ReviewKidney3602026
Angiotensin Receptor and Neprilysin Inhibitors in CKD: Opportunity or Concern?
Review in Kidney360, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled 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.
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.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Combined inhibition of neprilysin (NEP) and the angiotensin II receptor through angiotensin receptor-neprilysin inhibitors (ARNIs) has transformed heart failure management and is garnering increasing attention in nephrology. This article explores the renal role of NEP and critically reviews preclinical and clinical evidence on the use of ARNIs in CKD, following a bench-to-bedside approach. Experimental data show that NEP inhibition improves proteinuria, fibrosis, and endothelial function, with enhanced benefits when combined with renin-angiotensin-aldosterone system blockade. Randomized clinical trials in patients with heart failure (HF) (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Converting Enzyme inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF], Prospective Comparison Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin-Receptor Blockers Global Outcomes in Heart Failure with Preserved Ejection Fraction [PARAGON-HF], Prospective comparison of Angiotensin Receptor-neprilysin inhibitor with Angiotensin-Receptor Blockers Given following stabiLization In DEcompensated Heart Failure with preserved ejection fraction [PARAGLIDE-HF]) have demonstrated renal safety and potential benefit emerged in secondary end points and prespecified analysis. The only randomized clinical trial performed with primary kidney outcome, the UK Heart and Renal Protection III (HARP-III) trial, confirmed the tolerability of sacubitril/valsartan, and reported a significant reduction in proteinuria. No clear nephroprotective effect was observed; however, the trial design may not have been adequately structured to detect such an effect. On the other hand, real-world data indicate that ARNIs have an acceptable risk profile when patients are appropriately monitored, as renin-angiotensin-aldosterone system blockers. Moreover, the benefits of the treatment clearly outweigh the adverse effects. Therefore, sacubitril/valsartan may emerge as a promising therapeutic option in nephrology, especially in patients with cardiorenal disease, pending further trials to better define its role in CKD.
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What OpenQuestion holds
Registered trials
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.