3b:I[281230,["/_next/static/immutable/chunks/0l5c-zsrs2aic.js","/_next/static/immutable/chunks/3_n0rk2989-8h.js","/_next/static/immutable/chunks/3ofw495lt1gr1.js","/_next/static/immutable/chunks/3tofdpg99uc12.js","/_next/static/immutable/chunks/2rzojj6zgb9d9.js","/_next/static/immutable/chunks/42jxjvozn2thc.js","/_next/static/immutable/chunks/1jp6nkbajpbfs.js","/_next/static/immutable/chunks/3jn_lf7v27x-6.js","/_next/static/immutable/chunks/33qq2-hg37d0b.js","/_next/static/immutable/chunks/15isb0svrppbz.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/0asz50g5_lfq9.js","/_next/static/immutable/chunks/30ia-cxa0yoyc.js","/_next/static/immutable/chunks/3ghibkczd0agr.js","/_next/static/immutable/chunks/20mjl75wrar8n.js","/_next/static/immutable/chunks/3nxreg9fiyt2y.js","/_next/static/immutable/chunks/0c04lgvo3p78i.js","/_next/static/immutable/chunks/1u78gf_avpn77.js"],"PaperListPageClient"] 3e:I[70339,["/_next/static/immutable/chunks/355lxm8rh3fxr.js"],"IconMark"] 3c:T6e8,The renin-angiotensin-aldosterone system (RAAS) plays a central role in regulating renal hemodynamics, sodium and water balance, and cardiovascular homeostasis. Chronic RAAS activation contributes to hypertension, proteinuria, inflammation, fluid overload, and fibrosis, making RAAS blockade (RAASb) a cornerstone therapy across the kidney life cycle. Over the past decades, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid receptor antagonists have demonstrated substantial benefits in slowing chronic kidney disease (CKD) progression, reducing proteinuria, and lowering cardiovascular risk. However, the efficacy and safety of RAASb vary according to the kidney life cycle. Evidence supports its use in proteinuric CKD and even in advanced stages, whereas the benefit in non-proteinuric disease remains limited. Novel non-steroidal mineralocorticoid receptor antagonists such as finerenone further enhance renal and cardiovascular protection, particularly in persons with diabetes and CKD. In dialysis populations, RAASb may preserve residual kidney function improve cardiac structure/function, although the benefit of steroidal MRAs remains uncertain. In kidney transplantation, RAASb appears safe and may improve long-term graft and patient survival, particularly when initiated early. The emergence of SGLT2 inhibitors and GLP-1 receptor agonists has reshaped therapeutic strategies, with accumulating evidence supporting complementary rather than competing roles with RAASb. This review synthesizes current evidence on RAAS modulation across the kidney life cycle from primary prevention to advanced CKD, dialysis, and transplantation, highlighting both established benefits and areas of current clinical uncertainty.3d:T72c,ABSTRACT The renin–angiotensin–aldosterone system (RAAS) plays a central role in regulating renal hemodynamics, sodium and water balance, and cardiovascular homeostasis. Chronic RAAS activation contributes to hypertension, proteinuria, inflammation, fluid overload, and fibrosis, making RAAS blockade (RAASb) a cornerstone therapy across the kidney life cycle. Over the past decades, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid receptor antagonists (MRAs) have demonstrated substantial benefits in slowing chronic kidney disease (CKD) progression, reducing proteinuria, and lowering cardiovascular risk. However, the efficacy and safety of RAASb vary according to the kidney life cycle. Evidence supports its use in proteinuric CKD and even in advanced stages, whereas the benefit in non-proteinuric disease remains limited. Novel non-steroidal MRAs such as finerenone further enhance renal and cardiovascular protection, particularly in persons with diabetes and CKD. In dialysis populations, RAASb may preserve residual kidney function and improve cardiac structure/function, although the benefit of steroidal MRAs remains uncertain. In kidney transplantation, RAASb appears safe and may improve long-term graft and patient survival, particularly when initiated early. The emergence of SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists has reshaped therapeutic strategies, with accumulating evidence supporting complementary rather than competing roles with RAASb. This review synthesizes current evidence on RAAS modulation across the kidney life cycle from primary prevention to advanced CKD, dialysis, and transplantation, highlighting both established benefits and areas of current clinical uncertainty.28:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"ACE Inhibitor: Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on ACE Inhibitor (modality). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/modality/ACE%20Inhibitor\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Modalities\",\"item\":\"https://www.reachrx.ai/hub/tag/modality\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"ACE Inhibitor\",\"item\":\"https://www.reachrx.ai/hub/tag/modality/ACE%20Inhibitor\"}]}}"}}]],["$","$L3b",null,{"title":"ACE Inhibitor: Research & Clinical Takeaways","description":"Review evidence by treatment modality: ACE Inhibitor — concise summaries and practical next steps.","papers":[{"doi":"10.1016/j.cardfail.2026.09.036","pmid":"42925956","title":"Practical Prevention of Heart Failure Across Stages A and B: A Scientific Statement From the Japanese Heart Failure Society","journal_title":"Journal of Cardiac Failure","journal_issn":"1071-9164","published_at":"2026-10-24T00:00:00.000Z","url":"https://doi.org/10.1016/j.cardfail.2026.09.036","source_score":21,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-11-05T13:50:25.698Z","updated_at":"2026-11-05T13:50:25.698Z","tags":[{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"condition","value":"Atrial Fibrillation","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"condition","value":"Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"condition","value":"Diabetes Mellitus","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"condition","value":"Heart Failure","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"condition","value":"Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"condition","value":"Obesity","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"generic","value":"bisoprolol","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"generic","value":"canagliflozin","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"generic","value":"dapagliflozin","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"generic","value":"digoxin","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"generic","value":"empagliflozin","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"generic","value":"ramipril","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"generic","value":"semaglutide","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"generic","value":"tirzepatide","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"modality","value":"Angiotensin Receptor Blocker","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"modality","value":"Angiotensin Receptor-Neprilysin Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"modality","value":"GIP/GLP-1 Dual Receptor Agonist","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"modality","value":"Natriuretic Peptide Biomarker Screening","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"study_design","value":"Scientific Statement / Expert Consensus","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"warning","value":"Multiple authors report extensive financial relationships with pharmaceutical companies whose drugs are discussed in this statement, raising a potential conflict-of-interest concern","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"warning","value":"Several prevention recommendations are extrapolated from trials enrolling predominantly Western or non-Japanese populations, and the statement acknowledges direct Japan-specific evidence is often lacking","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2026.09.036","tag_type":"warning","value":"This statement is authored by a Japanese cardiovascular society and many recommendations are tailored to Japan's healthcare reimbursement system (e.g., UACR only reimbursed for diabetic nephropathy; finerenone not covered for non-diabetic CKD); applicability to other health systems requires local policy consideration","value_numeric":null}],"summaries":{"what_studied":"This scientific statement from the Japanese Heart Failure Society evaluated practical prevention strategies for patients with HF Stage A (at-risk) and Stage B (pre-HF), with emphasis on BNP/NT-proBNP-guided screening, disease-specific pharmacologic management, and collaborative care pathways between cardiologists and non-specialist physicians in Japan.","key_result":"BNP <35 pg/mL or NT-proBNP <125 pg/mL indicates low HF likelihood; levels at or above these thresholds signal Stage B and warrant cardiology referral. A Japanese community cohort found 17.9% of adults with NT-proBNP >55 pg/mL (but <125 pg/mL) progressed to NT-proBNP ≥125 pg/mL over 5 years, versus 4.2% of those with NT-proBNP ≤55 pg/mL. SGLT2 inhibitors, ACE inhibitors/ARBs, finerenone, and GLP-1 receptor agonists are recommended across relevant CKD/diabetes phenotypes; semaglutide reduced HF-related composite events in obese patients with atherosclerotic CVD (SELECT trial); early rhythm control in AF was associated with 57% lower incident HF risk versus antiarrhythmic drug therapy alone in one propensity-adjusted analysis.","limitations":"This is a consensus-based scientific statement, not a systematic review or meta-analysis; serial natriuretic peptide monitoring intervals are pragmatic rather than validated by prospective trials. Evidence gaps exist for several subgroups (e.g., non-diabetic CKD without proteinuria, asymptomatic reduced LVEF without prior MI). Many referenced trials were not conducted in Japanese populations, limiting direct generalizability.","practice_takeaway":"Measure BNP or NT-proBNP annually in Stage A patients and at least twice yearly in Stage B; refer to cardiology if levels meet or exceed threshold (BNP ≥35 pg/mL or NT-proBNP ≥125 pg/mL) for echocardiographic evaluation and optimization of preventive therapy. For patients with diabetes and/or CKD, combine ACE inhibitors/ARBs with SGLT2 inhibitors and consider adding finerenone or a GLP-1 receptor agonist based on CKD stage and comorbidity profile."}},{"doi":"10.1111/apt.70985","pmid":"42765157","title":"Medication Use and Risk of Microscopic Colitis: A Propensity‐Matched Analysis of US Adults ≥ 50 Years (2014–2024)","journal_title":"Alimentary Pharmacology & Therapeutics","journal_issn":"0269-2813","published_at":"2026-09-21T00:00:00.000Z","url":"https://doi.org/10.1111/apt.70985","source_score":9,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-26T13:50:03.054Z","updated_at":"2026-09-26T13:50:03.054Z","tags":[{"paper_doi":"10.1111/apt.70985","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"condition","value":"Microscopic Colitis","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Angiotensin Receptor Blocker","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Non-Steroidal Anti-Inflammatory Drug","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Statin","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"sample_size","value":"n=907266","value_numeric":907266},{"paper_doi":"10.1111/apt.70985","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"warning","value":"Exposure was defined as ≥3 prescriptions, which may not capture over-the-counter NSAID use, leading to possible exposure misclassification","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"warning","value":"MC diagnosis was based on administrative ICD codes, which may not reflect histologically confirmed cases — potentially inflating or diluting true associations","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"warning","value":"The study population is limited to U.S. adults ≥50 years with documented healthcare encounters, which may limit generalizability to younger patients or those with less healthcare access","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study used the TriNetX database (2014–2024) to evaluate whether NSAIDs, PPIs, SSRIs, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and statins are associated with incident microscopic colitis (MC) in U.S. adults ≥ 50 years, using 1:1 propensity score matching and Cox proportional hazards models over a 2-year follow-up.","key_result":"NSAIDs (HR 1.15; 95% CI 1.02–1.30), PPIs (HR 1.36; 95% CI 1.19–1.54), and SSRIs (HR 1.52; 95% CI 1.27–1.83) were each associated with significantly increased MC risk, while ACEIs, ARBs, and statins showed no significant association.","limitations":"The retrospective design using administrative diagnostic codes risks misclassification of MC (which requires biopsy confirmation); confounding by indication cannot be fully excluded despite propensity matching; and the study cannot establish causality or capture over-the-counter NSAID use systematically.","practice_takeaway":"In patients aged ≥ 50 presenting with new-onset chronic diarrhoea, clinicians should review current medications — particularly NSAIDs, PPIs, and SSRIs — as a potential contributing cause of microscopic colitis and consider withdrawal where clinically feasible."}},{"doi":"10.1093/eurheartj/ehag098","pmid":"42661426","title":"2026 ESC Guidelines for the management of cardiovascular disease and chronic kidney disease, in collaboration with the European Renal Association (ERA)","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-08-28T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehag098","source_score":365,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-02T06:22:32.576Z","updated_at":"2026-09-02T06:22:32.576Z","tags":[{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Atrial Fibrillation","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Venous Thromboembolism","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"generic","value":"apixaban","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"generic","value":"warfarin","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"modality","value":"Antiplatelet Therapy","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"modality","value":"Oral Factor Xa Inhibitor","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"modality","value":"Vitamin K Antagonist","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"study_design","value":"Clinical Practice Guideline / Evidence Tables","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"warning","value":"Many recommendations carry Level of Evidence C, meaning they rest on expert consensus or extrapolation rather than direct RCT evidence in CKD populations.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"warning","value":"Publication date listed in the document metadata (April 2026) differs slightly from the journal publication date (August 2026); the August 2026 date is used as provided.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"warning","value":"The document is labeled as 'Evidence Tables' (a supplement), not the full guideline text; some recommendations and their nuances may differ in the main guideline document.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"warning","value":"The full text of most pages was not extractable (blank pages 2–409 and beyond select tables); summaries are based only on the readable evidence table excerpts provided.","value_numeric":null}],"summaries":{"what_studied":"These are the 2026 ESC/ERA evidence tables supporting guidelines on managing cardiovascular disease (CVD) in patients with chronic kidney disease (CKD), covering topics including DAPT duration after PCI, ACE inhibitor use in ACS, anticoagulation for VTE, and anticoagulation for atrial fibrillation across CKD stages (eGFR <15 to 60 mL/min/1.73 m²).","key_result":"Key evidence-based recommendations include: (1) Abbreviated DAPT (1–3 months) is safe and reduces bleeding in CKD patients post-elective PCI (CoR IIa, LoE B2); (2) Early ACEi in ACS with eGFR >20 reduces all-cause mortality by ~7% (CoR IIa, LoE C); (3) DOACs (oral factor Xa inhibitors) are superior to warfarin for AF with eGFR 15–60 mL/min/1.73 m², reducing thromboembolic events (HR 0.86, 95% CI 0.78–0.95) and bleeding (HR 0.81, 95% CI 0.66–0.99); (4) Low-dose apixaban or VKA may be considered for VTE in eGFR <15 not on dialysis (CoR IIb, LoE C).","limitations":"Most CKD-specific evidence is derived from subgroup analyses, observational cohorts, and meta-analyses of trials that excluded advanced CKD; level of evidence for many recommendations is C (expert consensus/extrapolation). Residual confounding and high heterogeneity limit several conclusions.","practice_takeaway":"For CKD patients with AF and eGFR 15–60 mL/min/1.73 m², prefer oral factor Xa inhibitors over warfarin to cut stroke and bleeding risk. Use abbreviated DAPT (1 month) after elective PCI in high-bleeding-risk CKD patients, and start ACEi early after ACS if eGFR >20 mL/min/1.73 m²."}},{"doi":"10.1093/ndt/gfag184","pmid":"42584660","title":"Renin-Angiotensin System Inhibition in Dialysis-Dependent Patients with Chronic Heart Failure due to Reduced Ejection Fraction: A Systematic Review and Meta-Analysis","journal_title":"Nephrology Dialysis Transplantation","journal_issn":"0931-0509","published_at":"2026-08-12T00:00:00.000Z","url":"https://doi.org/10.1093/ndt/gfag184","source_score":24,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-19T06:28:54.888Z","updated_at":"2026-08-19T06:28:54.888Z","tags":[{"paper_doi":"10.1093/ndt/gfag184","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"condition","value":"End-Stage Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"condition","value":"Heart Failure with Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"generic","value":"sacubitril-valsartan","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"modality","value":"Angiotensin Receptor Blocker","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"modality","value":"Angiotensin Receptor-Neprilysin Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"modality","value":"Renin-Angiotensin System Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"sample_size","value":"n=13437","value_numeric":13437},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"warning","value":"Level of evidence rated '2' reflects the systematic review design, but the underlying studies are predominantly observational — causal inference is explicitly cautioned against by the authors.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"warning","value":"No specific ARNI brand or generic name is stated in the abstract; sacubitril-valsartan is inferred as the representative ARNI class agent.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"warning","value":"Sex distribution of the study population is not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag184","tag_type":"warning","value":"The total sample size (n=13,437) is approximated by summing treated and control groups across both ARNI and ACEi/ARB study pools; individual patient overlap between studies cannot be ruled out.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and meta-analysis evaluated the efficacy and safety of ARNIs and ACEi/ARBs versus control regimens in adult dialysis-dependent patients (hemodialysis or peritoneal dialysis) with chronic HFrEF, with outcomes of all-cause and cardiovascular mortality (literature searched through December 2025).","key_result":"ARNI vs. non-ARNI was associated with lower all-cause mortality (pooled HR 0.78, 95% CI 0.71–0.87); ACEi/ARB vs. placebo/no RAS blockade also reduced all-cause mortality (HR 0.76, 95% CI 0.68–0.84) and cardiovascular mortality (HR 0.62, 95% CI 0.54–0.71). ARNIs showed no significant benefit for cardiovascular mortality (HR 0.91, 95% CI 0.79–1.04). Safety data (ARNI studies only) showed no excess hypotension and a lower hyperkalemia risk vs. ACEi/ARBs.","limitations":"- Findings are derived predominantly from observational studies with high susceptibility to residual confounding, limiting causal inference.\n- Safety data were available only for ARNI studies, leaving ACEi/ARB safety largely uncharacterized in this population.\n- The meta-analysis pooled only 9 studies total, with relatively modest sample sizes for such a high-risk subgroup.","practice_takeaway":"RAS blockade with either ARNIs or ACEi/ARBs appears associated with lower mortality in dialysis-dependent HFrEF patients, but these are observational data — clinicians should weigh potential benefit against individual risk and avoid assuming causality. Hyperkalemia risk may favor ARNIs over ACEi/ARBs when RAS inhibition is pursued in this population."}},{"doi":"10.1093/ndt/gfag140","pmid":"42294943","title":"FINE-ONE, more to come: moving beyond ACEis and ARBs in type 1 diabetes with kidney disease?","journal_title":"Nephrology Dialysis Transplantation","journal_issn":"0931-0509","published_at":"2026-06-15T00:00:00.000Z","url":"https://doi.org/10.1093/ndt/gfag140","source_score":9,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-20T13:24:56.864Z","updated_at":"2026-06-20T13:24:56.864Z","tags":[{"paper_doi":"10.1093/ndt/gfag140","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"condition","value":"Type 1 Diabetes","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"modality","value":"Angiotensin Receptor Blocker","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"study_design","value":"Editorial","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"warning","value":"No sample size, outcomes, or drug-specific data could be extracted.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"warning","value":"Only bibliographic metadata was provided — no abstract, results, or methods text. All structured content is inferred from the title alone and may be incomplete or inaccurate.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"warning","value":"Study design classified as 'Editorial' based on the commentary-style title, but this cannot be confirmed without full text.","value_numeric":null}],"summaries":{"what_studied":"This appears to be an editorial or commentary evaluating the FINE-ONE trial and the potential role of therapies beyond ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) for kidney protection in type 1 diabetes with kidney disease.","limitations":"The source text provides only the title, DOI, journal, and publication date — no abstract, methods, results, or conclusions are available for extraction."}},{"doi":"10.1001/jama.2026.6214","pmid":"42207501","title":"Adverse Effects and Treatment Discontinuation of Blood Pressure–Lowering Drugs and Combinations","journal_title":"JAMA","journal_issn":"0098-7484","published_at":"2026-05-28T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13220152/","source_score":146,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-04T13:26:18.751Z","updated_at":"2026-07-04T13:26:18.751Z","tags":[{"paper_doi":"10.1001/jama.2026.6214","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"condition","value":"Hypertension","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"modality","value":"Angiotensin II Receptor Blocker","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"modality","value":"Beta-Blocker","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"modality","value":"Calcium Channel Blocker","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"modality","value":"Thiazide Diuretic","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"sample_size","value":"n=159362","value_numeric":159362},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"study_design","value":"Network Meta-Analysis of Randomized Controlled Trials","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"warning","value":"Impact flag 'practice_changing' applied because ARB-based regimens showing fewer discontinuations than placebo is a clinically striking and counterintuitive finding published in a high-impact journal, but clinicians should note the short follow-up caveat.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"warning","value":"Network meta-analysis relies on indirect comparisons and underlying statistical assumptions — individual patient-level variation is not captured.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.6214","tag_type":"warning","value":"The study spans short-term trials only (4–26 weeks; mean 8.6 weeks); long-term tolerability profiles may differ substantially.","value_numeric":null}],"summaries":{"what_studied":"This network meta-analysis of 716 double-blind RCTs (n=159,362; mean follow-up 8.6 weeks) evaluated adverse effects and treatment discontinuation due to adverse events (AEs) across 5 major BP-lowering drug classes — ACE inhibitors, ARBs, β-blockers, CCBs, thiazide/thiazide-like diuretics — and their combinations vs. placebo.","key_result":"CCBs (OR 1.43), ACE inhibitor + CCB (OR 1.46), and β-blocker + thiazide (OR 1.58) significantly increased discontinuation due to AEs vs. placebo. ARB monotherapy (OR 0.73; RD −0.8%) and ARB + CCB (OR 0.61; RD −1.2%) had significantly *fewer* discontinuations than placebo. All regimens increased dizziness; all except CCBs reduced headache vs. placebo.","limitations":"Follow-up was short (mean 8.6 weeks), limiting applicability to long-term tolerability. Results are trial-level and rely on network meta-analysis assumptions, which may not reflect individual patient experience. The study population (mean age 54.6 years, baseline BP 158/100 mmHg) may not represent all hypertensive patients.","practice_takeaway":"ARB-based regimens — especially ARB + CCB — are the best-tolerated options and may even reduce net symptom burden compared to placebo, making them strong candidates when tolerability drives treatment choice. CCB monotherapy and β-blocker + thiazide combinations carry the highest risk of AE-driven discontinuation and should be used with that trade-off in mind."}},{"doi":"10.1186/s12876-026-04935-x","pmid":"42204478","title":"ACE inhibitor–induced isolated intestinal angioedema mimicking functional bowel disorder: a case report","journal_title":"BMC Gastroenterology","journal_issn":"1471-230X","published_at":"2026-05-27T00:00:00.000Z","url":"https://doi.org/10.1186/s12876-026-04935-x","source_score":2,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-06T13:22:59.289Z","updated_at":"2026-06-06T13:22:59.289Z","tags":[{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"condition","value":"Angioedema","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"condition","value":"Essential Hypertension","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"condition","value":"Intestinal Angioedema","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"generic","value":"enalapril","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"generic","value":"losartan","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"modality","value":"Angiotensin Receptor Blocker","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"study_design","value":"Case Report","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"warning","value":"Diagnosis of intestinal angioedema was clinical; no imaging (e.g., CT showing bowel wall thickening) is mentioned in the abstract, limiting diagnostic certainty.","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"warning","value":"Single case report — findings should not be generalised without further evidence.","value_numeric":null},{"paper_doi":"10.1186/s12876-026-04935-x","tag_type":"warning","value":"The DOI year (2026) is consistent with the publication date provided; no discrepancy detected.","value_numeric":null}],"summaries":{"what_studied":"A case of ACE inhibitor–induced isolated intestinal angioedema in a 54-year-old Indian woman on enalapril 10 mg daily, presenting with recurrent abdominal pain, loose stools, and nausea over six weeks — without any cutaneous or oropharyngeal features — and initially misdiagnosed as acute gastroenteritis and then irritable bowel syndrome.","key_result":"Complete symptom resolution occurred after enalapril was withdrawn; causality was rated 'probable' by the Naranjo scale (score 7) and WHO-UMC criteria. Transition to losartan achieved sustained blood pressure control with no recurrence at 3 months.","limitations":"Single case report limits generalisability. Diagnosis was clinical (no imaging confirmation of bowel wall edema reported). Follow-up was only 3 months.","practice_takeaway":"In any patient taking an ACE inhibitor who has unexplained, treatment-refractory GI symptoms — even without skin or throat swelling — consider an empirical drug-withdrawal trial. Losartan (ARB) appears a safe alternative with no recurrence in this case."}},{"doi":"10.1016/j.jacc.2025.11.001","pmid":"42171544","title":"Optimization of Postpartum Care for Patients With and at Risk for Premature and Long-Term Cardiovascular Disease: 2026 ACC Expert Consensus Decision Pathway","journal_title":"JACC","journal_issn":"0735-1097","published_at":"2026-05-22T00:00:00.000Z","url":"https://doi.org/10.1016/j.jacc.2025.11.001","source_score":55,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-27T15:43:03.282Z","updated_at":"2026-05-27T15:43:03.282Z","tags":[{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Gestational Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Hypertensive Disorders of Pregnancy","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Postpartum Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"generic","value":"amlodipine","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"generic","value":"enalapril","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"generic","value":"labetalol","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"generic","value":"nifedipine","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"modality","value":"Beta Blocker","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"modality","value":"Calcium Channel Blocker","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"modality","value":"Remote Blood Pressure Monitoring","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"study_design","value":"Expert Consensus / Clinical Practice Toolkit","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"warning","value":"This document is a clinical toolkit and expert consensus statement, not a primary research study; level of evidence reflects expert opinion throughout. No sample size is applicable. The publication date in the DOI (2026-05-22) is consistent with the 2026 ACC Expert Consensus designation, though PDF metadata shows a 2024 creation date, suggesting the document was in preparation for some time before publication. BP titration targets in the fourth trimester are explicitly acknowledged by the authors as lacking high-quality trial evidence.","value_numeric":null}],"summaries":{"what_studied":"This ACC expert consensus toolkit provides a practical framework for establishing and operating postpartum hypertension clinics for individuals with hypertensive disorders of pregnancy (HDP), covering clinic models, staffing, BP management protocols, medication titration, remote monitoring, contraception, and cardiovascular risk counseling.","key_result":"Key guidance includes: start antihypertensives when BP ≥140/90 mmHg on 2+ occasions; target BP <140/90 mmHg early postpartum, then <130/80 mmHg long-term; first-line agents are nifedipine XL 30 mg daily, enalapril 5 mg daily, or amlodipine 5 mg daily (all safe with breastfeeding). Over 40% of patients with severe preeclampsia remain hypertensive at 1 year postpartum; the POP-HT RCT showed improved BP control with remote monitoring. HDP recurrence risk is ~21%.","limitations":"This is a consensus-based toolkit, not a systematic review or RCT; most specific numerical recommendations (e.g., BP titration intervals) are expert opinion, not derived from high-quality postpartum-specific trial data. Optimal BP targets throughout the fourth trimester are described as an 'evidence-free space.'","practice_takeaway":"Clinicians should schedule a BP check within 7–10 days of delivery for all HDP patients, initiate antihypertensives at BP ≥140/90 mmHg, and counsel every patient that HDP carries a cardiovascular risk comparable to smoking or diabetes. Telemedicine and remote BP monitoring improve retention and BP control; avoid combined hormonal contraceptives (estrogen-containing) in patients with uncontrolled hypertension (BP ≥160/100 mmHg)."}},{"doi":"10.1093/ndt/gfag090","pmid":"42008148","title":"RAAS blockade in the kidney life-cycle–treatment standard","journal_title":"Nephrology Dialysis Transplantation","journal_issn":"0931-0509","published_at":"2026-04-21T00:00:00.000Z","url":"https://doi.org/10.1093/ndt/gfag090","source_score":43,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-04-22","doi":"10.1093/ndt/gfag090","days":"30","issn":"0931-0509","rank":"3","field":"Clinical Medicine","score":"43","category":"Urology & Nephrology","categories":["Urology & Nephrology"],"_categories":["Urology & Nephrology"]},"pubmed":{"doi":"10.1093/ndt/gfag090","title":"RAAS blockade in the kidney Life-Cycle - Treatment Standard.","journal":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","methods":"","results":"","abstract":"$3c","keywords":["RAAS blockade","chronic kidney disease","dialysis","kidney transplantation"],"pubmed_id":"42008148","conclusions":"","publication_date":"2026-04-21T00:00:00"},"crossref":{"DOI":"10.1093/ndt/gfag090","URL":"https://doi.org/10.1093/ndt/gfag090","ISSN":["0931-0509","1460-2385"],"link":[{"URL":"https://academic.oup.com/ndt/advance-article-pdf/doi/10.1093/ndt/gfag090/68116033/gfag090.pdf","content-type":"application/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https://academic.oup.com/ndt/advance-article-pdf/doi/10.1093/ndt/gfag090/68116033/gfag090.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["RAAS blockade in the kidney life-cycle–treatment standard"],"author":[{"given":"Diego","family":"Moriconi","sequence":"first","affiliation":[{"name":"University of Pisa Department of Clinical and Experimental Medicine, , Pisa ,"},{"name":"AP-HP, Pharmacology Unit , Hopital Européen Georges Pompidou, Paris ,"}]},{"given":"Clara","family":"Garcia-Carro","sequence":"additional","affiliation":[{"name":"San Carlos University Clinical Hospital Nephrology Department, , Madrid ,"}]},{"given":"Julio","family":"Nuñez","sequence":"additional","affiliation":[{"name":"Hospital Clínico Universitario de Valencia, Fundación de Investigación INCLIVA Department of Cardiology, , Valencia ,"},{"name":"Universidad de Valencia, INCLIVA, CIBER Cardiovascular Department of Medicine, , Valencia ,"}]},{"given":"Ricardo","family":"Correa-Rotter","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Department of Nephrology and Mineral Metabolism, , Mexico City ,"}]},{"given":"Katherine","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Washington School of Medicine , Seattle, WA ,"},{"name":"Providence Medical Research Center , Providence Inland Northwest Health, Spokane, WA ,"}]},{"given":"María José","family":"Soler","sequence":"additional","affiliation":[{"name":"Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus Nephrology and Transplantation Research Group, Vall d’Hebron Institut de Recerca (VHIR), Nephrology Department, , Barcelona ,"},{"name":"Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS-2040)"}]}],"funder":[{"id":[{"id":"10.13039/100000002","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000002","name":"NIH","award":["R01MD014712"],"award-info":[{"award-number":["R01MD014712"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000002","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000002","name":"NIH","award":["U2CDK114886"],"award-info":[{"award-number":["U2CDK114886"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000002","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000002","name":"NIH","award":["UL1TR002319"],"award-info":[{"award-number":["UL1TR002319"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000002","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000002","name":"NIH","award":["U54DK083912"],"award-info":[{"award-number":["U54DK083912"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000002","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000002","name":"NIH","award":["U01DK100846"],"award-info":[{"award-number":["U01DK100846"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000002","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000002","name":"NIH","award":["OT2HL161847"],"award-info":[{"award-number":["OT2HL161847"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000002","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000002","name":"NIH","award":["UM1AI109568"],"award-info":[{"award-number":["UM1AI109568"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000002","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000002","name":"NIH","award":["OT2OD032581"],"award-info":[{"award-number":["OT2OD032581"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000030","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000030","name":"CDC","award":["75D301-21-P-12254"],"award-info":[{"award-number":["75D301-21-P-12254"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000030","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000030","name":"CDC","award":["75D301-23-C-18264"],"award-info":[{"award-number":["75D301-23-C-18264"]}],"doi-asserted-by":"publisher"},{"name":"Travere"},{"id":[{"id":"10.13039/100004326","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100004326","name":"Bayer","doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100000862","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000862","name":"Doris Duke Charitable Foundation","doi-asserted-by":"publisher"},{"name":"Benaroya Research Institute"},{"id":[{"id":"10.13039/100032489","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100032489","name":"Breakthrough T1D","doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/100022690","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100022690","name":"Juvenile Diabetes Research Foundation","doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/501100004587","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/501100004587","name":"Instituto de Salud Carlos III","award":["PI21/01292"],"award-info":[{"award-number":["PI21/01292"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/501100004587","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/501100004587","name":"Instituto de Salud Carlos III","award":["AC22/00029"],"award-info":[{"award-number":["AC22/00029"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/501100004587","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/501100004587","name":"Instituto de Salud Carlos III","award":["INT23/00078"],"award-info":[{"award-number":["INT23/00078"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/501100004587","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/501100004587","name":"Instituto de Salud Carlos III","award":["PI24/01510"],"award-info":[{"award-number":["PI24/01510"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/501100004587","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/501100004587","name":"Instituto de Salud Carlos III","award":["RD21/0005/31"],"award-info":[{"award-number":["RD21/0005/31"]}],"doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/501100004587","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/501100004587","name":"Instituto de Salud Carlos III","award":["RD24/0004/0031"],"award-info":[{"award-number":["RD24/0004/0031"]}],"doi-asserted-by":"publisher"},{"name":"Catalan Management Agency for University and Research","award":["2021 SGR 00883"],"award-info":[{"award-number":["2021 SGR 00883"]}]}],"issued":{"date-parts":[[2026,4,20]]},"member":"286","prefix":"10.1093","source":"Crossref","volume":null,"created":{"date-time":"2026-04-17T12:51:27Z","timestamp":1776430287000,"date-parts":[[2026,4,17]]},"indexed":{"date-time":"2026-05-09T09:18:43Z","timestamp":1778318323536,"date-parts":[[2026,5,9]]},"license":[{"URL":"https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model","start":{"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000,"date-parts":[[2026,4,20]]},"delay-in-days":0,"content-version":"am"}],"subject":[],"abstract":"$3d","language":"en","relation":{},"resource":{"primary":{"URL":"https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfag090/8659306"}},"subtitle":[],"deposited":{"date-time":"2026-05-09T09:07:08Z","timestamp":1778317628000,"date-parts":[[2026,5,9]]},"issn-type":[{"type":"print","value":"0931-0509"},{"type":"electronic","value":"1460-2385"}],"published":{"date-parts":[[2026,4,20]]},"publisher":"Oxford University Press (OUP)","reference":[{"DOI":null,"key":"2026050905065965600_bib1","year":"2025","issue":null,"author":"Fountain","volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":"10.1016/j.biopha.2017.07.091","key":"2026050905065965600_bib2","year":"2017","issue":null,"author":"Patel","volume":"94","first-page":"317","unstructured":null,"article-title":"Renin-angiotensin-aldosterone (RAAS): the ubiquitous system for homeostasis and pathologies","journal-title":"Biomed Pharmacother","doi-asserted-by":"publisher"},{"DOI":"10.1056/NEJMoa042167","key":"2026050905065965600_bib3","year":"2004","issue":null,"author":"Ruggenenti","volume":"351","first-page":"1941","unstructured":null,"article-title":"Preventing microalbuminuria in type 2 diabetes","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.1056/NEJMoa1007994","key":"2026050905065965600_bib4","year":"2011","issue":null,"author":"Haller","volume":"364","first-page":"907","unstructured":null,"article-title":"Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.2337/diacare.20.10.1576","key":"2026050905065965600_bib5","year":"1997","issue":null,"author":"Ahmad","volume":"20","first-page":"1576","unstructured":null,"article-title":"Effective postponement of diabetic nephropathy with enalapril in normotensive type 2 diabetic patients with microalbuminuria","journal-title":"Diabetes Care","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.kint.2023.10.018","key":"2026050905065965600_bib6","year":"2024","issue":null,"author":"Stevens","volume":"105","first-page":"S117","unstructured":null,"article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","journal-title":"Kidney Int","doi-asserted-by":"publisher"},{"DOI":"10.2337/dc25-S004","key":"2026050905065965600_bib7","year":"2025","issue":null,"author":null,"volume":"48","first-page":"S59","unstructured":null,"article-title":"4. Comprehensive medical evaluation and assessment of comorbidities: standards of care in diabetes-2025","journal-title":"Diabetes Care","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.kint.2025.04.005","key":"2026050905065965600_bib8","year":"2025","issue":null,"author":"Ortiz","volume":"108","first-page":"555","unstructured":null,"article-title":"Preventing chronic kidney disease and maintaining kidney health: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference","journal-title":"Kidney Int","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.kint.2020.11.003","key":"2026050905065965600_bib9","year":"2021","issue":null,"author":"Cheung","volume":"99","first-page":"S1","unstructured":null,"article-title":"KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease","journal-title":"Kidney Int","doi-asserted-by":"publisher"},{"DOI":null,"key":"2026050905065965600_bib10","year":"2025","issue":null,"author":"Mhmndar","volume":"17","first-page":"e78845","unstructured":null,"article-title":"Comparative efficacy and safety of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers in hypertensive patients with chronic kidney disease: a systematic review","journal-title":"Cureus","doi-asserted-by":null},{"DOI":"10.7326/0003-4819-135-2-200107170-00007","key":"2026050905065965600_bib11","year":"2001","issue":null,"author":"Jafar","volume":"135","first-page":"73","unstructured":null,"article-title":"Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data","journal-title":"Ann Intern Med","doi-asserted-by":"publisher"},{"DOI":"10.1056/NEJMoa011161","key":"2026050905065965600_bib12","year":"2001","issue":null,"author":"Brenner","volume":"345","first-page":"861","unstructured":null,"article-title":"Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.ahj.2008.01.031","key":"2026050905065965600_bib13","year":"2008","issue":null,"author":"Balamuthusamy","volume":"155","first-page":"791","unstructured":null,"article-title":"Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis","journal-title":"Am Heart J","doi-asserted-by":"publisher"},{"DOI":"10.1001/jama.285.21.2719","key":"2026050905065965600_bib14","year":"2001","issue":null,"author":"Agodoa","volume":"285","first-page":"2719","unstructured":null,"article-title":"Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial","journal-title":"JAMA","doi-asserted-by":"publisher"},{"DOI":"10.1056/NEJMoa0910975","key":"2026050905065965600_bib15","year":"2010","issue":null,"author":"Appel","volume":"363","first-page":"918","unstructured":null,"article-title":"Intensive blood-pressure control in hypertensive chronic kidney disease","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.1161/HYPERTENSIONAHA.124.23184","key":"2026050905065965600_bib16","year":"2024","issue":null,"author":"Shulman","volume":"81","first-page":"2082","unstructured":null,"article-title":"Cardiac effects of renin-angiotensin system inhibitors in nonproteinuric CKD","journal-title":"Hypertension","doi-asserted-by":"publisher"},{"DOI":"10.7326/M23-3236","key":"2026050905065965600_bib17","year":"2024","issue":null,"author":"Ku","volume":"177","first-page":"953","unstructured":null,"article-title":"Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers for advanced chronic kidney disease : a systematic review and retrospective individual participant-level meta-analysis of clinical trials","journal-title":"Ann Intern Med","doi-asserted-by":"publisher"},{"DOI":null,"key":"2026050905065965600_bib18","year":"2024","issue":null,"author":"Vendeville","volume":"40","first-page":"1718","unstructured":null,"article-title":"Clinical outcomes of renin-angiotensin-aldosterone blockade in patients with advanced chronic kidney disease: a systematic review and meta-analysis","journal-title":"Can J Cardiol","doi-asserted-by":null},{"DOI":"10.1016/j.kint.2023.09.012","key":"2026050905065965600_bib19","year":"2024","issue":null,"author":"Bhandari","volume":"105","first-page":"200","unstructured":null,"article-title":"Evaluation of the stopping angiotensin converting enzyme inhibitor compared to angiotensin receptor blocker (STOP ACEi trial) in advanced and progressive chronic kidney disease","journal-title":"Kidney Int","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.xkme.2020.04.002","key":"2026050905065965600_bib20","year":"2020","issue":null,"author":"Burnier","volume":"2","first-page":"231","unstructured":null,"article-title":"Renin-angiotensin system blockade in advanced kidney disease: stop or continue?","journal-title":"Kidney Med","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.hipert.2023.11.005","key":"2026050905065965600_bib21","year":"2024","issue":null,"author":"García-Prieto","volume":"41","first-page":"95","unstructured":null,"article-title":"Renin-angiotensin-aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial","journal-title":"Hipertension y Riesgo Vasc","doi-asserted-by":"publisher"},{"DOI":null,"key":"2026050905065965600_bib22","year":"2024","issue":null,"author":"Bakris","volume":"406","first-page":"2449","unstructured":null,"article-title":"Effective postponement of diabetic nephropathy with enalapril in normotensive type 2 diabetic patients with microalbuminuria","journal-title":"N Engl J Med","doi-asserted-by":null},{"DOI":"10.1056/NEJMoa2025845","key":"2026050905065965600_bib23","year":"2020","issue":null,"author":"Bakris","volume":"383","first-page":"2219","unstructured":null,"article-title":"Effect of Finerenone on chronic kidney disease outcomes in Type 2 diabetes","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.1093/ckj/sfac234","key":"2026050905065965600_bib24","year":"2022","issue":null,"author":"Agarwal","volume":"16","first-page":"293","unstructured":null,"article-title":"A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease","journal-title":"Clin Kidney J","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.nefroe.2023.12.002","key":"2026050905065965600_bib25","year":"2023","issue":null,"author":"Ortiz","volume":"43","first-page":"765","unstructured":null,"article-title":"Consensus document on the management of hyperkalemia","journal-title":"Nefrología (English Edition)","doi-asserted-by":"publisher"},{"DOI":"10.1016/S0140-6736(25)02014-8","key":"2026050905065965600_bib26","year":"2025","issue":null,"author":"Heerspink","volume":"406","first-page":"2449","unstructured":null,"article-title":"Balcinrenone in combination with dapagliflozin compared with dapagliflozin alone in patients with chronic kidney disease and albuminuria: a randomised, active-controlled double-blind, phase 2b clinical trial","journal-title":"Lancet","doi-asserted-by":"publisher"},{"DOI":"10.1093/ndt/gfae132","key":"2026050905065965600_bib27","year":"2025","issue":null,"author":"Heerspink","volume":"40","first-page":"308","unstructured":null,"article-title":"Design and baseline characteristics of the Finerenone, in addition to standard of care, on the progression of kidney disease in patients with Non-Diabetic Chronic Kidney Disease (FIND-CKD) randomized trial","journal-title":"Nephrol Dialysis Transplant","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.ekir.2025.07.039","key":"2026050905065965600_bib28","year":"2025","issue":null,"author":"Sun","volume":"10","first-page":"3694","unstructured":null,"article-title":"Finerenone as a nonsteroidal mineralocorticoid receptor antagonist for lupus nephritis","journal-title":"Kidney Int Rep","doi-asserted-by":"publisher"},{"DOI":"10.1093/eurheartj/ehab777","key":"2026050905065965600_bib29","year":"2022","issue":null,"author":"Agarwal","volume":"43","first-page":"474","unstructured":null,"article-title":"Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis","journal-title":"Eur Heart J","doi-asserted-by":"publisher"},{"DOI":"10.7326/M23-1023","key":"2026050905065965600_bib30","year":"2023","issue":null,"author":"Agarwal","volume":"176","first-page":"1606","unstructured":null,"article-title":"Impact of Finerenone-induced albuminuria reduction on chronic kidney disease outcomes in type 2 diabetes: a mediation analysis","journal-title":"Ann Intern Med","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.diabres.2023.110908","key":"2026050905065965600_bib31","year":"2023","issue":null,"author":"Heerspink","volume":"204","first-page":"110908","unstructured":null,"article-title":"Rationale and design of a randomised phase III registration trial investigating finerenone in participants with type 1 diabetes and chronic kidney disease: the FINE-ONE trial","journal-title":"Diabetes Res Clin Pract","doi-asserted-by":"publisher"},{"DOI":"10.1186/S13063-024-08021-Z","key":"2026050905065965600_bib32","year":"2024","issue":null,"author":"Schaefer","volume":"25","first-page":"203","unstructured":null,"article-title":"Investigating the use of finerenone in children with chronic kidney disease and proteinuria: design of the FIONA and open-label extension studies","journal-title":"Trials","doi-asserted-by":"publisher"},{"DOI":"10.1038/s41591-024-03263-5","key":"2026050905065965600_bib33","year":"2024","issue":null,"author":"Hobbs","volume":"30","first-page":"3634","unstructured":null,"article-title":"Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial","journal-title":"Nat Med","doi-asserted-by":"publisher"},{"DOI":"10.1093/ckj/sfaf038","key":"2026050905065965600_bib34","year":"2025","issue":null,"author":"García-Carro","volume":"18","first-page":"sfaf038","unstructured":null,"article-title":"Does low-dose spironolactone increase cardiovascular protection in patients with chronic kidney disease?","journal-title":"Clin Kidney J","doi-asserted-by":"publisher"},{"DOI":"10.1056/NEJMoa1811744","key":"2026050905065965600_bib35","year":"2019","issue":null,"author":"Perkovic","volume":"380","first-page":"2295","unstructured":null,"article-title":"Canagliflozin and renal outcomes in Type 2 diabetes and nephropathy","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.1056/NEJMoa2024816","key":"2026050905065965600_bib36","year":"2020","issue":null,"author":"Heerspink","volume":"383","first-page":"1436","unstructured":null,"article-title":"Dapagliflozin in patients with chronic kidney disease","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.1056/NEJMoa2204233","key":"2026050905065965600_bib37","year":"2023","issue":null,"author":"Herrington","volume":"388","first-page":"117","unstructured":null,"article-title":"Empagliflozin in patients with chronic kidney disease","journal-title":"N Engl J Med","doi-asserted-by":"crossref"},{"DOI":"10.1056/NEJMoa2410659","key":"2026050905065965600_bib38","year":"2025","issue":null,"author":"Agarwal","volume":"393","first-page":"533","unstructured":null,"article-title":"Finerenone with Empagliflozin in chronic kidney disease and Type 2 diabetes","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.1038/s41598-023-43614-9","key":"2026050905065965600_bib39","year":"2023","issue":null,"author":"Ishibashi","volume":"13","first-page":"16373","unstructured":null,"article-title":"Renoprotective potential of concomittant medications with SGLT2 inhibitors and renin-angiotensin system inhibitors in diabetic nephropathy without albuminuria: a retrospective cohort study","journal-title":"Sci Rep","doi-asserted-by":"publisher"},{"DOI":"10.1056/NEJMoa2403347","key":"2026050905065965600_bib40","year":"2024","issue":null,"author":"Perkovic","volume":"391","first-page":"109","unstructured":null,"article-title":"Effects of Semaglutide on chronic kidney disease in patients with Type 2 diabetes","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.1038/s41591-024-03327-6","key":"2026050905065965600_bib41","year":"2025","issue":null,"author":"Apperloo","volume":"31","first-page":"278","unstructured":null,"article-title":"Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial","journal-title":"Nat Med","doi-asserted-by":"publisher"},{"DOI":"10.1053/j.ajkd.2015.10.011","key":"2026050905065965600_bib42","year":"2016","issue":null,"author":"Xie","volume":"67","first-page":"728","unstructured":null,"article-title":"Renin-angiotensin system inhibitors and kidney and cardiovascular outcomes in patients with CKD: a Bayesian network meta-analysis of randomized clinical trials","journal-title":"Am J Kidney Dis","doi-asserted-by":"publisher"},{"DOI":"10.34067/KID.0005852020","key":"2026050905065965600_bib43","year":"2021","issue":null,"author":"Tuttle","volume":"2","first-page":"254","unstructured":null,"article-title":"Clinical outcomes by albuminuria status with Dulaglutide versus insulin glargine in participants with diabetes and CKD: AWARD-7 exploratory analysis","journal-title":"Kidney360","doi-asserted-by":"publisher"},{"DOI":"10.1056/NEJMoa1603827","key":"2026050905065965600_bib44","year":"2016","issue":null,"author":"Marso","volume":"375","first-page":"311","unstructured":null,"article-title":"Liraglutide and cardiovascular outcomes in Type 2 diabetes","journal-title":"N Engl J Med","doi-asserted-by":"publisher"},{"DOI":"10.1001/jamanetworkopen.2022.1169","key":"2026050905065965600_bib45","year":"2022","issue":null,"author":"Chen","volume":"5","first-page":"e221169","unstructured":null,"article-title":"Association of glucagon-like peptide-1 receptor agonist vs dipeptidyl peptidase-4 inhibitor use with mortality among patients with Type 2 diabetes and advanced chronic kidney disease","journal-title":"JAMA Netw Open","doi-asserted-by":"publisher"},{"DOI":"10.1038/s41467-024-50199-y","key":"2026050905065965600_bib46","year":"2024","issue":null,"author":"Pan","volume":"15","first-page":"5912","unstructured":null,"article-title":"GLP-1 receptor agonists’ impact on cardio-renal outcomes and mortality in T2D with acute kidney disease","journal-title":"Nat Commun","doi-asserted-by":"publisher"},{"DOI":"10.1161/CIRCULATIONAHA.123.067584","key":"2026050905065965600_bib47","year":"2024","issue":null,"author":"Neuen","volume":"149","first-page":"450","unstructured":null,"article-title":"Estimated lifetime cardiovascular, kidney, and mortality benefits of combination treatment with SGLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal MRA compared with conventional care in patients with Type 2 diabetes and albuminuria","journal-title":"Circulation","doi-asserted-by":"publisher"},{"DOI":"10.1155/2020/6762029","key":"2026050905065965600_bib48","year":"2020","issue":null,"author":"Ding","volume":"2020","first-page":"6762029","unstructured":null,"article-title":"Effects of ACEIs and ARBs on the residual renal function in peritoneal dialysis patients: a meta-analysis of randomized controlled trials","journal-title":"Biomed Res Int","doi-asserted-by":"publisher"},{"DOI":"10.1046/j.1472-8206.2002.00127.x","key":"2026050905065965600_bib49","year":"2002","issue":null,"author":"Zannad","volume":"16","first-page":"353","unstructured":null,"article-title":"FOSIDIAL: a randomised placebo controlled trial of the effects of fosinopril on cardiovascular morbidity and mortality in haemodialysis patients. Study design and patients’ baseline characteristics","journal-title":"Fundam Clin Pharmacol","doi-asserted-by":"publisher"},{"DOI":"10.1093/ndt/gfac253","key":"2026050905065965600_bib50","year":"2023","issue":null,"author":"Georgianos","volume":"38","first-page":"203","unstructured":null,"article-title":"Effect of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on cardiovascular outcomes in dialysis patients: a systematic review and meta-analysis","journal-title":"Nephrol Dialysis Transplant","doi-asserted-by":"publisher"},{"DOI":"10.1093/ndt/gft515","key":"2026050905065965600_bib51","year":"2014","issue":null,"author":"Agarwal","volume":"29","first-page":"672","unstructured":null,"article-title":"Hypertension in hemodialysis patients treated with atenolol or lisinopril: a randomized controlled trial","journal-title":"Nephrol Dial Transplant","doi-asserted-by":"publisher"},{"DOI":"10.1159/000438821","key":"2026050905065965600_bib52","year":"2015","issue":null,"author":"Weir","volume":"40","first-page":"232","unstructured":null,"article-title":"Angiotensin converting enzyme inhibitor dialyzability and outcomes in older patients receiving hemodialysis","journal-title":"Blood Purif","doi-asserted-by":"publisher"},{"DOI":"10.3389/fmed.2022.828189","key":"2026050905065965600_bib53","year":"2022","issue":null,"author":"Liu","volume":"9","first-page":"828189","unstructured":null,"article-title":"Safety and efficacy of spironolactone in dialysis-dependent patients: meta-analysis of randomized controlled trials","journal-title":"Front Med","doi-asserted-by":"publisher"},{"DOI":"10.3389/FPHAR.2022.823530","key":"2026050905065965600_bib54","year":"2022","issue":null,"author":"Gou","volume":"13","first-page":"823530","unstructured":null,"article-title":"Association of mineralocorticoid receptor antagonists with the mortality and cardiovascular effects in dialysis patients: a meta-analysis","journal-title":"Front Pharmacol","doi-asserted-by":"publisher"},{"DOI":"10.1016/S0140-6736(25)01198-5","key":"2026050905065965600_bib55","year":"2025","issue":null,"author":"Walsh","volume":"406","first-page":"695","unstructured":null,"article-title":"Spironolactone versus placebo in patients undergoing maintenance dialysis (ACHIEVE): an international, parallel-group, randomised controlled trial","journal-title":"Lancet","doi-asserted-by":"publisher"},{"DOI":"10.1016/S0140-6736(25)01194-8","key":"2026050905065965600_bib56","year":"2025","issue":null,"author":"Rossignol","volume":"406","first-page":"705","unstructured":null,"article-title":"Spironolactone in patients on chronic haemodialysis at high risk of adverse cardiovascular outcomes (ALCHEMIST): a multicentre, double-blind, randomised, placebo-controlled trial and updated meta-analysis","journal-title":"Lancet","doi-asserted-by":"publisher"},{"DOI":"10.1016/S0140-6736(25)01153-5","key":"2026050905065965600_bib57","year":"2025","issue":null,"author":"Pyne","volume":"406","first-page":"811","unstructured":null,"article-title":"Safety and efficacy of steroidal mineralocorticoid receptor antagonists in patients with kidney failure requiring dialysis: a systematic review and meta-analysis of randomised controlled trials","journal-title":"Lancet","doi-asserted-by":"publisher"},{"DOI":null,"key":"2026050905065965600_bib58","year":"2024","issue":null,"author":"Kung","volume":"148","first-page":"744","unstructured":null,"article-title":"Impact of renin-angiotensin system blockade on mortality and allograft loss among renal transplant recipients: a systematic review and meta-analysis","journal-title":"Nephron","doi-asserted-by":null},{"DOI":"10.2215/CJN.04800908","key":"2026050905065965600_bib59","year":"2009","issue":null,"author":"Naesens","volume":"4","first-page":"481","unstructured":null,"article-title":"Calcineurin inhibitor nephrotoxicity","journal-title":"Clin J Am Soc Nephrol","doi-asserted-by":"publisher"},{"DOI":"10.1038/nrneph.2013.110","key":"2026050905065965600_bib60","year":"2013","issue":null,"author":"Brown","volume":"9","first-page":"459","unstructured":null,"article-title":"Contribution of aldosterone to cardiovascular and renal inflammation and fibrosis","journal-title":"Nat Rev Nephrol","doi-asserted-by":"publisher"},{"DOI":"10.2215/CJN.0000000000000439","key":"2026050905065965600_bib61","year":"2024","issue":null,"author":"Mortensen","volume":"19","first-page":"755","unstructured":null,"article-title":"Effect of spironolactone on kidney function in kidney transplant recipients (the SPIREN trial): a randomized placebo-controlled clinical trial","journal-title":"Clin J Am Soc Nephrol","doi-asserted-by":"publisher"},{"DOI":"10.2215/CJN.05300516","key":"2026050905065965600_bib62","year":"2017","issue":null,"author":"Medeiros","volume":"12","first-page":"1291","unstructured":null,"article-title":"Randomized controlled trial of mineralocorticoid receptor blockade in children with chronic kidney allograft nephropathy","journal-title":"Clin J Am Soc Nephrol","doi-asserted-by":"publisher"},{"DOI":"10.3389/fphar.2024.1522558","key":"2026050905065965600_bib63","year":"2024","issue":null,"author":"Fu","volume":"15","first-page":"1522558","unstructured":null,"article-title":"Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis","journal-title":"Front Pharmacol","doi-asserted-by":"crossref"},{"DOI":"10.2337/dc25-S009","key":"2026050905065965600_bib64","year":"2025","issue":null,"author":null,"volume":"48","first-page":"S181","unstructured":null,"article-title":"9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2025","journal-title":"Diabetes Care","doi-asserted-by":"publisher"}],"short-title":[],"article-number":"gfag090","content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["Nephrology Dialysis Transplantation"],"reference-count":64,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,4,20]]},"references-count":64,"short-container-title":[],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1093/ndt/gfag090","is_oa":false,"title":"RAAS blockade in the kidney life-cycle–treatment standard","updated":"2026-05-10T08:57:56+00:00","published_date":"2026-04-17","best_oa_location":null}},"created_at":"2026-05-07T22:50:42.636Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1093/ndt/gfag090","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"End-Stage Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Hypertension","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Kidney Transplantation","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Proteinuria","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"Angiotensin Receptor Blocker","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"Direct Renin Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"warning","value":"No sample size is applicable as this is a review article; the sample_size tag has been omitted.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"warning","value":"The benefit of steroidal MRAs in dialysis patients is explicitly noted as uncertain; clinicians should interpret those recommendations cautiously.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"warning","value":"This is a narrative review ('Treatment Standard' article); no pooled statistics or original data are reported — all numerical conclusions reflect cited trial-level evidence.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates RAAS blockade (RAASb) — including ACE inhibitors, ARBs, direct renin inhibitors, and mineralocorticoid receptor antagonists — across the full kidney care continuum: primary prevention, proteinuric and non-proteinuric CKD, dialysis, and kidney transplantation, including interactions with SGLT2 inhibitors and GLP-1 receptor agonists.","key_result":"RAASb reduces proteinuria, slows CKD progression, and lowers cardiovascular risk, with strongest evidence in proteinuric CKD; novel non-steroidal MRAs (e.g., finerenone) add renal and cardiovascular protection in diabetic CKD; benefit in non-proteinuric disease is limited; in dialysis, RAASb may preserve residual kidney function and improve cardiac structure; in transplantation, early RAASb appears safe and may improve graft and patient survival.","limitations":"- Review article (not a meta-analysis or RCT); conclusions are synthesis-level and inherit the limitations of underlying studies.\n- Efficacy and safety data in dialysis populations and transplant recipients remain uncertain, particularly for steroidal MRAs in dialysis.\n- Evidence on optimal timing, agent selection, and combination with newer agents (SGLT2i, GLP-1 RA) across all lifecycle stages is still evolving.","practice_takeaway":"Use RAASb as first-line therapy in proteinuric CKD and consider adding finerenone in patients with diabetes and CKD for added renal and cardiovascular protection. In transplant recipients, early initiation of RAASb appears safe and may improve long-term outcomes; SGLT2 inhibitors and GLP-1 receptor agonists play a complementary — not competing — role alongside RAASb."}}],"initialOffset":9,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"ACE Inhibitor"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"ACE Inhibitor"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"ACE Inhibitor"}}}]] 2b:null

Papers

Papers