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Paricasitol as a VDR agonist can inhibit ferroptosis by activating VDR/Nrf2/HO1 signaling pathway in DN, which effectively attenuates iron deposition in renal tubular epithelial cells and renal damage after diabetic injury [82]

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If muscle symptoms are severe or persistent despite these interventions, clinicians should consider laboratory evaluation including creatine kinase, comprehensive metabolic panel with separate magnesium and calcium testing, thyroid function tests, vitamin D levels, and vitamin B12 levels to exclude alternative diagnoses