{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T15:53:10Z","timestamp":1767973990996,"version":"3.49.0"},"reference-count":54,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Oral molecularly targeted cancer medications are widely used. Product labels describe an increase in serum creatinine (sCr), potentially due to reversible inhibition of tubular creatinine secretion rather than acute kidney injury.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the 2-year incidence and relative rates of progressive kidney dysfunction in patients treated with molecularly targeted cancer medications associated with an acute change in sCr handling (pseudoacute kidney injury).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Retrospective cohort study of adult patients throughout the San Francisco Bay area treated at Stanford Hospital and clinics since 2008 receiving cyclin dependent kinase 4 or 6 (CDK4\/6) inhibitors, poly(adenosine diphosphate-ribose) polymerase inhibitors, and specific drugs within tyrosine kinases inhibitor subgroups with an available estimated glomerular filtration rate (eGFR) from days 1 to 60 after drug start compared with propensity score\u2013matched patients without cancer.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Molecularly targeted cancer medications associated with an acute change in sCr.<\/jats:p>\n <\/jats:sec>\n \n Main outcomes and measures<\/jats:title>\n Progressive kidney dysfunction defined as a sustained 30% or more decline in eGFR or reaching end-stage kidney disease, accounting for a potentially reversible rise in sCr at drug start by defining baseline eGFR as the mean value from days 1 to 60 after drug start.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 5015 patients in the treated cohort, the median (IQR) age was 62 (51-72) years, 3264 (65%) were female, and the mean (SD) baseline eGFR before drug start was 87 (23) mL\/min\/1.73m\n 2<\/jats:sup>\n . Using cox proportional hazards regression models, the overall incidence and rate of progressive kidney dysfunction was higher in the treated cohort than in propensity-matched cohorts of patients without cancer (44 vs 38 per 1000 person-years; hazard ratio [HR], 1.4; 95% CI, 1.2-1.6). Rates of kidney dysfunction were higher among patients treated with CDK4\/6 inhibitors (HR, 1.9; 95% CI, 1.4-2.6), epidermal growth factor receptor inhibitors (HR, 1.8; 95% CI, 1.2-2.5), vascular endothelial growth factor receptor inhibitors (HR, 2.1; 95% CI, 1.6-2.7), and B-Raf inhibitors (HR, 1.9; 95% CI, 1.1-3.3) compared with controls. These higher rates persisted in patients without a 20% or more increase in sCr at drug start and without exposure to chemotherapy or immunotherapy.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and relevance<\/jats:title>\n In this cohort study of patients treated with molecularly targeted anticancer medications associated with an acute rise in sCr, we observed higher incidence and relative rate for kidney dysfunction among treated patients, compared with matched cancer-free patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.41221","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T16:31:06Z","timestamp":1762446666000},"page":"e2541221","source":"Crossref","is-referenced-by-count":2,"title":["Molecularly Targeted Cancer Medications and Kidney Health"],"prefix":"10.1001","volume":"8","author":[{"given":"Susan","family":"Ziolkowski","sequence":"first","affiliation":[{"name":"Department of Medicine, Nephrology, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutong","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Morgan-Cooper","sequence":"additional","affiliation":[{"name":"Stanford Healthcare, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Wakelee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Oncology, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Khaki","sequence":"additional","affiliation":[{"name":"Department of Medicine, Oncology, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fauzia","family":"Riaz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Oncology, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Medicine, Oncology, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuchi","family":"Anand","sequence":"additional","affiliation":[{"name":"Department of Medicine, Nephrology, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"issue":"1","key":"zoi251128r1","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.ekir.2016.09.055","article-title":"Adverse renal effects of novel molecular oncologic targeted therapies: a narrative review.","volume":"2","author":"Jhaveri","year":"2016","journal-title":"Kidney Int Rep"},{"issue":"5","key":"zoi251128r2","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1002\/cpt.1296","article-title":"Abemaciclib inhibits renal tubular secretion without changing glomerular filtration rate.","volume":"105","author":"Chappell","year":"2019","journal-title":"Clin Pharmacol Ther"},{"issue":"7","key":"zoi251128r3","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1093\/jnci\/djad070","article-title":"Kidney function in patients with ovarian cancer treated with poly (ADP-ribose) polymerase (PARP) inhibitors.","volume":"115","author":"Gupta","year":"2023","journal-title":"J Natl Cancer Inst"},{"issue":"1","key":"zoi251128r4","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1136\/ijgc-2019-000714","article-title":"Discrepancy in calculated and measured glomerular filtration rates in patients treated with PARP inhibitors.","volume":"30","author":"Zibetti Dal Molin","year":"2020","journal-title":"Int J Gynecol Cancer"},{"issue":"1","key":"zoi251128r5","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1038\/s41523-023-00576-5","article-title":"Adverse kidney outcomes of CDK4\/6 inhibitors for metastatic breast cancer.","volume":"9","author":"Hanna","year":"2023","journal-title":"NPJ Breast Cancer"},{"issue":"6","key":"zoi251128r7","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1016\/j.jtho.2019.02.015","article-title":"Renal effects of crizotinib in patients with ALK-positive advanced NSCLC.","volume":"14","author":"Camidge","year":"2019","journal-title":"J Thorac Oncol"},{"issue":"10","key":"zoi251128r8","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1080\/00498254.2016.1241449","article-title":"In vitro assessment of the roles of drug transporters in the disposition and drug-drug interaction potential of olaparib.","volume":"47","author":"McCormick","year":"2017","journal-title":"Xenobiotica"},{"issue":"12","key":"zoi251128r9","doi-asserted-by":"publisher","first-page":"4426","DOI":"10.1002\/jps.23737","article-title":"Prediction of clinical drug-drug interactions of veliparib (ABT-888) with human renal transporters (OAT1, OAT3, OCT2, MATE1, and MATE2K).","volume":"102","author":"Kikuchi","year":"2013","journal-title":"J Pharm Sci"},{"issue":"9","key":"zoi251128r10","doi-asserted-by":"publisher","first-page":"2899","DOI":"10.1016\/j.xphs.2017.03.013","article-title":"Inhibitory effect of crizotinib on creatinine uptake by renal secretory transporter OCT2.","volume":"106","author":"Arakawa","year":"2017","journal-title":"J Pharm Sci"},{"issue":"1","key":"zoi251128r11","doi-asserted-by":"publisher","first-page":"9237","DOI":"10.1038\/s41598-018-27672-y","article-title":"Effect of tyrosine kinase inhibitors on renal handling of creatinine by MATE1.","volume":"8","author":"Omote","year":"2018","journal-title":"Sci Rep"},{"issue":"1","key":"zoi251128r12","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1111\/j.1365-2125.1981.tb01853.x","article-title":"Effect of cimetidine on renal function in man.","volume":"12","author":"Dutt","year":"1981","journal-title":"Br J Clin Pharmacol"},{"issue":"1-2","key":"zoi251128r13","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/j.0954-6820.1980.tb01145.x","article-title":"The effects of cimetidine (Tagamet) on renal function in patients with renal failure.","volume":"208","author":"Larsson","year":"1980","journal-title":"Acta Med Scand"},{"issue":"3","key":"zoi251128r14","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/j.ekir.2021.11.033","article-title":"Clinicopathologic features of acute kidney injury associated with CDK4\/6 inhibitors.","volume":"7","author":"Gupta","year":"2021","journal-title":"Kidney Int Rep"},{"issue":"6","key":"zoi251128r15","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1016\/j.ekir.2018.07.005","article-title":"Case of proteinuria, worsening hypertension, and glomerular endotheliosis with erlotinib and gefitinib.","volume":"3","author":"Latcha","year":"2018","journal-title":"Kidney Int Rep"},{"issue":"12","key":"zoi251128r16","doi-asserted-by":"publisher","first-page":"2504","DOI":"10.1200\/JCO.2004.09.064","article-title":"Side effects of therapy: case 1. Nephrotic syndrome associated with gefitinib therapy.","volume":"22","author":"Kumasaka","year":"2004","journal-title":"J Clin Oncol"},{"issue":"7","key":"zoi251128r17","doi-asserted-by":"publisher","first-page":"823","DOI":"10.2169\/internalmedicine.54.3661","article-title":"Minimal change nephrotic syndrome associated with gefitinib and a successful switch to erlotinib.","volume":"54","author":"Maruyama","year":"2015","journal-title":"Intern Med"},{"issue":"1","key":"zoi251128r18","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1186\/s13256-018-1849-y","article-title":"Alectinib (Alecensa)-induced reversible grade IV nephrotoxicity: a case report and review of the literature.","volume":"12","author":"Ramachandran","year":"2018","journal-title":"J Med Case Rep"},{"issue":"2","key":"zoi251128r19","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/j.lungcan.2013.08.007","article-title":"Acute kidney injury following crizotinib administration for non-small-cell lung carcinoma.","volume":"82","author":"Gastaud","year":"2013","journal-title":"Lung Cancer"},{"issue":"10","key":"zoi251128r20","doi-asserted-by":"publisher","first-page":"S1090","DOI":"10.1016\/j.jtho.2021.08.480","article-title":"Renal function change during alectinib in ALK rearranged non-small cell lung cancer: a retrospective multicentre analysis.","volume":"16","author":"Pignataro","year":"2021","journal-title":"J Thorac Oncol"},{"key":"zoi251128r21","doi-asserted-by":"crossref","DOI":"10.1200\/JCO.2018.36.15_suppl.e21026","article-title":"Abstract: Rapid drop in blood platelet count and increase in creatinine in non-small cell lung cancer (NSCLC) patients treated with osimertinib.","author":"Eide","year":"2018","journal-title":"J Clin Oncol"},{"issue":"10","key":"zoi251128r22","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1056\/NEJMoa1609324","article-title":"Long-term outcomes of imatinib treatment for chronic myeloid leukemia.","volume":"376","author":"Hochhaus","year":"2017","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi251128r23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0149873","article-title":"Mechanisms underpinning increased plasma creatinine levels in patients receiving vemurafenib for advanced melanoma.","volume":"11","author":"Hurabielle","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"zoi251128r24","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1053\/j.ajkd.2013.07.008","article-title":"Reduced estimated GFR and cancer mortality.","volume":"63","author":"Iff","year":"2014","journal-title":"Am J Kidney Dis"},{"issue":"6","key":"zoi251128r25","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1053\/j.ajkd.2014.07.030","article-title":"GFR decline as an end point for clinical trials in CKD: a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration.","volume":"64","author":"Levey","year":"2014","journal-title":"Am J Kidney Dis"},{"issue":"4","key":"zoi251128r26","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"zoi251128r27","doi-asserted-by":"publisher","first-page":"574","DOI":"10.3233\/978-1-61499-564-7-574","article-title":"Observational Health Data Sciences and Informatics (OHDSI): opportunities for observational researchers.","volume":"216","author":"Hripcsak","year":"2015","journal-title":"Stud Health Technol Inform"},{"issue":"19","key":"zoi251128r29","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C-based equations to estimate GFR without race.","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"issue":"1","key":"zoi251128r31","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1159\/000172836","article-title":"Inhibition of renal creatinine secretion by cimetidine in humans.","volume":"5","author":"Burgess","year":"1982","journal-title":"Ren Physiol"},{"issue":"5","key":"zoi251128r32","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1177\/106002809302700518","article-title":"Drug-induced alterations in serum creatinine concentrations.","volume":"27","author":"Ducharme","year":"1993","journal-title":"Ann Pharmacother"},{"issue":"24","key":"zoi251128r33","doi-asserted-by":"publisher","first-page":"2518","DOI":"10.1001\/jama.2014.6634","article-title":"Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality.","volume":"311","author":"Coresh","year":"2014","journal-title":"JAMA"},{"issue":"1","key":"zoi251128r34","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1055\/s-0040-1722220","article-title":"Validating the matching of patients in the linkage of a large hospital system\u2019s EHR with state and national death databases.","volume":"12","author":"Conway","year":"2021","journal-title":"Appl Clin Inform"},{"issue":"446","key":"zoi251128r35","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk.","volume":"94","author":"Fine","year":"1999","journal-title":"J Am Stat Assoc"},{"issue":"6","key":"zoi251128r36","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1161\/CIRCULATIONAHA.115.017719","article-title":"Introduction to the analysis of survival data in the presence of competing risks.","volume":"133","author":"Austin","year":"2016","journal-title":"Circulation"},{"issue":"12","key":"zoi251128r37","doi-asserted-by":"publisher","first-page":"2004","DOI":"10.3390\/pharmaceutics13122004","article-title":"In vitro and in vivo inhibition of MATE1 by tyrosine kinase inhibitors.","volume":"13","author":"Uddin","year":"2021","journal-title":"Pharmaceutics"},{"issue":"1","key":"zoi251128r38","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.ekir.2016.04.005","article-title":"Renal stress testing in the assessment of kidney disease.","volume":"1","author":"Chawla","year":"2016","journal-title":"Kidney Int Rep"},{"issue":"1-4","key":"zoi251128r39","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1159\/000363721","article-title":"Renal functional reserve and renal recovery after acute kidney injury.","volume":"127","author":"Sharma","year":"2014","journal-title":"Nephron Clin Pract"},{"issue":"4","key":"zoi251128r40","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1016\/j.athoracsur.2017.12.034","article-title":"Preoperative renal functional reserve predicts risk of acute kidney injury after cardiac operation.","volume":"105","author":"Husain-Syed","year":"2018","journal-title":"Ann Thorac Surg"},{"issue":"8","key":"zoi251128r41","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.2215\/CJN.0000000000000508","article-title":"Assessment of GFR in patients with cancer: a statement from the American Society of Onco-Nephrology.","volume":"19","author":"Kitchlu","year":"2024","journal-title":"Clin J Am Soc Nephrol"},{"issue":"4S","key":"zoi251128r42","doi-asserted-by":"publisher","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease.","volume":"105","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group","year":"2024","journal-title":"Kidney Int"},{"issue":"1","key":"zoi251128r43","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/s12882-023-03300-4","article-title":"Kidney function decline associated with proton pump inhibitors: results from the ELSA-Brasil cohort.","volume":"24","author":"Dos Santos","year":"2023","journal-title":"BMC Nephrol"},{"issue":"4","key":"zoi251128r44","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1053\/j.ajkd.2019.07.012","article-title":"Proton pump inhibitors and the kidney: implications of current evidence for clinical practice and when and how to deprescribe.","volume":"75","author":"Al-Aly","year":"2020","journal-title":"Am J Kidney Dis"},{"issue":"6","key":"zoi251128r45","doi-asserted-by":"publisher","first-page":"2003","DOI":"10.1111\/j.1523-1755.2004.00621.x","article-title":"The role of vascular endothelial growth factor (VEGF) in renal pathophysiology.","volume":"65","author":"Schrijvers","year":"2004","journal-title":"Kidney Int"},{"issue":"11","key":"zoi251128r46","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1056\/NEJMoa0707330","article-title":"VEGF inhibition and renal thrombotic microangiopathy.","volume":"358","author":"Eremina","year":"2008","journal-title":"N Engl J Med"},{"issue":"8","key":"zoi251128r47","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1681\/ASN.2010020167","article-title":"Bevacizumab increases risk for severe proteinuria in cancer patients.","volume":"21","author":"Wu","year":"2010","journal-title":"J Am Soc Nephrol"},{"issue":"1","key":"zoi251128r48","doi-asserted-by":"publisher","first-page":"340","DOI":"10.3390\/ijms25010340","article-title":"Administration of bevacizumab and the risk of chronic kidney disease development in Taiwan residents: a population-based retrospective cohort study.","volume":"25","author":"Lye","year":"2023","journal-title":"Int J Mol Sci"},{"issue":"6","key":"zoi251128r49","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1053\/j.ajkd.2013.01.008","article-title":"Diffuse proliferative glomerulonephritis associated with cetuximab, an epidermal growth factor receptor inhibitor.","volume":"61","author":"Sasaki","year":"2013","journal-title":"Am J Kidney Dis"},{"issue":"2","key":"zoi251128r50","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1053\/j.ajkd.2016.09.011","article-title":"Panitumumab-induced immune complex glomerulonephritis.","volume":"69","author":"Izzedine","year":"2017","journal-title":"Am J Kidney Dis"},{"issue":"5","key":"zoi251128r51","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1007\/s10157-008-0066-1","article-title":"Tubulointerstitial nephritis and IgA nephropathy in a patient with advanced lung cancer treated with long-term gefitinib.","volume":"12","author":"Masutani","year":"2008","journal-title":"Clin Exp Nephrol"},{"issue":"6","key":"zoi251128r52","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1093\/ndtplus\/sfp134","article-title":"Crescentic glomerulonephritis in a patient with advanced lung cancer during erlotinib therapy.","volume":"2","author":"Kurita","year":"2009","journal-title":"NDT Plus"},{"issue":"1","key":"zoi251128r53","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1038\/sj.cr.7290105","article-title":"MAPK signal pathways in the regulation of cell proliferation in mammalian cells.","volume":"12","author":"Zhang","year":"2002","journal-title":"Cell Res"},{"issue":"14","key":"zoi251128r54","doi-asserted-by":"publisher","first-page":"2158","DOI":"10.1002\/cncr.28709","article-title":"Acute renal failure associated with the new BRAF inhibitor vemurafenib: a case series of 8 patients.","volume":"120","author":"Launay-Vacher","year":"2014","journal-title":"Cancer"},{"key":"zoi251128r30","volume-title":"Brenner and Rector\u2019s The Kidney","author":"Brenner","year":"2004","edition":"7ed"},{"key":"zoi251128r6","unstructured":"Xalkori (crizotinib) prescribing information]. Pfizer Labs. 2022. Accessed October 9, 2025. https:\/\/labeling.pfizer.com\/showlabeling.aspx?id=676"},{"key":"zoi251128r28","unstructured":"GitHub. ziolkows36\/CKDOMOP. Accessed October 14, 2025. https:\/\/github.com\/ziolkows36\/CKDOMOP"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2841043\/ziolkowski_2025_oi_251128_1764884238.77607.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T16:00:31Z","timestamp":1765296031000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2841043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":54,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.41221","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]}}}