation, in the review, we discussed the impact of uremic toxins on vascular dysfunction in CKD patients and kidney transplant recipients. Special attention was paid to the role of native and transplanted kidney function.