{
  "abstract": "Background/Objectives: In contemporary chronic kidney disease care, determining whether an individual patient is benefiting from treatment is increasingly complex. Disease-modifying therapies may influence multiple clinical domains, and these effects may emerge with different magnitudes and time courses. Nevertheless, treatment response is frequently summarized using binary labels such as ‘responder’ and ‘nonresponder’, often on the basis of a single biomarker at a single time point. Such classifications are useful when associated with a clearly defined outcome, threshold, and assessment window, but may be misleading when interpreted as the patient’s overall response to therapy. Methods: This study examines the limitations of responder–nonresponder dichotomy, considering biological and analytical variability, treatment exposure, adherence, concomitant therapy, intercurrent events, and layered treatment. A domain-by-time framework for interpreting treatment-associated trajectories is proposed. Results: The framework first considers the nature and timing of observed changes, then assesses their interpretability considering treatment exposure and clinical context, and finally evaluates the strength of their attribution to treatment. It provides a conceptual, patient-level reporting and research framework that complements existing estimands principles, validated surrogate endpoints, and disease-specific response criteria. Conclusions: The proposed framework aims to improve the description and interpretation of treatment-associated trajectories without implying individual causal treatment effects. Its reproducibility and clinical utility require prospective evaluation.",
  "abstract_shown": true,
  "affiliations": [
    "Nephrology and Dialysis Unit, “Cannizzaro” Emergency Hospital, 95126 Catania, Italy",
    "Advanced School of Ultrasound in Nephrology, Italian Society for Ultrasound in Medicine and Biology (SIUMB), 00192 Catania, Italy",
    "Nephrology and Dialysis Unit, “St. Antonio Abate” Hospital, 91016 Trapani, Italy",
    "Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “A. Moro”, 70121 Bari, Italy",
    "Department of Medicine, University of Verona, 37131 Verona, Italy",
    "Nephrology and Dialysis Unit, Department of Internal Medicine, “C. e G. Mazzoni” Hospital, 63100 Ascoli Piceno, Italy",
    "Department of Medicine and Health Sciences, University of Trento, 38122 Trento, Italy",
    "Nephrology and Dialysis Unit, Santa Chiara Hospital, ASUIT, 38122 Trento, Italy"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Antonio Granata",
      "orcid": "0000-0002-7026-3952"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Rosario Maccarrone",
      "orcid": "0000-0002-8784-1552"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Alfio Edoardo Giuffrida",
      "orcid": "0000-0002-9390-1363"
    },
    {
      "affs": [
        2
      ],
      "name": "Leonardo Spatola",
      "orcid": "0000-0002-8883-4776"
    },
    {
      "affs": [
        3
      ],
      "name": "Francesco Pesce"
    },
    {
      "affs": [
        4
      ],
      "name": "Settimio Di Gregorio"
    },
    {
      "affs": [
        5
      ],
      "name": "Matthias Zeiler"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Yuri Battaglia",
      "orcid": "0000-0003-3947-1814"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8wcvtfvsteqnd.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15208095",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706145/?tool=EBI",
  "id": "8wcvtfvsteqnd",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/8095",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2613|Statistical Methods in Clinical Trials"
    ]
  ],
  "openalex": "W7222951997",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706145/pdf/?tool=EBI",
  "pmcid": "PMC13706145",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/8wcvtfvsteqnd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:01Z",
      "native_id": "10.3390/jcm15208095",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/8095"
    },
    {
      "first_seen": "2026-10-30T12:21:34Z",
      "native_id": "PMC:PMC13706145",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13706145"
    }
  ],
  "subjects": [
    {
      "field": "mathematics",
      "origin": "openalex:2613|Statistical Methods in Clinical Trials",
      "subfield": "statistics"
    }
  ],
  "title": "The Limits of the Dichotomy Between Responders and Nonresponders in Chronic Kidney Disease",
  "title_text": "The Limits of the Dichotomy Between Responders and Nonresponders in Chronic Kidney Disease",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:34Z",
  "url": "https://research.draconitic.com/paper/8wcvtfvsteqnd",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}