Search Results (5,016)

This study evaluated the efficacy of basil essential oil (BEO), extracted from basil plants irrigated with ozonated water, as a sustainable strategy to control grey mould (Botrytis cinerea, Bc) in grapevine, Vitis vinifera cv. Sangiovese. Bunches were treated with water (control) or BEO and, after Bc inoculation, disease progression (AUDPC), berry biometric traits and biochemical parameters were assessed. Treatment with BEO significantly reduced disease severity, lowering AUDPC values at 168 h post inoculation compared with untreated infected grapes, while limiting visible mycelial emergence. Anthocyanins and total phenols decreased following infection (−36 and −38%, respectively, in comparison to the control). By contrast, BEO-treated and infected grapes showed a more than 2-fold increase in resveratrol and condensed tannins, suggesting the activation of defence-related secondary metabolism. Lastly, glucose and fructose contents declined by 56% only in untreated infected berries, confirming active pathogen colonisation. These findings demonstrate that BEO significantly reduced grey mould development with enhanced defence-related metabolic responses, supporting its potential as an eco-friendly alternative to synthetic fungicides in sustainable viticulture. Full article

Background/Objectives: Insulin resistance (IR) and metabolic Syndrome (MSy) have been linked to cognitive decline, but their presence in mild cognitive impairment (MCI) and Alzheimer disease (AD) remains unclear. We evaluated MSy and IR in nonobese, nondiabetic older adults with cognitive dysfunction. Methods: The cross-sectional study included 143 participants aged 65–90 years: 62 with AD, 41 with MCI, and 40 cognitively preserved controls. Anthropometric measures, blood pressure, fasting glucose, insulin, and lipid levels were assessed. Diabetes was excluded by oral glucose tolerance testing. IR was estimated using HOMA-IR, and MSy was diagnosed according to International Diabetes Federation (IDF) criteria. Group differences and associations with cognitive impairment were assessed using analysis of variance and regression analyses. Results: Fasting insulin increased from controls to MCI and AD (7.18 ± 4.32, 13.76 ± 6.89, and 18.58 ± 8.19 mU/L), as did HOMA-IR (1.49 ± 0.98, 3.35 ± 1.72, and 4.59 ± 2.19, p < 0.05). Compared with controls, both cognitively impaired groups had higher fasting glucose, TCh, LDL-ch and lower HDL-ch (all p < 0.05), whereas triglycerides did not differ (p = 0.266). MSy prevalence was 22.5% in controls, 46.3% in MCI, and 35.5% in AD; however, the overall difference was not statistically significant (p = 0.079). In binary logistic regression analysis, sex, age, LDL-ch, and HOMA-IR were independently associated with cognitive impairment (all p < 0.05). Conclusions: Increased IR was more consistently associated with cognitive impairment than the presence of MSy, with the highest degree of IR observed in AD. These findings support an association between metabolic dysfunction and cognitive impairment and suggest that IR may represent a potential target for preventive and therapeutic strategies. Full article

This paper presents experimental results regarding the feasibility of producing porous ceramic filters through the valorization of two types of industrial waste, i.e., an aluminum-rich material derived from treated black aluminum dross, and coal ashes recovered from an old landfill. To enhance the open, interconnected porosity of the ceramic filters, glucose was employed as a pore-forming agent in two dosages (20% and 40%). The results show that by controlling the thermal treatment parameters together with the composition of the raw mix, it is possible to achieve a microstructure and filtration performance suitable for ceramic filter applications. X-ray diffraction (XRD) analyses confirmed the presence of corundum (αAl₂O₃) and MgAl₂O₄ spinel in the ceramics based on aluminum-rich material, phases well-suited for filtration applications due to their chemical and mechanical properties. When kaolin is used as a raw material in combination with the aluminum-rich material, mullite (3Al₂O₃·2SiO₂) can form, enhancing the mechanical strength of the ceramic. However, filters sintered at higher temperatures exhibit reduced filtration efficiency due to the decrease in porosity. In comparison, ceramic filters containing coal ashes, benefiting from the presence of fluxing oxides and gas-releasing components (unburnt fossil fuel and carbonates), develop higher open porosity at lower sintering temperatures. Microstructural analysis of the obtained ceramics revealed an interconnected pore network whose size and distribution depend on the raw-mix composition, glucose content, and sintering temperature. Increasing the glucose content from 20% to 40% significantly enhanced the open porosity and filtration flow rate, but at the expense of mechanical strength and ionic retention capacity. The filtration data confirmed that all investigated materials function effectively as gravity-driven filters without the need for applied pressure. The obtained results underline the strong potential of using waste-derived porous ceramics as sustainable and cost-effective filtration materials for wastewater treatment applications. Full article

We examined the effects of combining resistance training (RT) with semaglutide use on body composition, metabolism, strength, and muscle thickness and quality. Men and women (n = 11) aged 30–55 years participated in this study. Measurements included resting metabolic rate, body composition, fasting blood glucose, HbA1c, ultrasound-derived muscle thickness and quality of upper and lower extremity musculature, chest press and leg press 10-repetition maximum (10RM), and handgrip strength. Participants continued their medication use for four weeks without RT (GLP-1), and this was followed by an eight-week RT protocol alongside continued medication use (GLP-1+RT). Body mass decreased 0.991 kg (p = 0.019) and 2.627 kg (p = 0.011) during GLP-1 and GLP-1+RT, respectively. Fat mass and body fat percentage decreased significantly during GLP-1+RT (−3.355 kg, p = 0.008 and −3.073%, p = 0.013, respectively). There was a non-significant increase (1.1 kg) in fat-free mass. Muscle thickness and quality were maintained. Leg press and chest press 10RM improved during GLP-1+RT (p < 0.001 and p = 0.006, respectively). This exploratory study provides context regarding RT’s effects on fat-free mass, strength, and size and quality of muscle in individuals using semaglutide. Full article

Background: Metabolic syndrome (MetS) is characterized by the clustering of central adiposity, elevated blood pressure, dysglycemia, and atherogenic dyslipidemia. Machine learning models for metabolic syndrome may show inflated performance when predictors overlap with the diagnostic criteria used to define the reference outcome. Glucose, triglycerides, and high-density lipoprotein (HDL) cholesterol are components of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definition of MetS; therefore, their use as predictors may introduce incorporation bias. This study aimed to evaluate whether glycated hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL) cholesterol provide screening information for reference-defined MetS and to quantify the effect of predictor–outcome overlap. Methods: This retrospective cross-sectional analysis used de-identified routine-care data comprising 17,981 laboratory records, including 8982 records with MetS and 8999 without MetS. MetS was defined according to the updated NCEP ATP III criteria, with all five components available for reference classification from the same clinical encounter. The primary model used HbA1c and LDL cholesterol. For comparison, two additional models were evaluated: a criterion-component model using glucose, triglycerides, and HDL cholesterol, and a full biochemical model using all five variables. Gradient boosting was evaluated within a patient-level development and held-out internal test framework, with no patient shared between partitions. Model performance was assessed using ROC-AUC, threshold-based classification metrics, Brier score, calibration, decision curve analysis, and SHAP-based explainability. Results: The primary HbA1c–LDL cholesterol model showed moderate-to-strong discrimination for reference-defined MetS, with an ROC-AUC of 0.810, accuracy of 0.733, sensitivity of 0.824, specificity of 0.641, F1-score of 0.756, and Brier score of 0.174. The criterion-component model using glucose, triglycerides, and HDL cholesterol achieved a higher ROC-AUC of 0.935, consistent with a strong influence of predictor–outcome overlap. The full biochemical model achieved the highest ROC-AUC of 0.956 and Brier score of 0.084; however, this performance should be interpreted as an upper-bound estimate influenced by incorporation bias. SHAP analysis of the primary HbA1c–LDL cholesterol model indicated that HbA1c contributed more strongly than LDL cholesterol to the model output. Conclusions: HbA1c and LDL cholesterol provided measurable biochemical screening information for reference-defined MetS, although their discriminatory performance was lower than models including diagnostic criterion components. The substantially higher performance of models containing glucose, triglycerides, and HDL cholesterol is consistent with a substantial influence of incorporation bias when diagnostic criteria components are used as predictors. These findings should be interpreted as hypothesis-generating and limited to single-center internal validation. External, temporal, multicenter, and prospective validation is required before any clinical application can be considered. Full article

Background: Combined high fructose and high sodium diet (FHS) is linked to elevated blood pressure (BP), heightened sympathetic activity, and cardiovascular and renal dysfunction. Total-renal denervation is effective in lowering BP in some hypertension models. Objectives: The present studies tested whether selective afferent (A-RDNx) or total-renal denervation (T-RDNx) ameliorates FHS cardiovascular and renal function. Methods: Male and female Sprague Dawley rats were fed 20% glucose and 0.4% Na chow for one week then assigned to one of four groups: 20% glucose plus 0.4% Na sham-operation (G-Sham) or 20% fructose plus 4% Na with either sham-operation (F-Sham), A-RDNx, or T-RDNx for ~21 days. Telemetric BP and heart rate, echocardiography, pulse-wave velocity (PWV), and renal function were assessed. Results: T-RDNx reduced FHS-induced high BP in both sexes. LVEF did not differ, but global longitudinal strain showed hypercontractility in male F-Sham, which normalized with A-RDNx or T-RDNx. Increased LV perivascular fibrosis in F-Sham rats of both sexes was prevented by A-RDNx or T-RDNx. T-RDNx improved elevated PWV, endothelium-independent vasodilation by myography, and aortic oxidative stress in male F-Sham aortas. High plasma renin activity in male F-Sham decreased with T-RDNx to levels similar to G-Sham rats. Serum creatinine, urine albumin:creatinine ratio, and mesangial hypercellularity in F-Sham male rats decreased with A-RDNx or T-RDNx. Renal function was unchanged in female F-Sham; T-RDNx decreased albuminuria. Conclusions: Renal-sympathetic nerves play a crucial role in elevated BP, cardiac dysfunction, vascular stiffness, and renal impairment associated with FHS diet, particularly in male rats, and implicates a complex interplay with BP, the renin-angiotensin system, and oxidative stress. Full article

Background: Diabetes self-management is essential for type 2 diabetes care, but cross-sectional associations may be distorted when questionnaire scores are incorrectly derived or converted into arbitrary categories. We evaluated clinical and sociodemographic correlates of the continuous Diabetes Self-Management Questionnaire (DSMQ) total score in a secondary analysis of an outpatient clinical database. Methods: The analysis included 262 adults with type 2 diabetes recruited between 1 November 2025 and 1 May 2026. DSMQ total and subscale scores were independently recalculated from the 16 item-level responses using the published scoring algorithm. The primary analysis retained the DSMQ score as a continuous outcome. The database provided a participant-level count of documented glucose measurements > 250 mg/dL. This operational count was not treated as a standardized clinical event or severity category; individual measurement timestamps, participant-specific observation duration, and the total number of glucose measurements were unavailable. Results: The recalculated DSMQ score was 5.26 ± 2.35 (median 5.10; interquartile range 3.12–7.08). Among 261 participants with an interpretable sex code, 144 (55.2%) were women. In univariable analyses, lower DSMQ scores were concurrently associated with longer diabetes duration, a higher recorded severe-hyperglycemia count, higher HbA1c, and higher fasting glucose. In the adjusted model (n = 261), the recorded severe-hyperglycemia count remained negatively associated with DSMQ score (adjusted coefficient −0.412 points per recorded episode; 95% confidence interval −0.621 to −0.203; p < 0.001). Individualized versus hospital-based education was not independently associated with the corrected score. A beta-regression sensitivity analysis produced a concordant direction of association (coefficient −0.152 on the logit mean scale; p < 0.001). The linear model explained 17.2% of observed variance (adjusted R² = 0.136), with an optimism-corrected R² of 0.099. Conclusions: The recorded severe-hyperglycemia count was a concurrent correlate of lower DSMQ score. Because the study is cross-sectional and glucose-measurement counts were preaggregated without observation-time or monitoring-frequency data, the findings do not establish temporal direction, causality, or individual-level clinical prediction. Item-level score verification and continuous-outcome analysis materially changed the interpretation of the dataset. Full article

Background/Objectives: Metabolic syndrome (MetS) increases susceptibility to myocardial ischemia/reperfusion (I/R) injury through metabolic disturbance, hypertension, and oxidative stress. This study aimed to compare the effects of liraglutide and semaglutide on post-ischemic cardiac function, oxidative stress, and histomorphological changes in rats with MetS. Methods: MetS was induced in male Wistar rats by a high-fat diet followed by low-dose streptozotocin. After confirmation of MetS, animals were treated with saline, liraglutide, or semaglutide for 6 weeks. Blood pressure, glycemia, oral glucose tolerance, and lipid profile were assessed during the protocol. In vivo cardiac function was evaluated by echocardiography, whereas ex vivo I/R injury was induced using the Langendorff technique. Cardiodynamic parameters, coronary flow, oxidative stress markers, and histological changes in the heart, liver, and pancreas were analyzed. Results: Both liraglutide and semaglutide improved the cardiometabolic profile of MetS rats, with semaglutide showing a more evident effect on body weight control. In the Langendorff model, both treatments improved post-ischemic recovery of myocardial contractility and relaxation during reperfusion. Treated animals also showed a more favorable oxidative stress profile, particularly lower superoxide anion levels and enhanced antioxidant defense. Histologically, both agents attenuated myocardial hypertrophy and collagen deposition, improved hepatic architecture by reducing inflammatory changes, and preserved pancreatic structure with less lipid accumulation and tissue injury. Conclusions: Liraglutide and semaglutide exerted significant cardioprotective and tissue-protective effects in experimental MetS complicated by myocardial I/R injury. These findings support their potential in limiting post-ischemic cardiac dysfunction and multiorgan damage in metabolically compromised conditions. Full article

Tessaria absinthioides (Hook. & Arn.) DC. (Asteraceae) decoction (DTa) is used to treat hypercholesterolemia, diabetes and digestive disorders in the traditional medicine of Argentina, Bolivia, Chile, and Uruguay. The present study evaluated the effects of DTa on glucose metabolism and behavior and compared them with metformin under chronic sucrose exposure and normal conditions. Male Sprague-Dawley rats received water, sucrose, DTa (5 or 10% w/v) with or without sucrose, or metformin (12.5 or 25 mg/kg) under water- or sucrose-fed conditions for 40 days, according to the experimental design. Glucose homeostasis was assessed by fasting glycemia and a glucose tolerance test (GTT), while behavior was evaluated using the open field, elevated plus maze (EPM), and novel object location tests. Under sucrose-fed conditions, DTa was associated with lower fasting glycemia, while both DTa and metformin improved GTT, as evidenced by reduced iAUC values. Behavioral analyses revealed modulation of exploratory and risk-assessment behavior by DTa, particularly in the EPM, where DTa10 increased total distance traveled and head-dip behavior under sucrose-fed conditions. Under normal conditions, DTa10 was associated with lower fasting glucose levels without significant changes in GTT, whereas behavioral effects were mainly restricted to specific ethological parameters. No effects were detected on spatial recognition memory under either condition. In DTa, fifty-one compounds were detected by ultrahigh-performance liquid chromatography coupled to photodiode array and Orbitrap mass spectrometry (UHPLC-PDA-OT-MS/MS), of which forty-one were identified, including several caffeoylquinic acids, fatty acids, and characteristic eudesmane sesquiterpenoids. Several of these compounds have been previously associated with metabolic and neurobehavioral effects, providing further support for the pharmacological potential of DTa. Taken together, these findings highlight T. absinthioides as a promising source of bioactive phytocompounds with the potential to modulate glucose homeostasis and behavioral responses. Full article

Background and Objectives: Gestational diabetes mellitus (GDM) is usually diagnosed at 24–28 gestational weeks, although metabolic and placental alterations may emerge considerably earlier. This study evaluated whether routinely available first-trimester placental biomarkers, metabolic indices, and insulin-like growth factor (IGF)-axis components are associated with GDM diagnosed later in pregnancy and whether these markers provide complementary information across distinct biological domains. Materials and Methods: Of 200 women completing the 75-g OGTT (34 with GDM and 166 normoglycemic), deferred IGF-1 and IGFBP-5 assays were performed in a complete-biomarker analytic cohort of 90 participants with complete clinical follow-up and available stored specimens (30 GDM and 60 controls). At 11+0–13+6 weeks, pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (free β-hCG), IGF-1, IGF-binding protein-5 (IGFBP-5), fasting glucose, insulin, and lipid parameters were assessed. HOMA-IR, the triglyceride–glucose (TyG) index, TG/HDL-C, and LDL/HDL-C were calculated. GDM was diagnosed using a 75-g oral glucose tolerance test at 24–28 weeks. Group comparisons, correlation analyses, and logistic regression were performed. Results: Compared with controls, women who later developed GDM had higher first-trimester insulin, HOMA-IR, triglycerides, VLDL-C, TyG, and TG/HDL-C and lower HDL-C, free β-hCG, PAPP-A, PAPP-A MoM, and IGF-1 (all p < 0.05). Birth weight was also higher in the GDM group. Correlation patterns differed between groups, suggesting distinct relationships among placental, metabolic, and IGF-related markers. In the four-variable adjusted model, higher HOMA-IR (OR 2.123, 95% CI 1.089–4.137; p = 0.027) and TyG (OR 3.747, 95% CI 1.010–13.894; p = 0.048) were associated with increased GDM odds, whereas free β-hCG MoM (OR 0.325, 95% CI 0.115–0.920; p = 0.034) and IGF-1 (OR 0.856, 95% CI 0.748–0.980; p = 0.024) showed inverse associations. Conclusions: Pregnancies that subsequently developed GDM showed detectable first-trimester differences across metabolic, placental, and IGF-related pathways. The combined pattern supports further evaluation of multidomain early-risk assessment, although clinical predictive utility requires validation in larger independent cohorts. Full article

Administrative labels such as “organic” or “pasture-fed” animal food products inadequately capture the biological complexity of dairy production systems and consequently fail to differentiate potentially meaningful associations with nutritional quality, environmental impact and consumers’ health. We developed a functional classification framework based on three measurable traits: (1) botanical diversity, (2) concentrate dependence, and (3) input intensity, and applied it to six observational and/or experimental studies from tropical Mexico (n = 109 farms across Yucatán, Chiapas, and Colima federal states). Animal production systems were categorized as: (a) biodiverse grazing (silvopastoral, organic, or traditional grazing; >15 plant species or 8–14 species with concentrate < 25% dry matter intake and no synthetic inputs) or (b) conventional (monoculture/indoor systems; <5 plant species or 6–10 species with concentrate >40% with a use of agrochemicals). Biodiverse grazing systems produced lower daily milk yields (6.1 vs. 7.7 L d⁻¹; p < 0.0001) but yielded milk with more favorable cardiovascular lipid indices: atherogenic index (AI: 1.6–2.2 vs. 1.9–2.5), thrombogenic index (TI: 2.3–2.7 vs. 2.3–3.1), and health promotion index (HPI: 0.46–0.67 vs. 0.40–0.54). Artisan cheese from biodiverse systems contained substantially higher concentrations of tocopherols (127 vs. 77 mg 100 g⁻¹ DM) and monoterpenes (460–475 vs. 111–126 ng kg⁻¹). An intensive silvopastoral system reduced enteric methane emissions by 18.2% (376 vs. 460 g d⁻¹; p < 0.05) and by 21.3% per unit dry matter intake (24.0 vs. 30.5 g kg⁻¹ DMI; p < 0.0001). Forage nutritional quality (crude protein, neutral detergent fiber, acid detergent fiber) varied by species and season, with these parameters influencing estimated methane emissions. In a C57BL/6 murine model of high-fat diet-induced obesity, milk from biodiverse silvopastoral systems attenuated body weight gain (30.5 vs. 36.8 g; p < 0.05), preserved glucose tolerance (AUC: 32,616 vs. 45,248), nearly eliminated hepatic macrovesicular steatosis, and promoted smaller adipocyte size (1863 vs. 3880 µm²; p < 0.05) compared with conventional milk. These findings suggest that functional ecological traits provide a useful framework for evaluating dairy systems, with biodiverse grazing offering a potential convergence of environmental sustainability and preclinical health benefits. Nevertheless, external validation across diverse tropical regions and direct human intervention trials remain necessary to establish generalizability, and the associations identified should be considered hypothesis-generating rather than confirmatory. Full article

Cardiovascular–kidney–metabolic (CKM) syndrome is driven by the interplay of visceral adiposity, insulin resistance, chronic inflammation, oxidative stress, and progressive kidney dysfunction. These mechanisms generate a distinct atherogenic dyslipidaemic phenotype characterised by elevated triglycerides (TG), reduced high-density lipoprotein-cholesterol (HDL-C), increased apolipoprotein B (apoB)-containing lipoproteins, remnant cholesterol (RC) accumulation, small dense low-density lipoprotein (LDL) particles, and frequently elevated lipoprotein(a) [Lp(a)]. Such lipid abnormalities contribute to accelerated atherosclerosis and early renal deterioration. In turn, kidney dysfunction further amplifies lipid abnormalities. These pathways underscore the need for a timely and comprehensive lipid assessment using apoB, non-HDL-C, RC, and Lp(a) within the CKM framework. Effective lipid management is crucial for CKM syndrome treatment, with the potential to reduce residual cardiovascular and renal risk and improve long-term clinical outcomes. In this narrative review, we examine current evidence on the pathophysiological mechanisms underlying CKM-related dyslipidaemia and provide a practical framework for its assessment and management. Management requires a multimodal approach tailored to the patient’s lipid phenotype and overall cardiovascular risk, incorporating a range of lipid-lowering strategies including statins, ezetimibe, PCSK9 inhibitors, bempedoic acid, fibrates, icosapent ethyl, and emerging therapies targeting apoC-III, ANGPTL3, and Lp(a). Beyond lipid lowering, lifestyle interventions and cardiometabolic therapies such as glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and finerenone may provide complementary cardiometabolic and renal protection. Full article

(1) Background: Reference-interval flags read a lipid–glucose panel one analyte at a time. We asked whether a routine five-analyte panel supports reproducible, transportable, auditable descriptive grouping of laboratory profiles. (2) Methods: Retrospective analysis of 21,832 laboratory-order records (adults; glucose, total cholesterol, triglycerides, HDL-C, LDL-C; collection dates not exported) from purchasers of a screening panel in Kazakhstan: log transform, robust scaling, PCA, K-means; eight cluster-number criteria; bootstrap recovery with and without pipeline refitting; frozen-classifier transfer to an identifier-disjoint cohort ($n=\mathrm{11,382}$) with de novo re-derivation; a fully specified reference-interval rule layer. No clinical endpoints were available. (3) Results: Four descriptive laboratory-pattern clusters (lower glucose and lipids; higher LDL-C/TC; higher triglycerides, lower HDL-C; marked hyperglycaemia) had bootstrap Jaccard 0.965–0.981 with and without pipeline refitting and were re-derived independently in the validation cohort (ARI 0.82); a five-cluster configuration was not (0.33). Prevalence-shift point estimates were within 5 percentage points (post hoc exploratory benchmark; the C1 interval slightly crossed it). Rule-based reconciliation changed the delivered category of 8.2% of records from their K-means label; flags alone reproduced 77% of reports but 30% of the triglyceride–HDL-C pattern. (4) Conclusions: The panel supports a stable descriptive partition; prognostic and clinical validity remain to be shown. Full article

Gestational diabetes mellitus (GDM) is a common pregnancy complication, with inflammation and oxidative stress playing a significant role in its pathogenesis. Therefore, this study evaluated the effects of vildagliptin on metabolic, hormonal, inflammatory, and oxidative stress parameters in an STZ-induced GDM model. Rats were divided into five groups: control, GDM, GDM + V10, GDM + V20 and GDM + V30. High blood glucose levels were observed in the GDM group, while a slight decrease was observed in the vildagliptin groups. While GLP-1 levels decreased in the GDM group, they increased in the GDM + V20 and GDM + V30 groups. Overall, an increase in pro-inflammatory cytokines and a decrease in anti-inflammatory cytokines were observed in the GDM group, while vildagliptin administration reversed these effects. Among the vildagliptin groups, IL-10 was found to be lowest and IL-6 highest in the GDM + V20 group. Although fluctuations were generally observed in oxidative stress markers, the highest MDA levels and the lowest GSH levels were found in the GDM + V20 group. In the GDM group, FW and PE were lower, and PW was higher. In contrast, FW and PE were higher, and PW was lower in the GDM + V30 group than in the GDM group. The best results were obtained at a dose of 30 mg/kg; however, further research is needed to confirm this effect. Full article

Background/Objectives: Chronic kidney disease (CKD) is a major cause of morbidity and mortality. Evidence on routine management and patient-reported outcomes in Greece is limited. The SPIRIT study assessed real-world treatment patterns, disease management, and quality of life (QoL) among CKD patients in Greece. Methods: This was a prospective, multicenter, observational study in Outpatient Nephrology Clinics of fifteen National Health System (NHS) Hospitals in Greece enrolling adults with estimated glomerular filtration rate (eGFR) calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation (CKD-EPI eGFR) between 15 and <60 mL/min/1.73 m², with a 12-month follow-up. Results: A total of 305 CKD patients participated in the study (40.0% classified as stage G3a, 39.0% G3b, and 21.0% G4), with a mean age of 69.3 years. Antihypertensives were administered to 84.3%, 84.1%, and 85.1% of patients at baseline, 6, and 12 months, respectively, mostly calcium channel blockers, while lipid-lowering agents were administered to 63.3%, 64%, and 63.2% at baseline, 6, and 12 months, respectively, predominantly statins (95.3%, 95.9%, and 96.5% of lipid-lowering users). Interestingly, renin-angiotensin-aldosterone system (RAAS) inhibitors were administered to a total of 160 patients, 91.9% of whom had hypertension, while sodium-glucose cotransporter 2 (SGLT2) inhibitors were administered to 45 patients, with 66.7% of them suffering from CKD and type 2 diabetes. SGLT2i use increased from 15.3% at baseline to 35.4% at 12 months. Mean CKD-EPI eGFR remained stable (mean 40.1, 41.3, and 40.7 mL/min/1.73 m²), while median urine albumin-to-creatinine ratio (UACR) increased from 145.2 mg/g at baseline to 253.4 mg/g at 6 months and 246.6 mg/g at 12 months. Statistically significant improvements (p < 0.05) were observed between 6 and 12 months in specific domains of the Kidney Disease QoL-Short Form (KDQOL-SF) v1.3. Conclusions: The study provides real-world evidence on stage-related treatment patterns, routine management, and QoL in CKD outpatients in Greece. Full article