Search Results (377)

Introduction: Hypertensive disorders in pregnancy (HDP) and gestational diabetes mellitus (GDM) represent two significant maternal cardiometabolic disorders closely related to each other. This study aims to identify predictive risk factors for gestational hypertension in patients with GDM within our population. Methods: This cohort study was conducted at the Department of Obstetrics and Gynecology, Policlinico “G. Martino” of Messina from January 2012 to December 2019. It included 684 pregnant women diagnosed with GDM by Oral Glucose Tolerance Test (OGTT) according to Italian guidelines. A detailed medical history was taken for each patient to identify potential predictive risk factors for HDP. Patients with pre-existing hypertension or diabetes were excluded. Results: Among 684 women with GDM, 69 (10.1%) developed hypertensive disorders of pregnancy (HDP). Women with HDP had a significantly higher pregestational BMI (30.1 ± 7.7 vs. 26.5 ± 5.6 kg/m², p = 0.001) and a higher prevalence of obesity (51% vs. 34%, p = 0.0001). Post-load glucose at 60 min was higher in the HDP group (178 ± 34 vs. 164 ± 32 mg/dL, p = 0.0001), with more women exceeding the diagnostic threshold (>180 mg/dL: 56% vs. 35%, p = 0.001). Multivariate analysis confirmed that pregestational obesity and higher 60-min glucose levels during OGTT were the strongest independent predictors of HDP. Conclusions: Obesity and glycemia above the cut-off after 1 h during OGTT are predictive risk factors for hypertensive disorders in patients with GDM. Full article

Contrast-induced nephropathy (CIN), now more accurately referred to as contrast-induced acute kidney injury (CI-AKI), remains a major cause of hospital-acquired acute kidney injury (AKI) and is associated with increased morbidity and mortality, particularly in high-risk patients. This condition occurs following the intravascular administration of iodinated radiocontrast media (RCM), especially in individuals with pre-existing chronic kidney disease (CKD), diabetes mellitus, heart failure, advanced age, or exposure to high contrast volumes. The pathophysiology of CI-AKI is multifactorial and involves renal hemodynamic alterations, direct tubular toxicity, oxidative stress, inflammatory activation, and endothelial dysfunction, ultimately leading to tubular injury and reduced glomerular filtration rate (GFR). Traditional diagnostic markers such as serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) are limited by low sensitivity and delayed response, prompting growing interest in novel biomarkers, including cystatin C (CysC), β-2 microglobulin (β-2M), Interleukin-18 (IL-18), Kidney Injury Molecule-1 (KIM-1), Neutrophil Gelatinase-Associated Lipocalin (NGAL), and osteopontin (OPN), which allow earlier detection and risk stratification. Preventive strategies remain the cornerstone of management and include optimizing hydration protocols, minimizing contrast dose, selecting low- or iso-osmolar agents, and individualized risk assessments. Despite extensive research into pharmacological and procedural interventions, no effective treatment for established CI-AKI exists, underscoring the critical importance of prevention and ongoing investigation into safer contrast agents and innovative prophylactic approaches. Full article

Background/Objective: The C-reactive protein-to-albumin ratio (CAR) reflects both systemic inflammation and nutritional status and has been proposed as a prognostic marker in critical illness, yet its value in intensive care unit (ICU) patients with pre-existing hypertension is not well defined. Methods: This was a retrospective single-center study of 341 critically ill adults with pre-existing hypertension (June 2001–October 2012) from the Medical Information Mart for Intensive Care III database. CAR was calculated from the first C-reactive protein (CRP) and albumin measurements after ICU admission. Using adjusted Cox proportional hazard models, we examined the association of CAR with 30-day mortality in the overall hypertensive cohort, across hypertension groups, and in patients with coexisting diabetes. Results: Non-survivors had higher CAR than survivors (35.5 vs. 18.1, p = 0.008). CAR showed moderate discriminative ability in the overall hypertensive cohort (AUC = 0.637, 95% CI: 0.543–0.732), with better discrimination in patients with normal/elevated blood pressure (BP) (AUC = 0.748, 95% CI: 0.637–0.858) and a relatively higher AUC in the subgroup with diabetes and normal/elevated BP (0.833, 95% CI: 0.671–0.995). In univariable Cox analysis, high CAR was associated with increased 30-day mortality in the overall hypertensive cohort (HR: 3.02, 95% CI: 1.48–6.17, p = 0.0024), in patients with normal/elevated BP (HR: 8.90, 95% CI: 2.00–39.17, p = 0.0038), and in patients with diabetes and normal/elevated BP (HR: 10.00, 95% CI: 1.20–83.10, p = 0.0331). These associations remained significant after multivariable adjustment in the overall hypertensive cohort (adjusted HR: 3.01, 95% CI: 1.45–6.21, p = 0.0030), in patients with normal/elevated BP (adjusted HR: 10.12, 95% CI: 2.20–46.59, p = 0.0030), and in patients with diabetes and normal/elevated BP (adjusted: HR: 19.41, 95% CI: 1.37–275.28, p = 0.0284). Conclusions: These results suggest that CAR measured early after ICU admission may serve as a practical tool for mortality risk stratification in ICU patients with pre-existing hypertension, particularly those with diabetes. Full article

Chronic low-grade inflammation is a key feature of obesity-associated dysglycemia, yet substantial heterogeneity exists in inflammatory responses among individuals with normoglycemia, prediabetes, and type 2 diabetes mellitus (T2DM). Whether circulating inflammatory protein profiles define distinct patient phenotypes beyond conventional glycemic classification remains incompletely understood. In this cross-sectional analysis of 142 individuals with severe obesity, plasma inflammatory proteins were quantified using Olink proximity extension assay technology. Subjects were stratified by glycemic status (noDM, normoglycemia; PreDM, prediabetes and T2DM) while maintaining comparable distributions of metabolic dysfunction-associated steatotic liver disease. Differential expression analyses were performed across glycemic groups, and unsupervised topological data analysis (TDA) was applied to identify inflammatory protein-based patient subgroups. Several inflammatory proteins were significantly upregulated in T2DM and PreDM compared with noDM, with interleukin-8 (IL-8), Fms-relatedlike tyrosine kinase 3 ligand (Flt3L), and CUB domain containing protein (CDCP1) showing the largest significant differences. NPX distributions of these proteins exhibited gradual increases across glycemic stages with substantial inter-individual variability. TDA identified seven clusters defined by distinct inflammatory protein signatures. One cluster was enriched for individuals with T2DM and characterized by coordinated upregulation of IL-8, Flt3L, CDCP1, and additional immune- and cytokine-related proteins, whereas other clusters displayed alternative inflammatory profiles that were not explained by glycemic status alone. Inflammatory proteomic profiling in severe obesity reveals both glycemia-associated protein changes and distinct inflammatory phenotypes that transcend conventional clinical classification. Integration of differential expression analysis with TDA highlights heterogeneity in inflammatory states, supporting a hypothesis-generating framework for future studies aimed at validating these proteomic patterns and clarifying their longitudinal relevance in obesity-related dysglycemia. Full article

Background and Objectives: Pregnancy causes various physiological and hormonal changes that disrupt sleep architecture and modify respiratory patterns, increasing the risk of sleep-related breathing disorders (SBDs) such as obstructive sleep apnea (OSA) and potentially exacerbating pre-existing conditions. These disorders have been linked to adverse maternal and fetal outcomes. However, current screening tools remain inadequate, and data, including from Portugal, remain limited. This study aimed to assess the prevalence of SBD symptoms suggestive of sleep-disordered breathing during pregnancy, characterize the population, and explore associations with demographic and anthropometric parameters. Materials and Methods: A prospective observational study was conducted from July to December 2024 at Hospital da Luz Lisboa, involving pregnant women ≥ 18 years attending routine consultations. Participants completed a structured questionnaire that assessed demographic and anthropometric data, comorbidities, ten SBD symptoms, and the Epworth Sleepiness Scale (ESS). Results: The cohort included 289 participants, with a mean age of 34.4 years and pre-pregnancy body mass index (BMI) of 23.6 kg/m². On average, women reported 3.1 SBD symptoms, with fatigue (65.4%), memory/concentration impairment (52.2%), and non-restorative sleep (50.5%) being the most common. Excessive daytime sleepiness (ESS >10) was present in 22.8% of the population. Snoring was significantly associated with older age and higher BMI (p = 0.0009 and p < 0.0001, respectively). Both the number of symptoms and ESS scores tended to increase with gestational age, particularly in the third trimester. Women with diabetes had higher odds of reporting snoring, nocturnal dyspnea, and witnessed apneas, with odds ratios of 4.65, 8.77, and 11.38, respectively. Conclusions: SBD symptoms and daytime sleepiness are highly prevalent in pregnancy and typically increase with advancing gestation. These findings emphasize the need for improved clinical strategies to enable early identification and management of SBD in pregnant women, thereby reducing maternal-fetal complications. Full article

The disproportionately severe disease course of diabetic patients with SARS-CoV-2 infection was repeatedly observed by clinicians during the COVID-19 pandemic. The overlap between metabolic impairment, viral pathophysiology, and chronic inflammation created a pattern that urged deeper examination. The aim of this paper was to review and synthesize evidence regarding the interaction between diabetes mellitus and COVID-19. We synthesized evidence across mechanistic pathways (immune dysregulation, chronic inflammation, ACE2/DPP-4-related signaling, endothelial dysfunction, and pancreatic involvement) and key clinical outcomes (severity, intensive care unit (ICU) admission, mortality, dysglycaemia/new-onset diabetes, and DKA). This systematic search was conducted in PubMed, Clinical Key, and Google Scholar. The eligibility criteria included papers on adults (≥18 years) with pre-existing diabetes mellitus (type 1 or type 2) or newly diagnosed diabetes/hyperglycemia and confirmed SARS-CoV-2 infection, published between January 2020 and October 2025, in English language. The PRISMA guidelines were used for data extraction. We identified 412 articles, out of which only 30 met all the inclusion criteria. Diabetes was consistently evoked as a major risk factor for severe COVID-19, being associated with higher susceptibility to pneumonia, respiratory failure, ICU admission, and mortality. The explanation lies in the impaired immune system, endothelial dysfunction, and metabolic repercussions imposed by hyperglycemia. Several antidiabetic drugs appeared protective in multiple cohorts. In conclusion, the accumulated evidence underscores the tight interplay between metabolic disease and COVID-19. Essentially, the clinical management of these patients would be a thoughtful selection of antidiabetic therapy and close metabolic monitoring. Full article

Background/Objectives: The COVID-19 pandemic has brought about significant clinical challenges in regard to digestive systems, as well as causing complications such as pancreatitis and biliary infections. Whether diabetes mellitus (DM) contributes to both an increased risk for these complications and mortality amongst COVID-19 patients remains to be investigated. This study aimed to illuminate any possible outcomes, including pancreatitis, cholangitis, cholecystitis and all-cause mortality, among COVID-19 patients with and without pre-existing type 2 diabetes mellitus (T2DM), using real-world data taken from a multinational electronic health record database. Methods: A retrospective cohort study based upon data taken from the database of the TriNetX Global Collaborative Network was conducted. We included patients from the database who had been diagnosed with COVID-19 from January 2020 to December 2023. Enrolled subjects were divided into two cohorts: COVID-19 patients with pre-existing T2DM who had had at least two medical visits, and those without T2DM. Propensity score matching was performed using 68 baseline variables. Outcomes were evaluated within 90 days following COVID-19 diagnosis, with patients with prior relevant diagnoses being excluded. Risk analyses, Kaplan–Meier survival estimates, and hazard ratios were calculated as the outcomes. Results: The incidence of acute pancreatitis was significantly higher in the DM+ group when compared to the DM– group (Hazard ratio (HR) = 1.307; 95% confidence interval (CI) 1.048–1.630, p = 0.017) and mortality (HR = 1.141; 95% CI 1.102–1.181, p < 0.05) by Kaplan–Meier analysis. Risk of cholecystitis (HR = 1.264; 95% CI 1.042–1.533, p = 0.017) was borderline increased, and cholangitis was not significant (HR 0.847, 95% CI 0.583–1.230) Conclusions: In COVID-19 patients, pre-existing T2DM is independently associated with increased risks of acute pancreatitis and mortality. Full article

Background: Malnutrition and sarcopenia are highly prevalent in intensive care settings and are associated with adverse clinical outcomes. Aim: The study aimed to evaluate the association between nutritional care, nutritional status, and patient outcomes in intensive care units. Methods: This prospective observational study at a Tunisian tertiary hospital investigated nutritional status and management of 100 intensive care unit patients, each of whom was followed for seven days after ICU admission. Malnutrition Risk was assessed by NUTRIC and MNA scores. The severity of disease was assessed using the APACHE II and SOFA scores. Malnutrition was diagnosed using body mass index and weight loss. Sarcopenia was assessed through grip strength, calf circumference, and psoas muscle area. Nutritional management was evaluated using calculations of caloric and protein intake. Clinical outcomes included the need for intubation, difficulty with oxygen weaning, healthcare-associated infections, and the development of pressure ulcers. Results: The participants had a mean age of 54.85 ± 17.25 years, with a slight male predominance (53 males, 47 females). Pre-existing metabolic conditions affected 80% of patients, including hypertension (40 patients), diabetes (36), and obesity (18). The primary reasons for admission were respiratory disorders (25%), infectious diseases (23%), and metabolic disorders (16%). The mean APACHE II score was 15.91 ± 6.84, and the mean NUTRIC score was 3 ± 1.66; 27% were classified as at high risk of malnutrition. The prevalence of malnutrition reached 50% (28% moderate, 22% severe). Only 31% received adequate caloric intake, while 84% had insufficient protein intake. Malnourished patients required intubation more frequently (50% versus 22.5%; p = 0.014), experienced greater difficulty with oxygen weaning (78.4% versus 48.6%; p = 0.008), and developed pressure ulcers more often (43.5% versus 6%; p < 0.001). Sarcopenic patients showed similar patterns for intubation (51.4% versus 18.9%, p = 0.003), oxygen weaning difficulty (77.5% versus 46.9%, p = 0.007), and pressure ulcers (39.2% versus 6.7%, p < 0.001). Conclusions: Malnutrition and sarcopenia are highly prevalent in intensive care patients and are associated with severe complications, including prolonged mechanical ventilation and pressure ulcer development. Inadequate nutritional support remains common despite known consequences. Early comprehensive nutritional assessment and appropriate management from admission are essential to improve outcomes in critically ill patients. Full article

Background/Objectives: Gastrointestinal (GI) manifestations may persist in COVID-19 survivors, potentially worsening pre-existing conditions and increasing the risk of malnutrition. Understanding the long-term association between GI symptoms and nutritional risk is essential. This study aimed to investigate this relationship in COVID-19 survivors, regardless of comorbidities. Methods: A retrospective cohort study with prospective follow-up was conducted among 103 adults (52 males and 51 females) with PCR-confirmed COVID-19 admitted to King Salman Specialist Hospital, Ha’il, Saudi Arabia, between January 2021 and January 2023. Participants were grouped based on the presence of comorbidities, mainly type 2 diabetes mellitus (DM) and hypertension (HTN), and GI symptoms. Demographic characteristics, COVID-19 severity, and clinical data were obtained from medical records and structured interviews. Nutritional risk was assessed using the Malnutrition Screening Tool (MST). Statistical analysis was performed using Chi-Square tests, with p < 0.05 considered significant. Results: Over a mean follow-up of 26.6 months, 40.8% of participants reported at least one persistent GI symptom. Patients with comorbidities were older than those without comorbidities (mean age 58.24 ± 13.23 vs. 48.22 ± 14.83 years), and malnutrition risk was commonly observed in both groups during hospitalization and follow-up. The most frequently reported symptoms were abdominal pain (15.5%), diarrhea (12.6%), appetite loss (9.7%), and vomiting (7.8%), with no significant differences between groups. GI symptoms were significantly associated with reduced food intake, weight loss, and increased malnutrition risk (p < 0.05). Conclusions: Some COVID-19 survivors reported persistent GI symptoms during long-term follow-up, with no significant differences based on comorbidity status. GI symptoms were associated with nutritional risk and lifestyle changes, supporting the need for nutritional screening in post-COVID-19 care. Full article

Background/Objectives: Chronic hepatitis B (CHB) and type 2 diabetes mellitus (T2DM) frequently coexist. This study aimed to investigate the impact of T2DM and glycemic control on antiviral efficacy in CHB patients. Methods: This single-center, retrospective cohort study included treatment-naïve CHB patients who initiated nucleos(t)ide analogue (NA) therapy between January 2019 and January 2024. The primary endpoint was a complete virological response (CVR), defined as achieving HBV DNA levels below 20 IU/mL after 48 weeks of treatment. Results: The CHB + T2DM group (n = 81) demonstrated a significantly lower CVR rate than the CHB group (n = 106) (26.0% vs. 41.2%, p = 0.038). Multivariate analysis identified T2DM as an independent negative predictor of a CVR (OR = 0.400, 95% CI: 0.196–0.815, p = 0.012). Within the CHB + T2DM subgroup, adequate glycemic control (HbA1c < 7%) was associated with a higher CVR (38.7% vs. 16.7%, p = 0.034). Patients newly diagnosed with diabetes at enrollment showed a higher rate of HBeAg loss than those with pre-existing diabetes (57.1% vs. 10.0%, p = 0.036). Regarding antiviral regimens, entecavir-treated CHB + T2DM patients had a lower CVR than CHB controls (18.8% vs. 46.2%, p = 0.015). Furthermore, tenofovir-based regimens showed a more favorable antiviral trend than entecavir in CHB patients with T2DM. Conclusions: Comorbid T2DM was an independent risk factor for impaired antiviral efficacy in CHB patients. Optimal glycemic control may improve virological outcomes. These findings suggest that the early diagnosis and management of T2DM could enhance antiviral treatment efficacy in CHB patients. Full article

Background and Objectives: Acute myocardial infarction (AMI) increases the risk of developing type 2 diabetes mellitus (T2DM), yet the long-term prognostic significance of new-onset T2DM after AMI remains unclear. We aimed to evaluate long-term mortality among AMI survivors who developed T2DM during follow-up compared with those who remained non-diabetic and those with pre-existing T2DM. Materials and Methods: We conducted a retrospective cohort study of consecutive AMI patients hospitalized between 2002 and 2017 at a large tertiary medical center. Patients were categorized into three groups: (1) new-onset T2DM after AMI (NOT2DM), 1–15 years post-discharge; (2) no diabetes (No DM), with no evidence of T2DM during the same period; (3) pre-existing T2DM (T2DM), diagnosed prior to or during the index AMI. Age- and sex-matching was performed. Primary outcome: all-cause mortality with up-to 10 years of follow-up. Results: A total of 4207 patients were included (1202 NOT2DM; 2404 No DM; 601 T2DM). Over a median follow-up of 2729 days, 1492 patients (35.5%) died. Mortality was highest in the NOT2DM group (44.9%) compared with No DM (31.2%) and T2DM (33.4%) (p < 0.001). After adjustment, NOT2DM remained strongly associated with increased mortality versus No DM (AdjHR 1.408; 95% CI 1.256–1.578) and T2DM (AdjHR 1.272; 95% CI 1.074–1.508) (p < 0.001 for each). The mortality impact was most pronounced in patients < 65 years. Conclusions: Development of T2DM after AMI identifies a high-risk subgroup with significantly worse long-term survival, especially among the young patients. These findings underscore the need for systematic metabolic surveillance and early preventive strategies in AMI survivors. Full article

At the beginning of life, there are no sex differences in fetal kidney growth, nephron endowment nor in the prevalence of low birth weight. In chronic kidney disease (CKD) in adults, however, significant sex- and gender-specific differences exist in diagnosis, progression, and management of CKD. In adult individuals, CKD is more prevalent in women, but CKD progression is faster in men; nevertheless, women have a higher life expectancy than men. A possible explanation for the enigmatic higher CKD prevalence in women may derive from the Brenner–Luyckx concept of hyperfiltration. Diseases that lead to hyperfiltration will lead to premature nephron loss and to a faster decline in glomerular filtration rate (GFR). This condition is predominantly seen in middle-aged men with a higher GFR, larger hypertrophied kidneys, and a higher prevalence of arterial hypertension, diabetes mellitus, smoking, and hypercholesterolemia compared to women. Thus, a high GFR may not be a good sign if it reflects hyperfiltration. Any GFR must be interpreted against the comorbidities of an individual. An individual may end up with a realistic GFR far below normal once hyperfiltration is stopped, for example, by a Sodium Glucose-Linked Transporter 2 (SGLT2) inhibitor. With regard to the management of CKD, women with CKD receive poorer healthcare compared to men with CKD. Women less frequently receive a CKD diagnosis, are less frequently referred to nephrology for co-management, less frequently undergo eGFR and albuminuria assessments, and are less likely to receive guideline-recommended treatments for CKD, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and statins. Cardiovascular risk factors are less rigorously controlled in women with CKD compared to men with CKD. The causes for the poorer CKD care among women are to be found in gender rather than in sex. It is crucial to integrate assessments of sex and gender into both clinical routines and scientific reports. All studies should incorporate sex- and gender-specific analyses, and the evaluation of pre- and postmenopausal women should be conducted separately. The utilization of Gender Scores can help identify the impact of cultural, societal, and psychological factors on observed gender differences in ambulatory healthcare for those with CKD. Guidelines need to be sensitive to gender and emphasize the existing knowledge gaps regarding sex and gender differences in CKD healthcare. Urgent attention is required to substantially improve and ensure equitable healthcare for CKD across sexes and genders. Full article

Purpose: Hyperglycemia frequently occurs in critically ill patients with COVID-19 and may worsen outcomes. This study evaluated the prevalence, predictors, and clinical impact of poor glycemic control in severe and critical cases. Methods: We conducted a retrospective observational study of 338 ICU patients with COVID-19 and hyperglycemia at a tertiary center in Vietnam (August 2021–February 2022). Nearly 15,000 bedside glucose measurements were analyzed. Patients were classified into well-controlled or poorly controlled groups based on mean glucose levels (140–180 mg.dL⁻¹ target). Logistic regression identified predictors of poor control. The primary outcome was in-hospital mortality. Propensity score matching (PSM) and multivariable Cox regression were performed to adjust for confounders. Results: Poor glycemic control occurred in 79% of patients. Independent predictors included invasive mechanical ventilation, elevated admission glucose, pre-existing diabetes, HbA1c > 7.0%, and prolonged corticosteroid exposure. After PSM, mortality was higher in the poorly controlled group compared to the well-controlled group (54.8% vs. 35.5%, p = 0.047). Cox regression confirmed poor glycemic control as an independent predictor of death (adjusted hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.01–2.55, p = 0.045). Conclusions: Poor glycemic control is common and strongly associated with excess mortality in critically ill COVID-19 patients. Prolonged corticosteroid use emerged as a modifiable risk factor. Careful glucose monitoring and tailored steroid management are warranted to improve outcomes. Full article

COVID-19, caused by SARS-CoV-2, is a highly contagious disease with variable clinical presentation. Severe forms are more common in patients with pre-existing chronic conditions. The objective of this study is to evaluate the prognostic value of the Charlson Comorbidity Index (CCI) in relation to disease severity and outcome in hospitalized COVID-19 patients with comorbidities. A retrospective analysis was conducted on 558 patients, hospitalized at the Infectious Diseases Clinic of “St. Marina” University Hospital, Varna, Bulgaria, between March 2020 and March 2021. CCI score was calculated to estimate 10-year survival probabilities. Prevalent comorbidities were arterial hypertension (78.55%), type 2 diabetes (16.09%), and ischemic heart disease (5.82%). A higher number of comorbidities was associated with increased rates of bilateral pulmonary consolidation (χ² = 6.63, p = 0.010), oxygen therapy needs (χ² = 5.41, p = 0.020), and mortality (χ² = 7.88, p = 0.005). Patients with higher CCI scores had worse outcomes. A CCI score above 5 was common among non-survivors and those with pulmonary consolidation and respiratory failure. The findings confirm that advanced age and multiple comorbidities are strong predictors of poor COVID-19 prognosis. Early CCI calculation at hospital admission would help identify high-risk patients and support timely, targeted medical interventions. Full article

In recent decades, the rate of kidney transplantation has risen significantly, leading to better outcomes in terms of cardiovascular and overall mortality for patients with kidney failure. Although kidney transplantation represents the most effective therapeutic option, it is not devoid of the risk of failure. Immunological and non-immunological risk factors are involved. These factors often interact and may act synergistically, ultimately influencing graft longevity and patient survival. Both contribute to long-term transplant outcomes; however, non-immunological factors, representing a significant clinical challenge, will be the focus of our review. Of the numerous non-immunological risk factors, for clarity and to avoid overextending the discussion, only those most closely associated with chronic kidney disease have been considered: hypertension, anemia, diabetes mellitus, proteinuria, electrolyte and acid–base imbalances, and impaired bone mineralization. Hypertension is reported in approximately 90% of kidney transplant recipients, often related to immunosuppressive therapy and residual renal dysfunction, and it is strongly associated with reduced graft survival. Anemia affects approximately 20–51% of these patients, contributing to cardiovascular morbidity and a more rapid decline in graft function, as does pre-existing diabetes mellitus. Proteinuria has a prevalence ranging from 7.5% to 45%, depending on the established target, and is a significant negative prognostic factor. Metabolic complications are also frequent; for example, hyperkalemia has an incidence of 25–44%, and metabolic acidosis has a prevalence of 12–58%. In our review, each of these factors is analyzed in terms of clinical impact, etiopathogenic mechanism, and available therapeutic management. Full article