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Prolonged exposure to high blood glucose and oxidative stress compromises the cell\u2019s membrane architecture and ionic homeostasis, resulting in altered rheological properties. By synthesizing these molecular-to-rheological pathways, this review establishes a novel pathophysiological framework for understanding DKD, repositioning erythrocytes to a primary catalyst of renal injury and a highly sensitive target for early diagnostic intervention.<\/jats:p>","DOI":"10.3390\/ijms27083592","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T14:24:51Z","timestamp":1776435891000},"page":"3592","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hemorheological Alterations as a Driver of Microangiopathy in Diabetic Kidney Disease\u2014The Role of Erythrocyte"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3214-8504","authenticated-orcid":false,"given":"Michael","family":"Garoufis","sequence":"first","affiliation":[{"name":"Laboratory of Clinical Chemistry, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7045-1323","authenticated-orcid":false,"given":"Christina","family":"Kostara","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Chemistry, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sissy Foteini","family":"Sakkou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7173-5352","authenticated-orcid":false,"given":"Sempastian","family":"Filippas-Ntekouan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Bairaktari","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Chemistry, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1708-3415","authenticated-orcid":false,"given":"Vasileios","family":"Tsimihodimos","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1093\/ndt\/gfaf177","article-title":"IDF Diabetes Atlas 11th Edition 2025: Global Prevalence and Projections for 2050","volume":"41","author":"Duncan","year":"2025","journal-title":"Nephrol. 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