{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:11:44Z","timestamp":1777957904358,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Translational Sci"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Renin\u2013angiotensin\u2013aldosterone system inhibitors are widely prescribed for chronic kidney disease, but their causal effect on kidney function remains uncertain. This study investigated the impact of starting renin\u2013angiotensin blockade on renal function in adults with kidney disease. A retrospective cohort study was conducted in Korea using a quasi\u2010experimental staggered difference\u2010in\u2010differences design with propensity score matching to estimate time\u2010varying treatment effects. Overall, 1,204 adults (375 treated and 829 contemporaneous not\u2010yet\u2010treated controls) were followed for 3\u2009years. Initiation of angiotensin\u2010converting enzyme inhibitors or angiotensin II receptor blockers was recorded, and treatment exposure was categorized monthly. The primary outcome was a change in estimated glomerular filtration rate after initiation, evaluated over sequential intervals up to 12\u2009months. The overall average treatment effect of two\u2010way fixed effects model was not statistically significant (\u22121.47\u2009mL\/min\/1.73\u2009m\n                    <jats:sup>2<\/jats:sup>\n                    ;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.33). However, initiation was associated with an immediate and significant decline in eGFR at event time 0 (estimate: \u22123.87\u2009mL\/min\/1.73\u2009m\n                    <jats:sup>2<\/jats:sup>\n                    ,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05) and at event time 1 and 3 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Beyond these early intervals, there was no evidence of progressive deterioration in kidney function during the 1\u2010year follow\u2010up. Declines following initiation of renin\u2013angiotensin blockade are early, transient, and primarily hemodynamic in nature rather than reflective of structural kidney injury. Importantly, this quasi\u2010experimental analysis of real\u2010world data reproduced the findings of randomized trials, reinforcing current guideline recommendations to continue therapy in chronic kidney disease provided that reduction in filtration rate remains below the accepted threshold of 30%.\n                  <\/jats:p>","DOI":"10.1111\/cts.70533","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T03:45:43Z","timestamp":1774410343000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Causal Effects of Renin\u2013Angiotensin\u2013Aldosterone System Inhibition on Renal Function in Patients With Chronic Kidney Disease: A Quasi\u2010Experimental Study"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3713-0939","authenticated-orcid":false,"given":"Tae Ryom","family":"Oh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Mokpo Hankook Hospital  Mokpo Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4444-7261","authenticated-orcid":false,"given":"Jiyong","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Management Information Systems, Terry College of Business University of Georgia  Athens Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8191-4071","authenticated-orcid":false,"given":"Hong Sang","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Chonnam National University Medical School  Gwangju Korea"},{"name":"Department of Internal Medicine Chonnam National University Hospital  Gwangju Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6257-8551","authenticated-orcid":false,"given":"Harin","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Pusan National University School of Medicine  Yangsan Korea"},{"name":"Biomedical Research Institute Pusan National University Hospital  Busan Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9841-1139","authenticated-orcid":false,"given":"Gaeun","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Pharmacology Chonnam National University Medical School  Hwasun Korea"},{"name":"Division of Clinical Pharmacology Chonnam National University Hospital  Gwangju 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