{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:14:16Z","timestamp":1790187256409,"version":"4.1.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82370808"],"award-info":[{"award-number":["82370808"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the \"Climbing Peak\" Training Program for Innovative Technology Team of Yijishan Hospital","award":["PF2019013"],"award-info":[{"award-number":["PF2019013"]}]},{"name":"he \"Peak\" Training Program for Scientific Research of Yijishan Hospital","award":["GF2019J07"],"award-info":[{"award-number":["GF2019J07"]}]},{"name":"Major Project Funding from the Anhui Provincial Education Department","award":["2023AH040244"],"award-info":[{"award-number":["2023AH040244"]}]},{"name":"he Clinical Medical Research Transformation Project of Anhui Province","award":["202204295107020067"],"award-info":[{"award-number":["202204295107020067"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nephrol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to characterize urinary stress hormones and their metabolites in patients with chronic kidney disease associated with diabetes (CKD with diabetes) and to evaluate their associations with renal function, providing insights into stress-related mechanisms and potential biomarker utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We enrolled 735 participants, including 449 with type 2 diabetes mellitus(T2D)and 286 with CKD with diabetes. Urinary concentrations of norepinephrine, cortisol, aldosterone, and 17-ketosteroids were analyzed. Statistical methods included correlation and regression analyses, receiver operating characteristic (ROC) curves, and orthogonal partial least squares discriminant analysis (OPLS-DA) to evaluate diagnostic value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Urinary norepinephrine, cortisol, and 17-ketosteroids levels were significantly lower in CKD patients with diabetes than in those with diabetes alone. Norepinephrine was inversely correlated with albumin-to-creatinine ratio, urinary microalbumin, blood urea nitrogen, and serum creatinine, and positively with estimated glomerular filtration rate. Similar trends were observed for cortisol and 17-ketosteroids. Aldosterone was also negatively correlated with urinary microalbumin and creatinine. OPLS-DA showed distinct metabolic profiles between CKD with diabetes and diabetes, suggesting metabolic heterogeneity. Multivariate logistic regression identified norepinephrine as an independent protective factor, while diastolic blood pressure, urinary glucose, and homovanillic acid were risk factors. A composite model integrating norepinephrine, 17-ketosteroids, and homovanillic acid demonstrated high diagnostic performance, with the norepinephrine-based model achieving an AUC of 0.831 in validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Urinary adrenal hormones and their metabolites provide valuable insights into stress-related mechanisms in CKD with diabetes and may hold potential as complementary noninvasive biomarkers for disease assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12882-025-04717-9","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T10:48:09Z","timestamp":1766573289000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Urinary stress hormones and their metabolites as predictive biomarkers for CKD with diabetes"],"prefix":"10.1186","volume":"27","author":[{"given":"Yujie","family":"Jin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunchen","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shujuan","family":"Shang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengru","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahao","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MengMeng","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiqiang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizhuo","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liuming","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialin","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"issue":"1","key":"4717_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/S2213-8587(20)30374-0","volume":"9","author":"KR Tuttle","year":"2021","unstructured":"Tuttle KR. 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All procedures involving human participants were performed in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was obtained from all participants prior to their inclusion in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"75"}}