Clinical and Experimental Nephrology最新文献

{"title":"Gallstones and acute cholecystitis in CKD and dialysis: an underrecognized biliary burden in nephrology.","authors":"Yoshitaka Furuto, Daiki Yoshino, Akio Namikawa, Dai Sato, Yuko Shibuya","doi":"10.1007/s10157-026-02933-7","DOIUrl":"https://doi.org/10.1007/s10157-026-02933-7","url":null,"abstract":"<p><p>Gallstones and acute cholecystitis are not usually regarded as core nephrology problems, yet accumulating observational evidence suggests that their burden is increased in chronic kidney disease (CKD), particularly in advanced predialysis CKD and end-stage kidney disease (ESKD). Plausible contributors include impaired gallbladder motility related to uremia-associated autonomic dysfunction, shared metabolic risk clustering, and, in selected patients, hemodynamic vulnerability related to intradialytic hypotension or low-output states. The central clinical issue may be underrecognition. In CKD and dialysis, abdominal complaints are often nonspecific and may overlap with uremic or intercurrent illness-related symptoms. In addition, uncomplicated acute cholecystitis may present early with absent or only mild hepatobiliary enzyme abnormalities, whereas marked bilirubin elevation or a cholestatic pattern should prompt evaluation for choledocholithiasis or cholangitis. Ceftriaxone-associated pseudolithiasis and glucagon-like peptide-1 receptor agonist exposure may further complicate the diagnostic picture. Although evidence linking CKD itself to primary acute cholangitis is less robust than that linking CKD to gallstones and acute cholecystitis, biliary obstruction and endoscopic intervention remain relevant because advanced CKD and ESKD may increase procedure-related morbidity. Emerging data also caution against reflexive therapeutic nihilism: source control should not be deferred solely because a patient has advanced CKD or dialysis dependence, and gallbladder drainage may serve as a planned bridge or alternative in selected high-risk patients. This focused review summarizes the epidemiologic links, plausible mechanisms, diagnostic pitfalls, and practical management implications of gallstones and acute cholecystitis in CKD and dialysis, and highlights why biliary disease should be recognized as an underappreciated comorbidity in nephrology care.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of prior Angiotensin receptor-neprilysin inhibitor use with the initial eGFR dip after initiation of SGLT2 inhibitors in patients with chronic kidney disease.","authors":"Yusuke Ushio, Hiroshi Kataoka, Rina Takahashi, Momoko Seki, Anna Nakai, Hitoko Sumori, Shizuka Kobayashi, Shiho Makabe, Shun Manabe, Ken Tsuchiya, Kosaku Nitta, Junichi Hoshino","doi":"10.1007/s10157-026-02928-4","DOIUrl":"https://doi.org/10.1007/s10157-026-02928-4","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal protection; however, a transient decline in estimated glomerular filtration rate (eGFR), known as the ''initial dip'', is frequently observed after initiation. Although this phenomenon reflects changes in intraglomerular hemodynamics, excessive decline may be associated with worsening renal function. Angiotensin receptor-neprilysin inhibitors (ARNIs) have demonstrated renal protective effects in heart failure, but their impact on the initial dip after SGLT2 inhibitor initiation remains unclear.</p><p><strong>Methods: </strong>We retrospectively evaluated the effect of prior ARNI use on the initial dip following SGLT2 inhibitor initiation in 157 patients with chronic kidney disease who newly started SGLT2 inhibitors between 2022 and 2025. Patients were classified into an ARNI group and an angiotensin receptor blocker (ARB) group. The primary outcome was the incidence of an initial dip, defined as a ≥ 5% decline in eGFR after SGLT2 inhibitor initiation. The secondary outcome was the change in eGFR and urine protein excretion at 1 year.</p><p><strong>Results: </strong>The incidence of the initial dip did not significantly differ between the ARNI and ARB groups (30.0% vs. 46.5%, p = 0.10). However, multivariate logistic regression analysis showed that prior ARNI use was independently associated with a lower risk of initial dip (odds ratio 0.30, 95% CI 0.10-0.89, p = 0.02). Prior ARNI use was not significantly associated with longitudinal eGFR and urine protein changes at 1 year.</p><p><strong>Conclusions: </strong>Prior ARNI use was associated with a lower risk of the initial eGFR dip following SGLT2 inhibitor initiation, although prospective studies are needed to confirm these findings.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"Association of osteoporosis treatment with risk of fracture, cardiovascular disease, and all-cause mortality in patients on maintenance dialysis: a retrospective database study using real-world data in Japan\".","authors":"Baneen Javaid Arain, Jazbia, Eiman Fatima, Umema Nadeem","doi":"10.1007/s10157-026-02911-z","DOIUrl":"10.1007/s10157-026-02911-z","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1255-1256"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of multidisciplinary care for patients with chronic kidney disease in Japan.","authors":"Hiromu Tomishima, Motoki Odawara, Tsuguru Hatta, Yoshihiko Imamura, Tsutomu Sakurada, Takashi Maruyama, Masanori Abe, Shinya Kaname, Masaomi Nangaku, Hiroshi Nishi","doi":"10.1007/s10157-026-02883-0","DOIUrl":"10.1007/s10157-026-02883-0","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary care (MDC), where a team of various health professionals provides guidance to patients, is an effective approach for chronic kidney disease (CKD) and has been reimbursed by Japanese public healthcare insurance in 2024. To sustainably achieve medical benefits with limited resources, we examined the cost-effectiveness of MDC in Japan.</p><p><strong>Methods: </strong>A Markov model from a healthcare system perspective was used to evaluate the cost-effectiveness of adding MDC to the standard treatment for CKD in Japan over lifetime. Each cohort with an initial CKD stage (G3a, G3b, and G4) was analyzed. The parameters were based on previous studies including Chronic Kidney Disease Japan Cohort study. An incremental cost-effectiveness ratio (ICER) of < 5,000,000 Japanese yen (JPY) per quality-adjusted life-year (QALY) was considered cost-effective. One-way deterministic analyses, probabilistic sensitivity analyses, and scenario analyses were conducted to ensure the robustness of the results.</p><p><strong>Results: </strong>Adding MDC to the standard treatment for CKD decreased cost by 10.66 million, 8.42 million, 4.21 million JPY and increased utility by 9.52, 8.70, 7.17 QALYs in CKD G3a, G3b, and G4 cohort, respectively, suggesting that it was a dominant strategy. Sensitivity analyses showed that adding MDC was cost-effective in more than 99% of cases in all cohorts with an ICER threshold of 5,000,000 JPY. Scenario analyses, where smaller therapeutic effects of MDC were estimated, showed compatible results.</p><p><strong>Conclusion: </strong>Based on our model, adding MDC to the standard treatment for CKD stages G3a, G3b, and G4, is highly likely to be a cost-effective strategy in Japanese healthcare system.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1185-1195"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide questionnaire survey on collaboration for the management of chronic kidney disease from the perspective of referrals in Japan.","authors":"Tsuguru Hatta, Kazuo Kobayashi, Satoru Tatematsu, Taisuke Isozaki, Yosuke Nakayama, Junko Imura, Toshimasa Takahashi, Munehiro Kitada, Yasunori Utsunomiya","doi":"10.1007/s10157-026-02878-x","DOIUrl":"10.1007/s10157-026-02878-x","url":null,"abstract":"<p><strong>Background: </strong>Preventing end-stage renal failure progression of patients with chronic kidney disease (CKD) requires collaboration between nephrologists and general practitioners. Following the 2013 and 2019 surveys in Japan, a nationwide survey was conducted in 2024 to clarify collaborations for CKD management.</p><p><strong>Methods: </strong>An anonymous survey comprising CKD collaboration-related questions was conducted in 2024 among Japan Physicians Association members. In addition to comparing the results with past survey findings, responses were compared between those who refer and referral recipients.</p><p><strong>Results: </strong>Overall, 1,003 valid responses were obtained. Compared with previous surveys, the 2024 survey revealed a higher number of nephrologists with whom patients could consult (p < 0.001); however, the prevalence of respondents who answered that CKD collaboration was adequately active did not increase. The proportion of respondents who often used the CKD consultation referral criteria was lower in the 2024 survey than in the 2019 survey (p < 0.001). Furthermore, there were discrepancies in the estimated glomerular filtration rate and proteinuria at referral between respondents who referred and referral recipients (p < 0.001). Satisfaction regarding CKD referrals had not improved over the past decade, and the most frequent dissatisfaction causes among respondents who refer and referral recipients were no change in CKD treatment and late referrals, respectively. Many respondents answered that salt reduction guidance and management of blood pressure and glycemic control should be provided by general practitioners.</p><p><strong>Conclusion: </strong>Regional CKD management-related collaboration has not necessarily progressed, and there are discrepancies in CKD management between nephrologists and general practitioners.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1208-1217"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Season-adaptive blood pressure management in older adults with CKD: a practical review.","authors":"Yoshitaka Furuto, Daiki Yoshino, Iori Ejima, Sayako Ikeda, Akio Namikawa, Dai Sato, Yuko Shibuya","doi":"10.1007/s10157-026-02890-1","DOIUrl":"10.1007/s10157-026-02890-1","url":null,"abstract":"<p><p>Blood pressure management in chronic kidney disease (CKD) is often approached as a relatively stable, year-round therapeutic task. In older adults, however, this assumption may be misleading. During warm weather, seasonal declines in blood pressure may interact with frailty, impaired thirst response, orthostatic vulnerability, reduced renal autoregulatory reserve, reduced intake, and fixed-dose antihypertensive prescribing, thereby increasing the risk of symptomatic hypotension, falls, volume depletion, hypoperfusion-related acute kidney injury (AKI), and interruption of organ-protective therapy. Despite this vulnerability, antihypertensive therapy may remain insufficiently reassessed across seasons, with limited attention to dynamic changes in home blood pressure, body weight, symptoms, and kidney function. In this practical review, we examine the clinical rationale for season-adaptive blood pressure management in older adults with CKD. We discuss why this population is particularly susceptible to seasonal over-lowering of blood pressure and kidney hypoperfusion, how this vulnerability may differ across CKD phenotypes, and why fixed prescribing may become maladaptive in routine care. We summarize pragmatic indicators of emerging risk, including home blood pressure trends, diurnal blood pressure patterns when relevant, body weight assessment at each clinic visit, body weight trajectory over time, orthostatic symptoms and blood pressure changes, and serial serum creatinine and estimated glomerular filtration rate measurements. We also address the supportive but limited role of urinary markers such as urinary albumin-creatinine ratio and spot urinary sodium indices. A season-adaptive approach may help reduce avoidable hypotension and hypoperfusion-related AKI while supporting the safer and more sustainable use of organ-protective therapy in older adults with CKD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1150-1157"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathological diagnosis and differential considerations of renal diseases with organized deposits under an electron microscope: key points in diagnosis.","authors":"Akiko Mii, Yoshihiro Yamamoto, Arimi Ishikawa, Akira Shimizu","doi":"10.1007/s10157-026-02892-z","DOIUrl":"10.1007/s10157-026-02892-z","url":null,"abstract":"<p><p>Electron microscopy is crucial for detecting ultrastructural changes that are undetectable by conventional histology. A key application is the identification of organized electron-dense deposits with distinct morphologies, such as fibrillar, microtubular, lamellar, or crystalline forms. These structures, occasionally observed in renal biopsy specimens, provide important diagnostic clues and are often associated with monoclonal immunoglobulin-related or matrix-derived materials. Renal diseases with organized deposits encompass a broad and heterogeneous spectrum of conditions, including amyloidosis, fibrillary glomerulonephritis, immunotactoid glomerulopathy, cryoglobulinemic glomerulonephritis, crystalline nephropathies, and hereditary matrix-associated conditions. The clinical importance of detecting these deposits is highlighted by the emergence of monoclonal gammopathy of renal significance, even in patients with a low clonal burden. Careful differentiation from mimickers, such as non-specific matrix changes, fibrin tactoids, spheroids, and artifacts, is essential to avoid misdiagnosis. Diagnostic precision requires a multidisciplinary approach incorporating light microscopy, immunofluorescence, special stains such as Congo red, and advanced molecular tools, including mass spectrometry. The discovery of disease-specific markers, such as the DnaJ Heat Shock Protein Family Member B9, has greatly improved the diagnostic accuracy of fibrillary glomerulonephritis. Identifying organized deposits can prompt additional clinical evaluations, including hematologic workups, and help guide management. In conclusion, organized deposits provide key diagnostic insights and reflect a diverse spectrum of underlying pathologies. Owing to their structural complexity, careful ultrastructural assessments are essential for accurate diagnosis. Advances in proteomic and genomic methods will refine disease classification and support the development of targeted therapies. Continued interdisciplinary collaboration is crucial for optimizing care for complex renal disorders.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1158-1168"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-density lipoprotein cholesterol and cognitive function in patients undergoing hemodialysis.","authors":"Kazuhiko Kato, Akio Nakashima, Chiharu Aizawa, Arisa Kobayashi, Shunichiro Shinagawa, Ichiro Ohkido, Mitsuyoshi Urashima, Takashi Yokoo","doi":"10.1007/s10157-026-02879-w","DOIUrl":"10.1007/s10157-026-02879-w","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is highly prevalent among older adults receiving maintenance hemodialysis; however, its pathophysiology is multifactorial and poorly understood. Evidence linking the lipid-profile components to cognitive function in patients undergoing hemodialysis remains limited. To address this evidence gap, we evaluated the associations between serum lipid-profile components and global cognitive function.</p><p><strong>Methods: </strong>We conducted an exploratory cross-sectional study of patients aged ≥ 65 years receiving maintenance hemodialysis at seven dialysis centers in Japan. Serum high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels were measured immediately before the first hemodialysis session of the week. Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). Multivariate linear regression analyses were performed, adjusting for clinical comorbidities and markers of nutritional status, inflammation, and dialysis adequacy.</p><p><strong>Results: </strong>Among 265 participants (median age, 74 years; 67.6% male), higher serum HDL-C levels were independently associated with higher MoCA scores (fully adjusted model: β = 0.06; 95% confidence interval, 0.03-0.10; P < 0.001) and MMSE scores (β = 0.03; 95% confidence interval, 0.01-0.06; P = 0.031). In contrast, the serum LDL-C and TG levels showed no significant associations with either cognitive assessment.</p><p><strong>Conclusion: </strong>Higher serum HDL-C levels were associated with better global cognitive function in older patients undergoing hemodialysis, whereas the LDL-C and TG levels were not significantly related to cognitive scores.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1237-1244"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148027716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cell based therapy in chronic kidney disease: emerging evidence for a fifth pillar in guideline directed medical therapy.","authors":"Gerry George Mathew","doi":"10.1007/s10157-026-02891-0","DOIUrl":"10.1007/s10157-026-02891-0","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) affects over 800 million individuals globally and is a primary aetiology of premature cardiovascular mortality. Despite advancements in pharmacological therapies, these strategies remain incapable of regenerating nephrons lost due to fibrosis, ischemia, or immunological damage. Renal autologous cell therapy, which includes renal tubular epithelial cells, mesenchymal stromal cells, renal progenitor cells, urine-derived stem cells, endothelial progenitor cells, and induced pluripotent stem cell-derived nephron progenitors, signifies a transformative approach towards authentic nephron rescue and regeneration. Preclinical studies and early clinical trials evaluating selected renal cells (SRCs), including rilparencel (REACT®), suggest that autologous renal cell therapy may stabilize estimated glomerular filtration rate (eGFR) decline in diabetic kidney disease and other forms of CKD. This review consolidates the mechanistic foundations, emerging clinical trial data, and translational challenges associated with each principal autologous cell platform utilized in CKD. It critically evaluates the advantages, such as immunological compatibility, paracrine trophic effects, and utility in disease modelling, alongside significant drawbacks, including senescent cell dysfunction, scalability limitations, and regulatory complexities. Furthermore, a procurement pathway -to-in-clinic framework that incorporates bioengineered scaffolds, extracellular vesicle derivatives, CRISPR-corrected iPSC lines, and kidney-on-a-chip validation systems is discussed in this review, collectively delineating the applicability of regenerative medicine in nephrology.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1141-1149"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erythropoiesis-stimulating agent resistance is associated with diabetic kidney disease but not with diabetes: a post hoc analysis of the BRIGHTEN study.","authors":"Ryousuke Aoki, Keiichi Matsuzaki, Hitoshi Suzuki, Tatsuo Kagimura, Tadashi Sofue, Takashi Wada, Ichiei Narita, Yusuke Suzuki","doi":"10.1007/s10157-026-02881-2","DOIUrl":"10.1007/s10157-026-02881-2","url":null,"abstract":"<p><strong>Background: </strong>Erythropoiesis-stimulating agent (ESA) resistance in chronic kidney disease (CKD) is influenced by various factors, including diabetes. Although diabetes has been linked to ESA resistance, the BRIGHTEN study in Japan found no direct correlation. This study aimed to identify factors contributing to ESA resistance in patients with diabetes by analyzing the diabetic kidney disease (DKD) status and CKD stage.</p><p><strong>Methods: </strong>A post hoc analysis was conducted using data from the BRIGHTEN study, a multicenter prospective observational trial investigating ESA resistance in patients with non-dialysis-dependent CKD. Patients were categorized based on diabetes status (DM vs. non-DM) and further stratified by CKD stage and presence of DKD. ESA resistance was assessed using the erythropoietin resistance index.</p><p><strong>Results: </strong>No significant differences in ESA resistance were observed between the DM and non-DM groups. However, among patients with diabetes, those with DKD exhibited higher ESA resistance and required higher darbepoetin alfa (DA) dosages than did those with non-DKD nephropathy (NDKD-DM). ESA resistance and DA dosage increased with CKD progression, with notable differences in CKD stage G4 between the DKD and NDKD-DM groups.</p><p><strong>Conclusion: </strong>Although diabetes alone was not associated with ESA resistance, patients with DKD exhibited higher resistance, suggesting that ESA resistance is more closely linked to DKD than to diabetes itself. These findings highlight the role of proteinuria and inflammation in the ESA response, emphasizing the need for individualized anemia management strategies based on nephropathy type.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1196-1207"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}