{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:30Z","timestamp":1791244830682,"version":"4.1.0"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"crossref","award":["21K11199"],"award-info":[{"award-number":["21K11199"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2025,3]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n This study analyzed the prognostic value of reserves obtained from cardiopulmonary exercise testing in patients on hemodialysis.<\/jats:p>\n <\/jats:list-item>\n \n Each reserve (cardiac, autonomic, and muscular) was associated with mortality, with muscle reserve having the highest prognostic accuracy.<\/jats:p>\n <\/jats:list-item>\n \n Patients with physical frailty also had a fairly good prognosis if their physiological reserve is preserved by exercise testing.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Potential impairment of exercise capacity is prevalent even in patients undergoing hemodialysis without frailty. Cardiopulmonary exercise testing (CPET) can detect physiological reserves, such as cardiopulmonary, muscle, and autonomic function. We hypothesized that these indices could accurately determine the prognosis of patients on hemodialysis and analyzed them on the basis of their relationship to frailty.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this two-center prospective cohort study of patients on hemodialysis from Japan, patients underwent CPET and physical assessment to evaluate peak oxygen uptake (peak VO\n 2<\/jats:sub>\n , indicator of exercise capacity), peak work rate (WR, indicator of muscle function), ventilatory equivalent for carbon dioxide (VE\/VCO\n 2<\/jats:sub>\n ) slope (indicator of cardiac reserve), heart rate reserve (indicator of chronotropic incompetence), and frailty phenotype. Survival was followed up for up to 5 years.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Data from 189 patients (median [interquartile range] age: 71 [62\u201377] years) were analyzed. All CPET indicators showed a consistent nonlinear relationship with all-cause mortality after adjustment: for peak VO\n 2<\/jats:sub>\n , hazard ratio (HR), 0.79 (95% confidence interval [CI], 0.71 to 0.88),\n P<\/jats:italic>\n < 0.001; for peak WR, HR, 0.95 (95% CI, 0.93 to 0.97),\n P<\/jats:italic>\n < 0.001; for VE\/VCO\n 2<\/jats:sub>\n slope, HR, 1.09 (95% CI, 1.05 to 1.13),\n P<\/jats:italic>\n < 0.001; and for heart rate reserve, HR, 0.96 (95% CI, 0.93 to 0.99),\n P<\/jats:italic>\n = 0.02. Frailty phenotype was associated with mortality after adjustment (HR, 1.73 [95% CI, 1.06 to 2.81],\n P<\/jats:italic>\n = 0.03); however, this association was not statistically significant in the model after adding peak VO\n 2<\/jats:sub>\n (\n P<\/jats:italic>\n = 0.41). Furthermore, in both subgroups with and without frailty, CPET measures were significantly associated with mortality risk (peak VO\n 2<\/jats:sub>\n , peak WR, and VE\/VCO\n 2<\/jats:sub>\n slope:\n P<\/jats:italic>\n < 0.05). The peak VO\n 2<\/jats:sub>\n (\u0394 area under the curve, 0.09; 95% CI, 0.02 to 0.16) or the peak WR (\u0394 area under the curve, 0.09; 95% CI, 0.02 to 0.15) most significantly improved the prognostic accuracy.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Results showed the fragile aspect of the frailty phenotype in the hemodialysis population and the superior ability of CPET to indicate death risk complementing that aspect.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000000621","type":"journal-article","created":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T12:00:44Z","timestamp":1734523244000},"page":"420-431","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Association of Physiological Reserve Obtained from Cardiopulmonary Exercise Testing and Frailty with All-Cause Mortality in Patients on Hemodialysis"],"prefix":"10.2215","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5294-0972","authenticated-orcid":false,"given":"Naoto","family":"Usui","sequence":"first","affiliation":[{"name":"Department of Rehabilitation, Kisen Hospital, Tokyo, Japan"},{"name":"Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichiro","family":"Nakata","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akimi","family":"Uehata","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Kisen Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4147-3088","authenticated-orcid":false,"given":"Sho","family":"Kojima","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kisen Hospital, Tokyo, Japan"},{"name":"Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1663-1897","authenticated-orcid":false,"given":"Shuji","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Information Sciences, Tokyo University of Science, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8666-6353","authenticated-orcid":false,"given":"Masakazu","family":"Saitoh","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihito","family":"Inatsu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Kisen Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Hisadome","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Kisen Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Nishiyama","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kisen Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4077-9747","authenticated-orcid":false,"given":"Yusuke","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"issue":"11","key":"B1-20250326","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1111\/ggi.14681","article-title":"Relationships between frailty and exercise capacity in patients undergoing hemodialysis: a cross-sectional study","volume":"23","author":"Kojima","year":"2023","journal-title":"Geriatr Gerontol Int."},{"issue":"5","key":"B2-20250326","doi-asserted-by":"crossref","first-page":"101588","DOI":"10.1016\/j.rehab.2021.101588","article-title":"Cardiopulmonary reserve examined with cardiopulmonary exercise testing in individuals with chronic kidney disease: a systematic review and meta-analysis","volume":"65","author":"Pella","year":"2022","journal-title":"Ann Phys Rehabil Med."},{"issue":"2","key":"B3-20250326","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1681\/ASN.2013040431","article-title":"Association between body composition and frailty among prevalent hemodialysis patients: a US Renal Data System special study","volume":"25","author":"Johansen","year":"2014","journal-title":"J Am Soc Nephrol."},{"issue":"2","key":"B4-20250326","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/j.1523-1755.2004.00411.x","article-title":"Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease","volume":"65","author":"Sietsema","year":"2004","journal-title":"Kidney Int."},{"issue":"3","key":"B5-20250326","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1093\/gerona\/gly206","article-title":"Frailty among patients receiving hemodialysis: evolution of components and associations with mortality","volume":"74","author":"Johansen","year":"2019","journal-title":"J Gerontol A Biol Sci Med Sci."},{"issue":"11","key":"B6-20250326","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1056\/NEJMoa011858","article-title":"Exercise capacity and mortality among men referred for exercise testing","volume":"346","author":"Myers","year":"2002","journal-title":"N Engl J Med."},{"issue":"2","key":"B7-20250326","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1161\/CIRCHEARTFAILURE.112.000073","article-title":"Validation of a cardiopulmonary exercise test score in heart failure","volume":"6","author":"Myers","year":"2013","journal-title":"Circ Heart Fail."},{"issue":"3","key":"B8-20250326","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci."},{"issue":"8","key":"B9-20250326","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1111\/ggi.14223","article-title":"Association between social frailty as well as early physical dysfunction and exercise intolerance among older patients receiving hemodialysis","volume":"21","author":"Usui","year":"2021","journal-title":"Geriatr Gerontol Int."},{"issue":"14","key":"B10-20250326","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1161\/hc3901.095960","article-title":"Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association","volume":"104","author":"Fletcher","year":"2001","journal-title":"Circulation."},{"issue":"1","key":"B11-20250326","first-page":"217","article-title":"A test to determine parameters of aerobic function during exercise","volume":"50","author":"Whipp","year":"1981","journal-title":"J Appl Physiol Respir Environ Exerc Physiol."},{"issue":"1","key":"B12-20250326","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1519\/JSC.0b013e31820238c5","article-title":"Relation between cycling exercise capacity, fiber-type composition, and lower extremity muscle strength and muscle endurance","volume":"25","author":"Segerstr\u00f6m","year":"2011","journal-title":"J Strength Cond Res."},{"issue":"5","key":"B13-20250326","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/S0002-8703(98)70121-8","article-title":"Impaired ventilatory efficiency in chronic heart failure: possible role of pulmonary vasoconstriction","volume":"136","author":"Reindl","year":"1998","journal-title":"Am Heart J."},{"issue":"24","key":"B14-20250326","doi-asserted-by":"crossref","first-page":"2803","DOI":"10.1161\/01.CIR.101.24.2803","article-title":"Impairment of ventilatory efficiency in heart failure: prognostic impact","volume":"101","author":"Kleber","year":"2000","journal-title":"Circulation."},{"issue":"9","key":"B15-20250326","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1161\/CIRCULATIONAHA.110.940577","article-title":"Chronotropic incompetence: causes, consequences, and management","volume":"123","author":"Brubaker","year":"2011","journal-title":"Circulation."},{"issue":"2","key":"B16-20250326","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.jacc.2004.02.060","article-title":"The incremental prognostic value of percentage of heart rate reserve achieved over myocardial perfusion single-photon emission computed tomography in the prediction of cardiac death and all-cause mortality: superiority over 85% of maximal age-predicted heart rate","volume":"44","author":"Azarbal","year":"2004","journal-title":"J Am Coll Cardiol."},{"issue":"10","key":"B17-20250326","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1111\/ggi.14005","article-title":"The revised Japanese version of the Cardiovascular Health Study criteria (revised J-CHS criteria)","volume":"20","author":"Satake","year":"2020","journal-title":"Geriatr Gerontol Int."},{"issue":"6","key":"B18-20250326","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1111\/ggi.12543","article-title":"Validity of the Kihon Checklist for assessing frailty status","volume":"16","author":"Satake","year":"2016","journal-title":"Geriatr Gerontol Int."},{"issue":"12","key":"B19-20250326","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1093\/gerona\/glx225","article-title":"Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly","volume":"73","author":"Tanaka","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci."},{"issue":"11","key":"B20-20250326","doi-asserted-by":"crossref","first-page":"105238","DOI":"10.1016\/j.jamda.2024.105238","article-title":"Prevalence and prognostic impact of multiple frailty domain in Japanese older adults","volume":"25","author":"Shimoda","year":"2024","journal-title":"J Am Med Dir Assoc."},{"issue":"12","key":"B21-20250326","doi-asserted-by":"crossref","first-page":"2629","DOI":"10.1111\/ggi.13129","article-title":"Prevalence of frailty among community-dwellers and outpatients in Japan as defined by the Japanese version of the Cardiovascular Health Study criteria","volume":"17","author":"Satake","year":"2017","journal-title":"Geriatr Gerontol Int."},{"issue":"3","key":"B22-20250326","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1002\/ehf2.14114","article-title":"The interaction between physical frailty and prognostic impact of heart failure medication in elderly patients","volume":"10","author":"Abe","year":"2023","journal-title":"ESC Heart Fail."},{"key":"B23-20250326","article-title":"Usefulness of frailty assessment using the revised Japanese version of the Cardiovascular Health Study on the prediction of clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement","author":"Abe","year":"2024","journal-title":"Cardiovasc Interv Ther."},{"issue":"4","key":"B24-20250326","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s41999-023-00803-z","article-title":"Frailty and sarcopenia in older kidney transplant recipients: a cross-sectional study","volume":"14","author":"Kosoku","year":"2023","journal-title":"Eur Geriatr Med."},{"issue":"1","key":"B25-20250326","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1186\/s12882-020-02019-w","article-title":"Association among kidney function, frailty, and oral function in patients with chronic kidney disease: a cross-sectional study","volume":"21","author":"Kosaka","year":"2020","journal-title":"BMC Nephrol."},{"issue":"2","key":"B26-20250326","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1038\/ki.2009.413","article-title":"An improved comorbidity index for outcome analyses among dialysis patients","volume":"77","author":"Liu","year":"2010","journal-title":"Kidney Int."},{"issue":"4","key":"B27-20250326","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/ajcn\/82.4.777","article-title":"Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients","volume":"82","author":"Bouillanne","year":"2005","journal-title":"Am J Clin Nutr."},{"issue":"8","key":"B28-20250326","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.jchf.2016.03.022","article-title":"Cardiopulmonary exercise testing in heart failure","volume":"4","author":"Malhotra","year":"2016","journal-title":"JACC Heart Fail."},{"issue":"1","key":"B29-20250326","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/sim.4026","article-title":"Several methods to assess improvement in risk prediction models: extension to survival analysis","volume":"30","author":"Chambless","year":"2011","journal-title":"Stat Med."},{"issue":"7","key":"B30-20250326","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1681\/ASN.2020091319","article-title":"Cardiac and noncardiac determinants of exercise capacity in CKD","volume":"32","author":"Chinnappa","year":"2021","journal-title":"J Am Soc Nephrol."},{"issue":"3","key":"B31-20250326","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1093\/ndt\/gfx064","article-title":"Early and asymptomatic cardiac dysfunction in chronic kidney disease","volume":"33","author":"Chinnappa","year":"2018","journal-title":"Nephrol Dial Transplant."},{"issue":"8","key":"B32-20250326","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1038\/s41581-022-00576-x","article-title":"Cardiac metabolic remodelling in chronic kidney disease","volume":"18","author":"Patel","year":"2022","journal-title":"Nat Rev Nephrol."},{"issue":"2","key":"B33-20250326","doi-asserted-by":"crossref","first-page":"M85","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission","volume":"49","author":"Guralnik","year":"1994","journal-title":"J Gerontol."},{"issue":"1","key":"B34-20250326","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1186\/s12872-020-01725-5","article-title":"Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis","volume":"20","author":"Fuentes-Abolafio","year":"2020","journal-title":"BMC Cardiovasc Disord."},{"issue":"1","key":"B35-20250326","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.cardfail.2018.09.002","article-title":"Lower extremity function is independently associated with hospitalization burden in heart failure with preserved ejection fraction","volume":"25","author":"Hornsby","year":"2019","journal-title":"J Card Fail."},{"issue":"14","key":"B36-20250326","doi-asserted-by":"crossref","first-page":"e016845","DOI":"10.1161\/JAHA.120.016845","article-title":"Short physical performance battery and incident cardiovascular events among older women","volume":"9","author":"Bellettiere","year":"2020","journal-title":"J Am Heart Assoc."},{"key":"B37-20250326","doi-asserted-by":"crossref","first-page":"1087248","DOI":"10.3389\/fpubh.2023.1087248","article-title":"Physical performance and muscle strength rather than muscle mass are predictor of all-cause mortality in hemodialysis patients","volume":"11","author":"Chen","year":"2023","journal-title":"Front Public Health."},{"issue":"7","key":"B38-20250326","doi-asserted-by":"crossref","first-page":"afac168","DOI":"10.1093\/ageing\/afac168","article-title":"The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: a secondary analysis of a multicentre cohort study","volume":"51","author":"Corsonello","year":"2022","journal-title":"Age Ageing."},{"issue":"10","key":"B39-20250326","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.2215\/CJN.12371213","article-title":"Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS","volume":"9","author":"Lopes","year":"2014","journal-title":"Clin J Am Soc Nephrol."},{"issue":"12","key":"B40-20250326","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.2215\/CJN.03660412","article-title":"Habitual physical activity measured by accelerometer and survival in maintenance hemodialysis patients","volume":"7","author":"Matsuzawa","year":"2012","journal-title":"Clin J Am Soc Nephrol."},{"issue":"3","key":"B41-20250326","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1038\/nrneph.2016.187","article-title":"Physical inactivity: a risk factor and target for intervention in renal care","volume":"13","author":"Zelle","year":"2017","journal-title":"Nat Rev Nephrol."},{"key":"B42-20250326","doi-asserted-by":"crossref","first-page":"l4570","DOI":"10.1136\/bmj.l4570","article-title":"Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis","volume":"366","author":"Ekelund","year":"2019","journal-title":"BMJ."},{"issue":"5","key":"B43-20250326","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1111\/sms.13616","article-title":"Consequences of physical inactivity in older adults: a systematic review of reviews and meta-analyses","volume":"30","author":"Cunningham","year":"2020","journal-title":"Scand J Med Sci Sports."},{"issue":"1","key":"B44-20250326","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s41100-022-00393-9","article-title":"Renal rehabilitation as a management strategy for physical frailty in CKD","volume":"8","author":"Matsuzawa","year":"2022","journal-title":"Ren Replace Ther."},{"issue":"10","key":"B45-20250326","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.1093\/ndt\/gfad083","article-title":"Efficacy of six exercise-based interventions for individuals undergoing hemodialysis: a network meta-analysis of randomized clinical trials","volume":"38","author":"Ferrari","year":"2023","journal-title":"Nephrol Dial Transplant."},{"issue":"8","key":"B46-20250326","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.2215\/CJN.03160322","article-title":"Long-term effect of physical exercise on the risk for hospitalization and death in dialysis patients: a post-trial long-term observational study","volume":"17","author":"Mallamaci","year":"2022","journal-title":"Clin J Am Soc Nephrol."},{"issue":"3","key":"B47-20250326","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.ekir.2019.11.020","article-title":"The marginal cost of frailty among medicare patients on hemodialysis","volume":"5","author":"Sy","year":"2020","journal-title":"Kidney Int Rep."},{"issue":"6","key":"B48-20250326","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1016\/j.ekir.2021.02.036","article-title":"A cost-effective analysis of the CYCLE-HD randomized controlled trial","volume":"6","author":"March","year":"2021","journal-title":"Kidney Int Rep."}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000621","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:42:53Z","timestamp":1786369373000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,18]]},"references-count":48,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.0000000621","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,18]]},"assertion":[{"value":"2024-08-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-13","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}