{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T18:43:49Z","timestamp":1773254629596,"version":"3.50.1"},"reference-count":52,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["MOST 111\u20102314\u2010B\u2010002\u2010082\u2010MY3"],"award-info":[{"award-number":["MOST 111\u20102314\u2010B\u2010002\u2010082\u2010MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      This nationwide cohort study examined the effects of discontinuation versus continuation of renin\u2013angiotensin system inhibitors (RASis) on major renal and cardiovascular outcomes after the estimated glomerular filtration rate (eGFR) decreased to below 45\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      in patients with type 2 diabetes and treated with RASis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using linked Taiwanese databases with claims and clinical data, we identified patients with type 2 diabetes who used RASis during 2016\u20132020, and either discontinued or continued RASis within 180\u2009days when their eGFR fell below 45\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      . The outcomes of interest included end\u2010stage renal disease (ESRD), myocardial infarction, stroke, heart failure, and all\u2010cause mortality. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for RASi discontinuation versus RASi continuation using on\u2010treatment and intention\u2010to\u2010treat analyses and inverse probability weighting to adjust for baseline and time\u2010varying covariates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 251\u2009853 eligible patients, of whom 37\u2009108 (15%) discontinued RASis and 214\u2009745 (85%) continued RASis. The on\u2010treatment HR associated with RASi discontinuation was 2.52 (95% CI, 2.33\u20132.73) for ESRD, 1.18 (1.08\u20131.30) for myocardial infarction, 1.28 (1.19\u20131.37) for stroke, 1.18 (1.13\u20131.24) for heart failure, and 1.77 (1.70\u20131.84) for all\u2010cause mortality. Results from the intention\u2010to\u2010treat analysis were similar, albeit more conservative. Findings remained consistent across eGFR strata (\u2265\u200930 to &lt;\u200945 and &lt;\u200930\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      ), urine albumin\u2010creatinine ratio categories (\u2265\u2009300 and &lt;\u2009300\u2009mg\/g), and patient subgroups with various baseline characteristics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Our results support continuing RASi treatment even when the eGFR declines to below 45\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      based on potential renal, cardiovascular, and survival benefits.\n                    <\/jats:p>\n                  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