{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:16:38Z","timestamp":1787991398675,"version":"build-2784847793"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2027,7,31]],"date-time":"2027-07-31T00:00:00Z","timestamp":1816992000000},"content-version":"am","delay-in-days":365,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#am"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["JPMJSP2110"],"award-info":[{"award-number":["JPMJSP2110"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate whether a study\u2010defined high\u2010altitude renal\u2010metabolic stress phenotype is associated with albuminuria\u2010related kidney involvement in hospitalized patients with diabetes in Tibet.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross\u2010sectional study included 867 hospitalized patients with diabetes in Lhasa, Tibet. An exploratory HARS\u2010like score was constructed from high hemoglobin, high red blood cell distribution width (RDW), high uric acid and hypertension. Albuminuria and macroalbuminuria were defined as urinary albumin\u2010to\u2010creatinine ratio (ACR)\u2009\u2265\u200930 and\u2009\u2265\u2009300\u2009mg\/g. Modified Poisson regression estimated adjusted prevalence ratios (PRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 724 patients with ACR data, albuminuria and macroalbuminuria were present in 306 (42.3%) and 102 (14.1%). High exploratory HARS\u2010like stress (score\u2009\u2265\u20092) was associated with albuminuria (PR 1.70, 95% confidence interval [CI], 1.38\u20132.08) and macroalbuminuria (PR 2.82, 95% CI, 1.84\u20134.33) after adjustment for age, sex, diabetes duration, body mass index, HbA1c and fasting plasma glucose. Severe stress (score\u2009\u2265\u20093) showed a stronger association with macroalbuminuria. Results were broadly consistent after estimated glomerular filtration rate adjustment, alternative score definitions and extended available\u2010confounder adjustment. High hemoglobin with high RDW identified a subgroup with greater albuminuria burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In hospitalized patients with diabetes in Tibet, clustering of erythrocyte abnormality, hyperuricemia, and hypertension was associated with albuminuria\u2010related kidney involvement, especially macroalbuminuria. External validation is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ggi.70707","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T10:15:17Z","timestamp":1785492917000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High\u2010Altitude Renal\u2010Metabolic Stress and Albuminuria in Hospitalized Patients With Diabetes in Tibet"],"prefix":"10.1111","volume":"26","author":[{"given":"Zhining","family":"Zhang","sequence":"first","affiliation":[{"name":"Geriatric Unit, Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Seno","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihui","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Science and Education People's Hospital of Xizang Autonomous Region  Lhasa Tibet Autonomous Region China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kondoh","sequence":"additional","affiliation":[{"name":"Geriatric Unit, Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(25)00299-2"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-1296"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.18"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2016060666"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2016020154"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/1234059"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.872918"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-016-0134-z"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-023-02768-x"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2022.969456"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.00756"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2010121316"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-017-0456-0"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2025.2482125"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/03000605261437612"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-011-2331-1"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2018.1532906"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.3109\/10408363.2014.992064"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.23876\/j.krcp.2017.36.3.232"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2012070718"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/1479164113500798"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gft051"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.5858\/133.4.628"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-1346"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2369-15-122"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-009-1268-0"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/jalm\/jfad047"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2012.65"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2017040421"}],"container-title":["Geriatrics &amp; 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