Evidence map›Paper›PMID 41921787›Full record

ReviewClinical medicine (London, England)2026

Renin-angiotensin system inhibitors (RASi) are not nephrotoxic - they protect the kidneys and the heart.

Jonathan S Murray, Paul R Kalra, Lisa J Anderson, Nicholas M Selby, Simon Sawhney, William S McKane, Marlies Ostermann, Nitin V Kolhe, Stephen J McWilliam, Karen Nagalingam and 14 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Clinical medicine (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. Article
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

24 authors.

Jonathan S MurraySouth Tees Hospitals NHS Foundation Trust, Middlesbrough TS4 3BW, UK; School of Health & Life Sciences, Centuria Building, Teesside University, Middlesbrough TS1 3BX, UK. Electronic address: jonathan.murray2@nhs.net.
Paul R KalraDept Cardiology, Portsmouth Hospitals University NHS Trust, Cosham PO6 3LY, UK; Faculty of Science and Health, University of Portsmouth, Portsmouth, UK. Electronic address: p.kalra@nhs.net.
Lisa J AndersonSt George's University Hospitals NHS Foundation Trust and City St George's University of London, UK. Electronic address: lisa.anderson@stgeorges.nhs.uk.
Nicholas M SelbyCentre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, UK. Electronic address: Nicholas.Selby@nottingham.ac.uk.
Simon SawhneyCentre for Biostatistics and Health Data Science, Polwarth Building, University of Aberdeen, AB25 2ZD, UK. Electronic address: simon.sawhney@abdn.ac.uk.
William S McKaneSheffield Teaching Hospitals NHSFT, Sheffield S5 7AU, UK. Electronic address: william.mckane@nhs.net.
Marlies OstermannKing's College London, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK. Electronic address: marlies.ostermann@kcl.ac.uk.
Nitin V KolheDepartment of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK. Electronic address: nitin.kolhe@nhs.net.
Stephen J McWilliamDepartment of Women's and Children's Health, University of Liverpool, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK. Electronic address: stevemcw@liverpool.ac.uk.
Karen NagalingamLister Hospital, East and North Hertfordshire NHS Trust, Corey Mill Lane, Stevenage SG1 4AJ, UK. Electronic address: k.l.nagalingam@herts.ac.uk.
Shelagh BickertonRoyal Wolverhampton NHS Trust, WV10 0QP, UK. Electronic address: shelagh.bickerton@nhs.net.
Andrew J P LewingtonSt. James's University Hospital, Leeds LS9 7TF, UK; National Institute for Health and Care Research (NIHR) HealthTech Research Centre, Leeds, UK. Electronic address: andrew.lewington@nhs.net.
William T HinchliffeCounty Durham and Darlington NHS Foundation Trust, University Hospital of North Durham, North Road, Durham DH1 5TW, UK. Electronic address: whinchliffe@nhs.net.
Simon J SmithSouth Tees Hospitals NHS Foundation Trust, Middlesbrough TS4 3BW, UK.
Michael WisePatient Representative.
Alan HancockPatient Representative.
Edward KingdonSussex Kidney Unit, University Hospitals Sussex NHSFT, Eastern Rd, Brighton, Brighton and Hove BN2 5BE, UK. Electronic address: ekingdon@nhs.net.
Paul CockwellDepartment of Nephrology, Queen Elizabeth Hospital, Mindlesohn Way, Birmingham B15 2WG, UK; College of Medical and Dental Sciences, University of Birmingham, B15 2TT, UK. Electronic address: Paul.Cockwell@uhb.nhs.uk.
Matthew T JamesDepartments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta T2N 4Z6, Canada. Electronic address: mjames@ucalgary.ca.
Thomas BlakemanCentre for Primary Care and Health Services Research, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester M13 9PL, UK. Electronic address: t.m.blakeman@manchester.ac.uk.
John D DeanEast Lancashire Hospitals NHS Trust, UK. Electronic address: Johndddean1@gmail.com.
Clare MorlidgeEast and North Herts NHS Teaching Trust, Pharmacy Department, Coreys Mill Lane, Stevenage SG1 4AB, UK. Electronic address: Claremorlidge@nhs.net.
Laurie A TomlinsonFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. Electronic address: laurie.tomlinson@lshtm.ac.uk.
Darren GreenSalford Care Organisation, Northern Care Alliance NHS Foundation Trust, UK; University of Manchester, Manchester, UK. Electronic address: darren.green@nca.nhs.net.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Healthcare professionals should not label medications as 'kidney toxins' unless this is actually the case, especially medications that instead confer clear prognostic benefit, such as renin-angiotensin system inhibitors (RASi). This is imperative when discussing treatments with people with long-term health conditions, for whom RASi significantly reduce death, progression of chronic kidney disease (CKD) and hospitalisation. RASi are fundamental to management of heart failure with reduced ejection fraction (HFrEF) and CKD with proteinuria, yet are frequently called 'nephrotoxic'. The association between RASi use and acute kidney injury (AKI) is too often mistaken for 'causation'; it is largely driven by the use of RASi to treat long-term conditions that increase AKI risk, such as HFrEF, CKD and diabetes mellitus. Mislabelling RASi as 'nephrotoxic' adversely affects vital decision making, driving a tendency for RASi avoidance, even when RASi use has clear prognostic benefit. Healthcare education must embed this clinically important change to convention.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsHeartKidneyRenin-Angiotensin SystemAcute Kidney InjuryHeart FailureHumansAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsHealthcare and patient educationHeart failureKidney diseaseMedicines safety

Identifiers

PMID41921787
PMCPMC13137178

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

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.