{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:09:34Z","timestamp":1784282974733,"version":"3.55.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Exp Nephrol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10157-026-02881-2","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:14:43Z","timestamp":1779110083000},"page":"1196-1207","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Erythropoiesis-stimulating agent resistance is associated with diabetic kidney disease but not with diabetes: a post hoc analysis of the BRIGHTEN study"],"prefix":"10.1007","volume":"30","author":[{"given":"Ryousuke","family":"Aoki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Matsuzaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1901-2111","authenticated-orcid":false,"given":"Hitoshi","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuo","family":"Kagimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadashi","family":"Sofue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Wada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiei","family":"Narita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"2881_CR1","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1007\/s10157-010-0396-7","volume":"15","author":"T Akizawa","year":"2011","unstructured":"Akizawa T, Makino H, Matsuo S, et al. 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Ltd. (KKC). KKC proposed the concept of this trial and provided information, but did not take any part in collecting, analysing, or interpreting the results. The Translational Research Centre for Medical Innovation, a third-party organization that is independent of the primary investigator\u2019s institution, was contracted to perform the trial and manage the data.\u00a0TW received honoraria, subsidies, and donations from Kyowa Kirin. TS received a grant from Kyowa Kirin, Japan. IN received lecture fees and grants from Kyowa Kirin (KK). Other authors declare no conflicts of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Approval for the study was granted by the Institutional Review Board of Niigata University (No. MH26-004), and Institutional Review Board of Juntendo University Hospital (No. C23-0036) in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants involved in this study.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}