{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T10:46:20Z","timestamp":1782384380996,"version":"3.54.5"},"reference-count":63,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Chronic kidney disease (CKD) is associated with numerous oral manifestations that may negatively affect quality of life, nutrition, and overall health. This narrative review aimed to summarize current evidence regarding oral manifestations of CKD and kidney transplantation, examine their proposed underlying mechanisms, and discuss implications for dental management. Methods: A structured literature search of PubMed\/MEDLINE was conducted for English-language publications from January 2000 to March 2026. Original studies, systematic reviews, meta-analyses, clinical guidelines, and relevant narrative reviews were included. Additional references were identified through manual screening of bibliographies. Results: Oral manifestations associated with CKD include xerostomia, periodontal disease, oral infections, anemia-related mucosal pallor, developmental enamel defects, and medication-related gingival overgrowth. Kidney transplant recipients are additionally at risk of opportunistic infections and oral malignancies related to long-term immunosuppressive therapy. While oral diseases, particularly periodontal disease and oral infections, may contribute to systemic inflammation, much of the available evidence remains observational. Similarly, many recommendations for dental management are based on expert consensus and clinical experience rather than high-quality interventional studies. Conclusions: Oral complications are common throughout the CKD continuum and warrant regular assessment and preventive care. Multidisciplinary collaboration is essential, while further prospective studies are needed to strengthen the evidence base for clinical management.<\/jats:p>","DOI":"10.3390\/jcm15134940","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T08:14:12Z","timestamp":1782375252000},"page":"4940","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Chronic Kidney Disease on Oral Health: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Petra Magdalena","family":"Kes","sequence":"first","affiliation":[{"name":"University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An\u0111ela","family":"Krndelj","sequence":"additional","affiliation":[{"name":"University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Juri\u0107","sequence":"additional","affiliation":[{"name":"University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ena","family":"Had\u017eovi\u0107","sequence":"additional","affiliation":[{"name":"University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0221-2758","authenticated-orcid":false,"given":"Nikolina","family":"Ba\u0161i\u0107 Juki\u0107","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, Clinical Hospital Centre, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8449-871X","authenticated-orcid":false,"given":"Vlaho","family":"Brailo","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine, University of Zagreb School of Dental Medicine, University Clinical Hospital Centre, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1016\/S0140-6736(16)32064-5","article-title":"Chronic kidney disease","volume":"389","author":"Webster","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1001\/jama.2019.14745","article-title":"Chronic kidney disease diagnosis and management: A review","volume":"322","author":"Chen","year":"2019","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: An update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int. Suppl."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Rios, P., Rodr\u00edguez-Lozano, F.J., and P\u00e9rez-Guzm\u00e1n, N. (2025). Oral Findings Linked to Chronic Kidney Disease: A Comprehensive Systematic Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14124380"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/j.1601-0825.2012.01925.x","article-title":"Orofacial diseases in solid organ and hematopoietic stem cell transplant recipients","volume":"19","author":"Petti","year":"2013","journal-title":"Oral Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"218","DOI":"10.2215\/CJN.05470610","article-title":"Systemic consequences of poor oral health in chronic kidney disease patients","volume":"6","author":"Akar","year":"2011","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Baciu, S.F., Mesaro\u0219, A.\u0218., and Kacso, I.M. (2023). Chronic Kidney Disease and Periodontitis Interplay\u2014A Narrative Review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021298"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4300\/JGME-D-22-00480.1","article-title":"Narrative Reviews: Flexible, Rigorous, and Practical","volume":"14","author":"Sukhera","year":"2022","journal-title":"J. Grad. Med. Educ."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mohammadi, P., Bots, C.P., and Brand, H.S. (2025). Salivary Flow Rate in Patients with Kidney Failure on Hemodialysis-A Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14176108"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1007\/s40620-022-01274-4","article-title":"Salivary changes in chronic kidney disease and in patients undergoing hemodialysis: A systematic review and meta-analysis","volume":"35","author":"Rodrigues","year":"2022","journal-title":"J. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1111\/sdi.12821","article-title":"Xerostomia in patients on chronic hemodialysis: An update","volume":"32","author":"Bossola","year":"2019","journal-title":"Semin. Dial."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"235","DOI":"10.4103\/0971-4065.82634","article-title":"Oral health status in Iranian hemodialysis patients","volume":"21","author":"Malekmakan","year":"2011","journal-title":"Indian J. Nephrol."},{"key":"ref_13","first-page":"e185","article-title":"Risk factors associated with xerostomia in haemo-dialysis patients","volume":"22","year":"2017","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ijnurstu.2016.08.009","article-title":"Effects of mouthwash interventions on xerostomia and unstimulated whole saliva flow rate among hemodialysis patients: A randomized controlled study","volume":"63","author":"Yu","year":"2016","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1186\/s40001-023-01351-9","article-title":"Effectiveness of thyme honey in the management of xerostomia in geriatric patients with end-stage renal disease: A randomized controlled clinical trial with a biochemical assessment","volume":"28","author":"Ibrahim","year":"2023","journal-title":"Eur. J. Med. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"38739","DOI":"10.1038\/s41598-025-22546-6","article-title":"Ultrafiltration-sodium profiles and their impact on thirst and xerostomia in hemodialysis patients","volume":"15","author":"Miri","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1038\/ki.2010.384","article-title":"Bidirectional relationship between chronic kidney and periodontal disease: A study using structural equation modeling","volume":"79","author":"Fisher","year":"2011","journal-title":"Kidney Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1111\/jre.13161","article-title":"Demystifying the connection between periodontal disease and chronic kidney disease\u2014An umbrella review","volume":"58","author":"He","year":"2023","journal-title":"J. Periodontal Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/odi.14062","article-title":"Association between chronic kidney disease and periodontitis. A systematic review and metanalysis","volume":"29","author":"Serni","year":"2023","journal-title":"Oral Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/odi.12834","article-title":"Association between periodontitis and chronic kidney disease: Systematic review and meta-analysis","volume":"25","author":"Hannedouche","year":"2019","journal-title":"Oral Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/jcpe.13414","article-title":"Oxidative stress links periodontal inflammation and renal function","volume":"48","author":"Sharma","year":"2021","journal-title":"J. Clin. Periodontol."},{"key":"ref_22","first-page":"15","article-title":"Impact of periodontal treatment on inflammatory oxidative stress in chronic kidney disease subjects: An interventional clinical trial","volume":"36","author":"Maheshwari","year":"2023","journal-title":"Am. J. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e19492","DOI":"10.7717\/peerj.19492","article-title":"Exploring the outcomes of non-surgical periodontal therapy in modulating periodontal parameters, renal function, and inflammatory biomarkers in chronic kidney disease patients with periodontitis","volume":"13","author":"Rajaratinam","year":"2025","journal-title":"PeerJ"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Delbove, T., Gueyffier, F., Juillard, L., Kalbacher, E., Maucort-Boulch, D., Nony, P., Grosgogeat, B., and Gritsch, K. (2021). Effect of periodontal treatment on the glomerular filtration rate, reduction of inflammatory markers and mortality in patients with chronic kidney disease: A systematic review. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0245619"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lauritano, D., Palmieri, A., Lucchese, A., Di Stasio, D., Moreo, G., and Carinci, F. (2020). Role of Cyclosporine in Gingival Hyperplasia: An In Vitro Study on Gingival Fibroblasts. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21020595"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Takeuchi, R., Nomura, T., Yaguchi, M., Kuwahara, N., Amino, Y., Taguchi, C., Suzuki, I., Suzuki, H., Nagashima, T., and Arikawa, K. (2024). Cyclosporine A causes gingival overgrowth via reduced G1 cell cycle arrest in gingival fibroblasts. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0309189"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1902\/jop.2006.050327","article-title":"Prevalence, severity, and risk variables associated with gingival overgrowth in renal transplant subjects treated under tacrolimus or cyclosporin regimens","volume":"77","author":"Aguiar","year":"2006","journal-title":"J. Periodontol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1111\/j.1600-051X.2010.01601.x","article-title":"Gingival overgrowth in subjects under immunosuppressive regimens based on cyclosporine, tacrolimus, or sirolimus","volume":"37","author":"Cota","year":"2010","journal-title":"J. Clin. Periodontol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1902\/jop.2008.070434","article-title":"Gingival enlargement among renal transplant recipients in the era of new-generation immunosuppressants","volume":"79","author":"Greenberg","year":"2008","journal-title":"J. Periodontol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1016\/j.transproceed.2009.06.052","article-title":"Amlodipine and nifedipine used with cyclosporine induce different effects on gingival enlargement","volume":"41","author":"Morales","year":"2009","journal-title":"Transplant. Proc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1902\/jop.2001.72.5.605","article-title":"Prevalence and risk of gingival enlargement in patients treated with nifedipine","volume":"72","author":"Miranda","year":"2001","journal-title":"J. Periodontol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3067","DOI":"10.1007\/s00467-020-04913-9","article-title":"Oral health in children with chronic kidney disease","volume":"36","author":"Velan","year":"2021","journal-title":"Pediatr. Nephrol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1159\/000357274","article-title":"Effect of periodontal treatment in renal transplant recipients","volume":"23","author":"Pejcic","year":"2014","journal-title":"Med. Princ. Pr."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Dembowska, E., Jaro\u0144, A., Gabrysz-Trybek, E., Bladowska, J., and Trybek, G. (2023). Oral Mucosa Status in Patients with End-Stage Chronic Kidney Disease Undergoing Hemodialysis. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/jcm11061584"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1111\/odi.14663","article-title":"Prevalence of oral infections in chronic kidney disease patients: A cross-sectional study","volume":"30","author":"Palmeira","year":"2024","journal-title":"Oral Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Costa, C.F.F.A., Merino-Ribas, A., Ferreira, C., Campos, C., Silva, N., Pereira, L., Garcia, A., Azevedo, \u00c1., Mesquita, R.B.R., and Rangel, A.O.S.S. (2021). Characterization of Oral Enterobacteriaceae Prevalence and Resistance Profile in Chronic Kidney Disease Patients Undergoing Peritoneal Dialysis. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.736685"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1080\/00365590802464817","article-title":"Clinical findings in oral health during progression of chronic kidney disease to end-stage renal disease in a Swedish population","volume":"43","author":"Thorman","year":"2009","journal-title":"Scand. J. Urol. Nephrol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Bhandari, S., Spencer, S., Oliveira, B., Mikhail, A., Brooks, O., Bryant, G., Willicombe, M., Baines, R., Alldridge, L., and Haslam-England, S. (2025). UK kidney association clinical practice guideline: Update of anaemia of chronic kidney disease. BMC Nephrol., 26.","DOI":"10.1186\/s12882-025-04115-1"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1182\/blood.2019004330","article-title":"How I treat renal anemia","volume":"136","author":"Fishbane","year":"2020","journal-title":"Blood"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1681\/ASN.2019020213","article-title":"Iron Deficiency in Chronic Kidney Disease: Updates on Pathophysiology, Diagnosis, and Treatment","volume":"31","author":"Batchelor","year":"2020","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"\u00d6ne\u00e7, K., Altun, G., \u00d6zdemir Aytekin, \u015e., Davran, F., and \u00d6ne\u00e7, B. (2025). Erythroferrone, Hepcidin, and Erythropoietin in Chronic Kidney Disease: Associations with Hemoglobin and Renal Function. J. Clin. Med., 14.","DOI":"10.3390\/jcm14217789"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Gluba-Brz\u00f3zka, A., Franczyk, B., Olszewski, R., and Rysz, J. (2020). The Influence of Inflammation on Anemia in CKD Patients. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21030725"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"106506","DOI":"10.1016\/j.ejim.2025.106506","article-title":"Anemia in cardiorenal disease: From pathogenesis to treatment","volume":"143","author":"Heng","year":"2025","journal-title":"Eur. J. Intern. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1007\/s004670050061","article-title":"Oral health in children with renal disease","volume":"14","author":"Nunn","year":"2000","journal-title":"Pediatr. Nephrol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1111\/odi.12993","article-title":"Dental caries and developmental defects of enamel in individuals with chronic kidney disease: Systematic review and meta-analysis","volume":"25","author":"Limeira","year":"2019","journal-title":"Oral Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s00467-022-05590-6","article-title":"Assessment of the oral health status of children with chronic kidney disease","volume":"38","author":"Sezer","year":"2023","journal-title":"Pediatr. Nephrol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Costacurta, M., Di Lauro, M., Cornali, K., Docimo, R., and Noce, A. (2025). Developmental Defects of Enamel and Dental Caries in Pediatric Patients with Chronic Kidney Disease\u2013Mineral Bone Disorders. Appl. Sci., 15.","DOI":"10.3390\/app15031164"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"11795565241271689","DOI":"10.1177\/11795565241271689","article-title":"Oral Health in Children with Chronic Kidney Disease, Hemodialysis, and Renal Transplantation: A Comprehensive Narrative Review of the Oral Manifestations and Dental Implications","volume":"18","author":"Elhusseiny","year":"2024","journal-title":"Clin. Med. Insights Pediatr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.1007\/s00467-025-06698-1","article-title":"Oral health status in children with chronic kidney disease, kidney transplantation, and nephrotic syndrome: A cross-sectional study","volume":"40","author":"Beyer","year":"2025","journal-title":"Pediatr. Nephrol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2481","DOI":"10.1007\/s11136-019-02196-8","article-title":"Health and oral health-related quality of life of children and adolescents with chronic kidney disease: A cross-sectional study","volume":"28","author":"Silva","year":"2019","journal-title":"Qual. Life Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.sdentj.2014.11.014","article-title":"Oral conditions in renal disorders and treatment considerations\u2014A review for pediatric dentist","volume":"27","author":"Gupta","year":"2015","journal-title":"Saudi Dent. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1399-0012.2005.00251.x","article-title":"A survey of dental care protocols among US organ transplant centers","volume":"19","author":"Guggenheimer","year":"2005","journal-title":"Clin. Transplant."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/idj.12585","article-title":"Importance of oral health and dental treatment in organ transplant recipients","volume":"70","author":"Kwak","year":"2020","journal-title":"Int. Dent. J."},{"key":"ref_54","first-page":"35","article-title":"Medical and dental standardization for solid organ transplant recipients","volume":"79","author":"Weinberg","year":"2013","journal-title":"N. Y. State Dent. J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/00016357.2019.1685680","article-title":"Oral manifestations of allograft recipients immediately before and after kidney transplantation","volume":"78","author":"Sarmento","year":"2020","journal-title":"Acta Odontol. Scand."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.adaj.2021.08.004","article-title":"Extractions in kidney transplant recipients: A prospective observational pilot study","volume":"153","author":"Caliento","year":"2022","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1002\/cam4.3636","article-title":"Cumulative cancer incidence and mortality after kidney transplantation in Japan: A long-term multicenter cohort study","volume":"10","author":"Imamura","year":"2021","journal-title":"Cancer Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.1001\/jama.296.23.2823","article-title":"Cancer Incidence Before and After Kidney Transplantation","volume":"296","author":"Vajdic","year":"2006","journal-title":"JAMA"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.oraloncology.2010.10.017","article-title":"Lip cancer in renal transplant patients","volume":"47","year":"2011","journal-title":"Oral Oncol."},{"key":"ref_60","first-page":"119","article-title":"Carcinoma of the Tongue in Renal Transplant Recipients: An Unusual Spectrum of De novo Malignancy at a Tertiary Care Center in India Over a Period of 26 Years","volume":"28","author":"Narayan","year":"2018","journal-title":"Indian J. Nephrol."},{"key":"ref_61","first-page":"E0623","article-title":"Late malignant oral lesions after kidney transplantation","volume":"26","author":"Santos","year":"2023","journal-title":"Braz. J. Transplant."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"262","DOI":"10.4103\/ijot.ijot_152_24","article-title":"An Uncommon Instance of Squamous Cell Carcinoma of the Buccal Mucosa in a Kidney Transplant Recipient","volume":"19","author":"Sharma","year":"2025","journal-title":"Indian J. Transplant."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e2019112","DOI":"10.4322\/acr.2019.112","article-title":"Oral carcinoma development after 23 years of renal transplantation","volume":"9","author":"Faustino","year":"2019","journal-title":"Autops. Case Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4940\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T09:47:52Z","timestamp":1782380872000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":63,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15134940"],"URL":"https:\/\/doi.org\/10.3390\/jcm15134940","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]}}}