The DOI matches its Crossref record; the references it cites are not checked yet.
Estimated Effect of Restarting Renin-Angiotensin System Inhibitors after Discontinuation on Kidney Outcomes and Mortality
Open accessAbstract
Key Points: Restarting renin-angiotensin system inhibitor after discontinuation was associated with a lower risk of kidney outcomes and mortality but not related to hyperkalemia. Our findings support a proactive approach to restarting renin-angiotensin system inhibitor among patients with CKD. Background: While renin-angiotensin system inhibitors (RASi) have been the mainstream treatment for patients with CKD, they are often discontinued because of adverse effects such as hyperkalemia and AKI. It is unknown whether restarting RASi after discontinuation improves clinical outcomes. Methods: Using the Osaka Consortium for Kidney disease Research database, we performed a target trial emulation study including 6065 patients with an eGFR of 10–60 ml/min per 1.73 m 2 who were followed up by nephrologists and discontinued RASi between 2005 and 2021. With a clone-censor-weight approach, we compared a treatment strategy for restarting RASi within a year after discontinuation with that for not restarting RASi. Patients were followed up for 5 years at maximum after RASi discontinuation. The primary outcome was a composite kidney outcome (initiation of KRT, a ≥50% decline in eGFR, or kidney failure [eGFR <5 ml/min per 1.73 m 2 ]). Secondary outcomes were all-cause death and incidence of hyperkalemia (serum potassium levels ≥5.5 mEq/L). Results: Among those who discontinued RASi (mean [SD] age 66 [15] years, 62% male, mean [SD] eGFR 40 [26] ml/min per 1.73 m 2 ), 2262 (37%) restarted RASi within a year. Restarting RASi was associated with a lower hazard of the composite kidney outcome (hazard ratio [HR], 0.85; 95% confidence intervals [CIs], 0.78 to 0.93]) and all-cause death (HR, 0.70; 95% CI, 0.61 to 0.80) compared with not restarting RASi. The incidence of hyperkalemia did not differ significantly between the two strategies (HR, 1.11; 95% CI, 0.96 to 1.27). Conclusions: Restarting RASi after discontinuation was associated with a lower risk of kidney outcomes and mortality but not related to the incidence of hyperkalemia.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Hattori et al. (83) evaluated 6,065 participants between 2005 and 2021 (approximately 40% had diabetes) with eGFR ranging from 10 to 60 mL/min/1.73m 2 who had ACE inhibitors or ARBs stopped (usually due to hyperkalemia or AKI) and found that those who restarted the ACE inhibitor or ARB had better long-term kidney outcomes and lower mortality”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [83]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“(there was no significant difference in hyperkalemia in those who restarted ACE inhibitors or ARBs)”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [83]
The cited source says what the claim attributes to it.
In the citing paper
“Hattori et al. (91) evaluated 6,065 participants between 2005 and 2021 (∼40% had diabetes) with eGFR ranging from 10 to 60 mL/min/1.73m 2 who had ACE inhibitors or ARBs stopped (usually due to hyperkalemia or AKI) and found that those who restarted the ACE inhibitor or ARB had better long-term kidney outcomes and lower mortality (there was no significant difference in hyperkalemia in those who re”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [91]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
The citation lists haven’t been fetched yet
References 38 · Cited by 27
Metadata
- Authors
- Hattori, K., Sakaguchi, Y., Oka, T., Asahina, Y., Kawaoka, T., Doi, Y., Hashimoto, N., Kusunoki, Y., Yamamoto, S., Yamato, M., Yamamoto, R., Matsui, I., Mizui, M., Kaimori, J.-Y., & Isaka, Y.
- Affiliations
- The University of Osaka (JP)
- Osaka Prefectural Medical Center (JP)
- Toyonaka Municipal Hospital (JP)
- Ikeda Municipal Hospital (JP)
- Sakai City Medical Center (JP)
- Corresponding author
- Sakaguchi, Yusuke
- ORCID
- Venue
- Journal of the American Society of Nephrology
- Published
- 2024-06-18
- Volume
- 35
- Issue
- 10
- Pages
- 1391-1401
- ISSN
- 1046-6673 (ISSN-L)
- 1533-3450
- PMC
- PMC11452132
- OpenAlex
- W4399767378
- Semantic Scholar
- ed020f16eb2ace002a46febc5ff828f752373ea2
- Cited by
- 27
- References
- 38
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 3
- FWCI
- 7.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Society of Nephrology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion)
- OUKA (Osaka University Knowledge Archive) (Osaka University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- renin-angiotensin system inhibitors, chronic kidney disease, renal failure, all-cause mortality, hyperkalemia, acute kidney injury, renal replacement therapy, estimated glomerular filtration rate decline, target trial emulation, treatment strategy comparison, adverse drug reactions, nephrology follow-up
- MeSH terms
- Aged, Angiotensin-Converting Enzyme Inhibitors, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Renin-Angiotensin System, Treatment Outcome, Renal Insufficiency, Chronic, Angiotensin Receptor Antagonists
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
