INTRODUCTION: This study aimed to evaluate intima-media thickness (IMT) as a surrogate marker for atherosclerosis and to analyze potential risk factors associated with increased IMT values in kidney transplant patients as well as to analyze its connection with nutritional and parodontal status. This study analyzed the relationship between adropin levels and body composition parameters in kidney transplant patients, with a particular focus on gender differences. MATHERIALS AND METHODS: This study included 93 kidney transplant patients. Clinical and laboratory parameters, body composition, anthropometrics, advanced glycation end products (AGEs), blood pressure, and arterial stiffness measurements were collected. All participants underwent ultrasound examination of IMT and periodontal assessment. Adropin levels in serum determined with comercial ELISA test set. RESULTS: Patients with IMT values ≥ 0.9 mm were significantly older, had lower levels of total cholesterol, less adipose tissue, and fewer teeth. They also showed significantly higher values for pulse wave velocity (PWV), resistive index (RI), and end-diastolic velocity (EDV). We confirmed a positive correlation between IMT values and dialysis duration, age, vascular stiffness parameters, AGE, RI, and clinical attachment loss (CAL). Regression modeling indicated that IMT in kidney transplant recipients was associated with higher vascular stiffness, malnutrition, and a lower number of teeth. Kidney transplant recipients with IMT ≥ 0.9 mm had less number of teeth i higher value of CAL. These parodontal paramete have proven to be the most important predictors of IMT in KTR. The analysis included a subset of 59 transplant patients (28 postmenopausal women and 31 men), further categorized based on adropin values relative to the average within each group. Univariate regression analysis revealed a negative association between adropin levels and most anthropometric and body composition parameters in male transplant patients. In contrast, serum adropin levels were negatively associated only with phase angle in female patients. Multivariate regression analysis showed that skeletal muscle mass and phase angle were the only negative predictors in the female group, while in men, body mass index (BMI) and body water percentage were negative predictors. CONCLUSION: Our findings suggest that nutritional and periodontal status are associated with higher IMT values in kidney transplant patients. These findings suggest that adropin may have a sex-specific impact on metabolic homeostasis in kidney transplant patients and may be considered a negative predictor of body composition within this patient group. The primary strength of this study on kidney transplant recipients lies in being the first to analyze the association between periodontal and nutritional parameters and inflammatory mediators like adropin with intima-media thickness as a marker of subclinical atherosclerosis and CV risk.