{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T01:10:16Z","timestamp":1780449016115,"version":"3.54.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Alma Mater Studiorum - Universit\u00e0 di Bologna"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Nephrol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic kidney disease (CKD) represents a major global health burden, often diagnosed at advanced stages when treatment is less effective. Albuminuria, assessed by the urine albumin-to-creatinine ratio (uACR), is a key biomarker for CKD detection and risk stratification. Despite guideline recommendations, adherence to uACR testing remains low, limiting early diagnosis and timely referral. The ALLIANCE project aimed to develop a multidisciplinary consensus on optimizing uACR testing and referral pathways for improved CKD management in at-risk populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A modified nominal group technique was used to achieve expert consensus. Seven nephrologists and eight specialists\u00a0in other disciplines\u00a0 (cardiologists, endocrinologists, diabetologists, and a clinical biochemist) participated in structured discussions and ranked statements across three domains: (1) at-risk population definition, (2) barriers to uACR testing, and (3) CKD management and referral. Relevance rankings were analyzed using hierarchical clustering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-seven consensus statements were developed, eight of which were deemed highly relevant. Key recommendations included expanding CKD risk awareness to encompass obesity and family history, enhancing clinician education, and improving coordination between nephrologists and other specialists. Early nephrology referral was emphasized for patients with marked albuminuria, rapid renal decline, or specific risk factors. Integration of digital health tools, including shared electronic health records, was advised to support coordinated care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The ALLIANCE project identified critical gaps in CKD detection and management. Addressing these through clinician education, standardized uACR testing protocols, and multidisciplinary collaboration may improve outcomes and reduce cardiorenal risk. Implementation of these consensus recommendations could facilitate earlier diagnosis and better management of high-risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s40620-025-02371-w","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T17:10:45Z","timestamp":1755709845000},"page":"2067-2075","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Optimizing urine albumin-to-creatinine ratio testing and referral pathways for chronic kidney disease: a nominal group technique consensus study among Italian experts"],"prefix":"10.1093","volume":"38","author":[{"given":"Irene","family":"Capelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"De Benedictis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Di Lenarda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Di Maso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Fabbrini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Galli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Garofalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Maria","family":"Leone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Ida","family":"Maiorino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marita","family":"Marengo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Pasqualetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pesce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Polimeni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Provenzano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo","family":"Ribichini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"2371_CR1","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","volume":"396","author":"GBD 2019 Diseases and Injuries Collaborators","year":"2020","unstructured":"GBD 2019 Diseases and Injuries Collaborators (2020) Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396:1204\u20131222","journal-title":"Lancet"},{"key":"2371_CR2","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/S0140-6736(20)30045-3","volume":"395","author":"GBD Chronic Kidney Disease Collaboration","year":"2020","unstructured":"GBD Chronic Kidney Disease Collaboration (2020) Global, regional, and national burden of chronic kidney disease, 1990\u20132017: a systematic analysis for the Global burden of Disease Study 2017. Lancet 395:709\u2013733. https:\/\/doi.org\/10.1016\/S0140-6736(20)30045-3","journal-title":"Lancet"},{"key":"2371_CR3","first-page":"21","volume":"7","author":"SD Fraser","year":"2016","unstructured":"Fraser SD, Blakeman T (2016) Chronic kidney disease: identification and management in primary care. Pragmat Obs Res 7:21\u201332","journal-title":"Pragmat Obs Res"},{"key":"2371_CR4","unstructured":"KDIGO CKD (2024). https:\/\/kdigo.org\/wp-content\/uploads\/2024\/03\/KDIGO-2024-CKD-Guideline.pdf"},{"key":"2371_CR5","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s12882-024-03466-5","volume":"25","author":"DR Farrell","year":"2024","unstructured":"Farrell DR, Vassalotti JA (2024) Screening, identifying, and treating chronic kidney disease: why, who, when, how, and what? BMC Nephrol 25:34","journal-title":"BMC Nephrol"},{"key":"2371_CR6","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.030131","volume":"13","author":"JI Barzilay","year":"2024","unstructured":"Barzilay JI, Farag YMK, Durthaler J (2024) Albuminuria: an underappreciated risk factor for cardiovascular disease. JAHA J Am Heart Assoc 13:e030131","journal-title":"JAHA J Am Heart Assoc"},{"key":"2371_CR7","doi-asserted-by":"publisher","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","volume":"42","author":"FLJ Visseren","year":"2021","unstructured":"Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, B\u00e4ck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B, ESC National Cardiac Societies, ESC Scientific Document Group (2021) 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 42:3227\u20133337","journal-title":"Eur Heart J"},{"key":"2371_CR8","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1093\/eurheartj\/ehac683","volume":"44","author":"LM Ruilope","year":"2023","unstructured":"Ruilope LM, Ortiz A, Lucia A, Miranda B, Alvarez-Llamas G, Barderas MG et al (2023) Prevention of cardiorenal damage: importance of albuminuria. Eur Heart J 44:1112\u20131123","journal-title":"Eur Heart J"},{"key":"2371_CR9","doi-asserted-by":"publisher","first-page":"1544","DOI":"10.1097\/HJH.0000000000003756","volume":"42","author":"JM Halimi","year":"2024","unstructured":"Halimi JM, Sarafidis P, Azizi M, Bilo G, Burkard T, Bursztyn M, Camafort M, Chapman N, Cottone S, de Backer T, Deinum J, Delmotte P, Dorobantu M, Doumas M, Dusing R, Duly-Bouhanick B, Fauvel JP, Fesler P, Gaciong Z, Gkaliagkousi E, Gordin D, Grassi G, Grassos C, Guerrot D, Huart J, Izzo R, \u00c1guila FJ, J\u00e1rai Z, Kahan T, Kantola I, Koci\u00e1nov\u00e1 E, Limbourg FP, Lopez-Sublet M, Mallamaci F, Manolis A, Marketou M, Mayer G, Mazza A, MacIntyre IM, Mourad JJ, Muiesan ML, Nasr E, Nilsson P, Oliveras A, Ormezzano O, Paix\u00e3o-Dias V, Papadakis I, Papadopoulos D, Perl S, Pol\u00f3nia J, Pontremoli R, Pucci G, Robles NR, Rubin S, Ruilope LM, Rump LC, Saeed S, Sanidas E, Sarzani R, Schmieder R, Silhol F, Sokolovic S, Solbu M, Soucek M, Stergiou G, Sudano I, Tabbalat R, Tengiz I, Triantafyllidi H, Tsioufis K, V\u00e1clav\u00edk J, van der Giet M, Van der Niepen P, Veglio F, Venzin RM, Viigimaa M, Weber T, Widimsky J, Wuerzner G, Zelveian P, Zebekakis P, Lueders S, Persu A, Kreutz R, Vogt L, European Society of Hypertension Working Group on Hypertension, the Kidney (2024) Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire. J Hypertens 42:1544\u20131554","journal-title":"J Hypertens"},{"key":"2371_CR10","doi-asserted-by":"publisher","first-page":"145","DOI":"10.5414\/CN111106","volume":"100","author":"F Groehl","year":"2023","unstructured":"Groehl F, Garreta-Rufas A, Meredith K, Harris J, Rossing P, Hobbs FDR, Wanner C (2023) The drivers of non-adherence to albuminuria testing guidelines and the clinical and economic impact of not identifying chronic kidney disease. CN 100:145\u2013156","journal-title":"CN"},{"key":"2371_CR11","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1373\/clinchem.2008.106567","volume":"55","author":"WG Miller","year":"2009","unstructured":"Miller WG, Bruns DE, Hortin GL, Sandberg S, Aakre KM, McQueen MJ, Itoh Y, Lieske JC, Seccombe DW, Jones G, Bunk DM, Curhan GC, Narva AS, National Kidney Disease Education Program-IFCC Working Group on Standardization of Albumin in Urine, National Kidney Disease Education Program-IFCC Working Group on Standardization of Albumin in Urine (2009) Current issues in measurement and reporting of urinary albumin excretion. Clin Chem 55:24\u201338. https:\/\/doi.org\/10.1373\/clinchem.2008.106567","journal-title":"Clin Chem"},{"key":"2371_CR12","doi-asserted-by":"publisher","first-page":"547","DOI":"10.2147\/CEOR.S470728","volume":"16","author":"F Pesce","year":"2024","unstructured":"Pesce F, Bruno GM, Colombo GL, Di Matteo S, Maurizi AR, Mongelli V, Mele S, Narici L, Bianchi S, Bonomini M, Castellano G, De Nicola L, Gambaro G, Grandaliano G, La Manna G, Pani A, Ranghino A, Gesualdo L (2024) Clinical and economic impact of early diagnosis of chronic kidney disease in general practice: the Endorse study. Clinicoecon Outcomes Res 16:547\u2013555","journal-title":"Clinicoecon Outcomes Res"},{"key":"2371_CR13","doi-asserted-by":"publisher","first-page":"2869","DOI":"10.1007\/s12325-023-02482-5","volume":"40","author":"N Tangri","year":"2023","unstructured":"Tangri N, Peach EJ, Franz\u00e9n S, Barone S, Kushner PR (2023) Patient management and clinical outcomes associated with a recorded diagnosis of stage 3 chronic kidney disease: the REVEAL-CKD study. Adv Ther 40:2869\u20132885. https:\/\/doi.org\/10.1007\/s12325-023-02482-5","journal-title":"Adv Ther"},{"key":"2371_CR14","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1093\/ndt\/gfq605","volume":"26","author":"EP McQuarrie","year":"2011","unstructured":"McQuarrie EP, Shakerdi L, Jardine AG, Fox JG, Mackinnon B (2011) Fractional excretions of albumin and IgG are the best predictors of progression in primary glomerulonephritis. Nephrol Dial Transplant 26:1563\u20131569","journal-title":"Nephrol Dial Transplant"},{"key":"2371_CR15","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1093\/ndt\/gfy217","volume":"35","author":"M Provenzano","year":"2020","unstructured":"Provenzano M, Chiodini P, Minutolo R, Zoccali C, Bellizzi V, Conte G, Locatelli F, Tripepi G, Del Vecchio L, Mallamaci F, Di Micco L, Russo D, Heerspink HJL, De Nicola L (2020) Reclassification of chronic kidney disease patients for end-stage renal disease risk by proteinuria indexed to estimated glomerular filtration rate: multicentre prospective study in nephrology clinics. Nephrol Dial Transpl 35:138\u2013147","journal-title":"Nephrol Dial Transpl"},{"key":"2371_CR16","doi-asserted-by":"publisher","DOI":"10.1111\/ped.15722","volume":"66","author":"S Shimizu","year":"2024","unstructured":"Shimizu S, Saito H, Takahashi S, Morohashi T, Hamada R, Hataya H, Kondo Y, Morioka I (2024) Fractional excretion of total protein in patients with nephrotic syndrome. Pediatr Int 66:e15722. https:\/\/doi.org\/10.1111\/ped.15722","journal-title":"Pediatr Int"},{"key":"2371_CR17","doi-asserted-by":"publisher","first-page":"sfae071","DOI":"10.1093\/ckj\/sfae071","volume":"17","author":"H Kuno","year":"2024","unstructured":"Kuno H, Kanzaki G, Sasaki T, Okabayashi Y, Haruhara K, Yokote S, Koike K, Ueda H, Tsuboi N, Yokoo T (2024) Fractional excretion of total protein predicts renal prognosis in Japanese patients with primary membranous nephropathy. Clin Kidney J 17:sfae071. https:\/\/doi.org\/10.1093\/ckj\/sfae071","journal-title":"Clin Kidney J"},{"key":"2371_CR18","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1056\/NEJMoa021778","volume":"348","author":"P Gaede","year":"2003","unstructured":"Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O (2003) Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348:383\u2013393. https:\/\/doi.org\/10.1056\/NEJMoa021778","journal-title":"N Engl J Med"},{"key":"2371_CR19","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1093\/qjmed\/hcl016","volume":"99","author":"MK Jayapaul","year":"2006","unstructured":"Jayapaul MK, Messersmith R, Bennett-Jones DN, Mead PA, Large DM (2006) The joint diabetic-renal clinic in clinical practice: 10 years of data from a district general hospital. QJM 99:153\u2013160. https:\/\/doi.org\/10.1093\/qjmed\/hcl016","journal-title":"QJM"},{"key":"2371_CR20","doi-asserted-by":"publisher","first-page":"1472","DOI":"10.1093\/ndt\/gfab230","volume":"37","author":"E Zimbudzi","year":"2022","unstructured":"Zimbudzi E, Lo C, Ranasinha S, Earnest A, Teede H, Usherwood T, Polkinghorne KR, Fulcher G, Gallagher M, Jan S, Cass A, Walker R, Russell G, Johnson G, Kerr PG, Zoungas S (2022) A co-designed integrated kidney and diabetes model of care improves mortality, glycaemic control and self-care. Nephrol Dial Transplant 37:1472\u20131481. https:\/\/doi.org\/10.1093\/ndt\/gfab230","journal-title":"Nephrol Dial Transplant"},{"key":"2371_CR21","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1681\/ASN.2008030292","volume":"20","author":"EC Witte","year":"2009","unstructured":"Witte EC, Lambers Heerspink HJ, de Zeeuw D, Bakker SJ, de Jong PE, Gansevoort R (2009) First morning voids are more reliable than spot urine samples to assess microalbuminuria. J Am Soc Nephrol 20:436\u2013443","journal-title":"J Am Soc Nephrol"},{"key":"2371_CR22","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1373\/clinchem.2012.195644","volume":"59","author":"SH Saydah","year":"2013","unstructured":"Saydah SH, Pavkov ME, Zhang C, Lacher DA, Eberhardt MS, Burrows NR, Narva AS, Eggers PW, Williams DE (2013) Albuminuria prevalence in first morning void compared with previous random urine from adults in the National Health and Nutrition Examination Survey, 2009\u20132010. Clin Chem 59:675\u2013683","journal-title":"Clin Chem"},{"key":"2371_CR23","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1053\/j.ackd.2017.09.013","volume":"25","author":"WG Miller","year":"2018","unstructured":"Miller WG, Jones GRD (2018) Estimated glomerular filtration rate; laboratory implementation and current global status. Adv Chronic Kidney Dis 25:7\u201313. https:\/\/doi.org\/10.1053\/j.ackd.2017.09.013","journal-title":"Adv Chronic Kidney Dis"},{"key":"2371_CR24","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1681\/ASN.V72306","volume":"7","author":"B Cianciaruso","year":"1996","unstructured":"Cianciaruso B, Bellizzi V, Minutolo R, Colucci G, Bisesti V, Russo D, Conte G, De Nicola L (1996) Renal adaptation to dietary sodium restriction in moderate renal failure resulting from chronic glomerular disease. J Am Soc Nephrol 7:306\u2013313","journal-title":"J Am Soc Nephrol"},{"key":"2371_CR25","doi-asserted-by":"publisher","first-page":"3366","DOI":"10.3390\/diagnostics13213366","volume":"13","author":"YJ Chou","year":"2023","unstructured":"Chou YJ, Yang CC, Chang SJ, Yang SS (2023) Albuminuria is affected by urinary tract infection: a comparison between biochemical quantitative method and automatic urine chemistry analyzer UC-3500. Diagnostics (Basel) 13:3366. https:\/\/doi.org\/10.3390\/diagnostics13213366","journal-title":"Diagnostics (Basel)"},{"key":"2371_CR26","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.858267","volume":"13","author":"WH Tang","year":"2022","unstructured":"Tang WH, Hung WC, Wang CP, Wu CC, Hsuan CF, Yu TH, Hsu CC, Cheng YA, Chung FM, Lee YJ, Lu YC (2022) The lower limit of reference of urinary albumin\/creatinine ratio and the risk of chronic kidney disease progression in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 13:858267","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2371_CR27","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1007\/s11255-023-03499-z","volume":"55","author":"ZW Yang","year":"2023","unstructured":"Yang ZW, Fu YB, Wei XB, Fu BQ, Huang JL, Zhang GR, Yu DQ (2023) Optimal threshold of urinary albumin-to-creatinine ratio (UACR) for predicting long-term cardiovascular and noncardiovascular mortality. Int Urol Nephrol 55:1811\u20131819","journal-title":"Int Urol Nephrol"},{"key":"2371_CR28","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1093\/clinchem\/hvad080","volume":"69","author":"DB Sacks","year":"2023","unstructured":"Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark \u00c5, Metzger BE, Nathan DM, Kirkman MS (2023) Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 69:808\u2013886","journal-title":"Clin Chem"},{"key":"2371_CR29","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1159\/000111825","volume":"28","author":"PA Sarafidis","year":"2008","unstructured":"Sarafidis PA, Riehle J, Bogojevic Z, Basta E, Chugh A, Bakris GL (2008) A comparative evaluation of various methods for microalbuminuria screening. Am J Nephrol 28:324\u2013329","journal-title":"Am J Nephrol"},{"key":"2371_CR30","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1093\/clinchem\/hvad174","volume":"70","author":"JC Seegmiller","year":"2024","unstructured":"Seegmiller JC, Bachmann LM (2024) Urine albumin measurements in clinical diagnostics. Clin Chem 70:382\u2013391. https:\/\/doi.org\/10.1093\/clinchem\/hvad174","journal-title":"Clin Chem"},{"key":"2371_CR31","doi-asserted-by":"publisher","first-page":"2073","DOI":"10.1016\/S0140-6736(10)60674-5","volume":"375","author":"K Matsushita","year":"2010","unstructured":"Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Gansevoort RT, Chronic Kidney Disease Prognosis Consortium (2010) Association of estimated glomerular filtration rate and albuminuria with allcause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 375:2073\u20132081","journal-title":"Lancet"}],"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40620-025-02371-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40620-025-02371-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40620-025-02371-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T15:59:20Z","timestamp":1777564760000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/article\/38\/8\/2067\/8457468"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["2371"],"URL":"https:\/\/doi.org\/10.1007\/s40620-025-02371-w","relation":{},"ISSN":["1724-6059"],"issn-type":[{"value":"1724-6059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]},"assertion":[{"value":"8 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"On behalf of all authors, the corresponding author states that there is no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was not required for this study, as no patient data or biological samples were collected or analyzed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Consent was not required for this study, as no patient data or biological samples were collected or analyzed.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}