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The study population included adults (\u226518\u2009years) with diabetes who had at least one documented visit at a referral institution between December 1, 2015, and March 31, 2021, with concurrent measurements of serum creatinine and hemoglobin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 12,416 and 11,157 patients were eligible for assessment of eGFR change at 1 and 2\u2009years, respectively. Multivariable logistic regression identified several consistent risk factors for \u226530% eGFR reduction at both time points: low serum albumin, elevated triglycerides, anemia as defined by JSDT, diabetic retinopathy, CKD Stage G4 or higher, albuminuria category A3, and chronic heart failure. Additional predictors at 1 year included age under 65 and elevated HbA1c, while smoking, hypertension, and diabetic neuropathy were significant only at 2\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Beyond retinopathy and advanced kidney disease, anemia, hypoalbuminemia, and heart failure independently contributed to persistent eGFR decline, supporting the clinical relevance of cardio\u2010renal anemia syndrome in diabetic populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdi.70214","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T04:33:11Z","timestamp":1765600391000},"page":"242-255","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk factors for persistent decline in\n                    <scp>eGFR<\/scp>\n                    of Japanese patients with diabetes: Analysis using a large\u2010scale diabetes registry J\u2010\n                    <scp>DREAMS<\/scp>"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9292-1522","authenticated-orcid":false,"given":"Kota","family":"Yamada","sequence":"first","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine (Currently National Center for Global Health and Medicine, Japan Institute for Health Security) Center Hospital  Toyama, Shinjuku\u2010ku Tokyo Japan"},{"name":"Department of Diabetes &amp; Metabolic Diseases, Graduate School of Medicine The University of Tokyo  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3222-8507","authenticated-orcid":false,"given":"Mitsuru","family":"Ohsugi","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine (Currently National Center for Global Health and Medicine, Japan Institute for Health Security) Center Hospital  Toyama, Shinjuku\u2010ku Tokyo Japan"},{"name":"Diabetes and Metabolism Information Center Research Institute, National Center for Global Health and Medicine (Currently National Institute for Global Health and Medicine, Japan Institute for Health Security)  Toyama, Shinjuku\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3117-9328","authenticated-orcid":false,"given":"Yuichiro","family":"Ito","sequence":"additional","affiliation":[{"name":"Medical Affairs, Astellas Pharma Inc.  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