{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:21:47Z","timestamp":1788168107038,"version":"build-2803163510"},"reference-count":35,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and hypothesis<\/jats:title>\n                    <jats:p>Evidence supporting renin\u2013angiotensin system (RAS) inhibition in dialysis-dependent patients with heart failure with reduced ejection fraction (HFrEF) remains limited. We performed a systematic review and meta-analysis to assess the efficacy and safety of angiotensin receptor\u2013neprilysin inhibitors (ARNIs) and angiotensin-converting enzyme inhibitors\/angiotensin receptor blockers (ACEis\/ARBs) in this population (PROSPERO ID: CRD420251274393).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Outcomes of interest included all-cause mortality and cardiovascular mortality. Eligible studies included adult patients with chronic HFrEF on maintenance hemodialysis or peritoneal dialysis, comparing ARNI versus non-ARNI regimens and ACEi\/ARB versus control regimens. Literature searches were conducted through December 2025 in PubMed, Embase, Google Scholar, and Web of Science. Hazard ratios (HRs) and their respective 95% confidence intervals (CIs) were pooled and meta-analyzed across studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, six studies evaluated ARNIs (3818 treated; 4344 controls), and three studies evaluated ACEis\/ARBs (3293 treated; 1982 controls). ARNI use versus non-ARNI regimens was associated with significantly lower all-cause mortality (pooled HR 0.78, 95% CI 0.71\u20130.87), as was ACEi\/ARB use versus placebo or no RAS blockade (pooled HR 0.76, 95% CI 0.68\u20130.84). ACEi\/ARB therapy was also associated with lower cardiovascular mortality (pooled HR 0.62, 95% CI 0.54\u20130.71), whereas no significant association was observed with ARNIs (pooled HR 0.91, 95% CI 0.79\u20131.04). Safety data were sparse and heterogeneous, precluding pooled analysis; among ARNI studies, no consistent excess hypotension was observed, and some studies suggested a lower risk of hyperkalemia versus ACEi\/ARB therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In dialysis-dependent patients with HFrEF, ARNI use versus non-ARNI regimens, and ACEi\/ARB use versus placebo or no RAS blockade, were each associated with lower all-cause mortality, while lower cardiovascular mortality was observed only with ACEi\/ARB therapy. These findings suggest a potential overall benefit of RAS inhibition in this population; however, they are derived predominantly from observational studies, remain susceptible to residual confounding, and should not be interpreted as demonstrating causal treatment effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfag184","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T11:48:43Z","timestamp":1786535323000},"source":"Crossref","is-referenced-by-count":0,"title":["Renin\u2013angiotensin system inhibition in dialysis-dependent patients with chronic heart failure due to reduced ejection fraction: a systematic review and meta-analysis"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0195-3792","authenticated-orcid":false,"given":"Aarthiga","family":"Sritharan","sequence":"first","affiliation":[{"name":"Division of Cardiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL) , Lausanne 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,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1027-1851","authenticated-orcid":false,"given":"Menno","family":"Pruijm","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Lausanne University Hospital (CHUV), University of Lausanne (UNIL) , Lausanne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2430-8953","authenticated-orcid":false,"given":"Philippe","family":"Meyer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Geneva University Hospital (HUG), University of Geneva , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3083-7333","authenticated-orcid":false,"given":"Pierre","family":"Monney","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Lausanne University Hospital (CHUV), 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