Evidence map›Paper›PMID 40345511›Full record

ArticleThe American journal of medicine2025

Renin Angiotensin Inhibition and Lower Risk of Kidney Failure in Patients with Heart Failure.

Samir S Patel, Venkatesh K Raman, Sijian Zhang, Helen M Sheriff, Gregg C Fonarow, Paul A Heidenreich, Charles Faselis, Phillip H Lam, Charity J Morgan, Hans Moore and 13 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Samir S PatelVeterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Venkatesh K RamanVeterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Sijian ZhangVeterans Affairs Medical Center, Washington, DC.
Helen M SheriffVeterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Gregg C FonarowUniversity of California, Los Angeles.
Paul A HeidenreichVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif; Stanford University School of Medicine, Stanford, Calif.
Charles FaselisVeterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Uniformed Services University, Washington, DC.
Phillip H LamGeorgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC.
Charity J MorganVeterans Affairs Medical Center, Washington, DC; University of Alabama at Birmingham, Birmingham.
Hans MooreVeterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Georgetown University, Washington, DC; Uniformed Services University, Washington, DC.
David AtkinsVeterans Affairs Medical Center, Washington, DC.
Yan ChengVeterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Yijun ShaoVeterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Prakash DeedwaniaVeterans Affairs Medical Center, Washington, DC; University of California, San Francisco.
Carlos E PalantGeorge Washington University, Washington, DC.
Brian C SauerVeterans Affairs Medical Center, Salt Lake City, Utah; University of Utah, Salt Lake City.
Ravindra L MehtaUniversity of California San Diego, La Jolla.
Thomas E LoveCase Western Reserve University, Cleveland, Ohio.
Richard M AllmanGeorge Washington University, Washington, DC; University of Alabama at Birmingham, Birmingham; Wake Forest University, Winston-Salem, NC.
Michael S HeimallVeterans Affairs Medical Center, Washington, DC; HealthWell Foundation, Germantown, Md.
Wen-Chih WuVeterans Affairs Medical Center, Providence, RI; Brown University, Providence, RI.
Qing Zeng-TreitlerVeterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Ali AhmedVeterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Georgetown University, Washington, DC. Electronic address: ali.ahmed@va.gov.

Funding

HSRD VA I01 HX002422HSRD VA SDR 02-237
6 · The paper itself

Abstract

backgroundRenin-angiotensin system (RAS) inhibitors reduce risk of kidney failure in patients with chronic kidney disease, but worsen kidney function in heart failure patients, especially in those with chronic kidney disease. Less is known about risk of kidney failure in heart failure patients receiving RAS inhibitors.

methodsWe used propensity score matching for outcome-blinded assembly of 168,860 Veterans with heart failure phenotyped by artificial intelligence who were balanced on 77 baseline characteristics and initiated on RAS inhibitors. Hazard ratio (95% confidence interval [CI]) for 5-year kidney failure in high-dose (vs low-dose) RAS inhibitor group was estimated, accounting for competing risk of death. Kidney failure was defined as kidney replacement therapy or estimated glomerular filtration rate (eGFR) rate <15 mL/min/1.73 m

resultsNew-onset kidney failure occurred in 4.1% (3455/84,430) and 3.5% (2966/84,430) of patients in low-dose and high-dose RAS inhibitor groups, respectively (hazard ratio, 0.85; 95% CI, 0.81-0.89). Respective hazard ratios (95% CIs) in eGFR rate subgroups ≥60, 45-59, and 15-44 mL/min/1.73 m

conclusionsPatients with heart failure receiving high-dose (vs low-dose) RAS inhibitors had a lower associated risk of kidney failure, which was driven by the subgroup with chronic kidney disease. This new information may help to inform future guideline recommendations and clinical practice regarding RAS inhibitor use in these patients. Future studies need to examine this association in those with normal kidney function.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsHeart FailureRenal InsufficiencyRenin-Angiotensin SystemAgedFemaleGlomerular Filtration RateHumansMaleMiddle AgedPropensity ScoreRenal Insufficiency, ChronicAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsHeart failureKidney failureRAS inhibitors

Identifiers

PMID40345511
PMCPMC12844219

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.