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In September 2020, the Japanese Society of Nephrology published recommendations for the appropriate use of HIF-PH inhibitors, which emphasized monitoring iron indices. However, real-world adherence to these recommendations remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrieved the data of new users of erythropoietin-stimulating agents (ESAs) or HIF-PH inhibitors from a large Japanese claims database (DeSC, Tokyo, Japan) between 2018 and 2022. Adherence to iron testing before and after the treatments was analyzed using modified Poisson regression and Cox models. Facility-level variations were assessed via mixed-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 105,346 patients who had a new prescription of ESAs (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200986,263) or HIF-PH inhibitors (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200919,083) and did not have kidney failure with replacement therapy. The proportion of HIF-PH inhibitor use increased from 3.6% in 2020 to 42.7% in 2022. During the study period, testing frequency for serum iron, serum TIBC or UIBC, and ferritin ranged from 57.2\u201359.8%, 39.2\u201342.8%, and 50.6\u201352.6%, respectively. Multivariate analysis showed that adherence to testing was significantly higher in university hospitals, Diagnosis Procedure Combination-affiliated DPC hospitals, and non-DPC hospitals compared with clinics. A similar tendency was observed in testing after the index date.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The type of facility was the primary determinant of adherence to the recommendation for iron indices testing before the initiation of ESAs or HIF-PH inhibitors. Targeted educational interventions in low-adherence settings may help improve adherence rates and optimize patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10157-025-02761-1","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T08:13:56Z","timestamp":1758010436000},"page":"57-64","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Adherence to monitoring iron indices at the initiation of erythropoiesis-stimulating agents or hypoxia-inducible factor prolyl hydroxylase inhibitors"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2852-2946","authenticated-orcid":false,"given":"Yoshihisa","family":"Miyamoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Okada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Sasabuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaomi","family":"Nangaku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Yasunaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"2761_CR1","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1093\/ckj\/sfac240","volume":"16","author":"CP Kovesdy","year":"2023","unstructured":"Kovesdy CP, Davis JR, Duling I, Little DJ. 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