{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:56:20Z","timestamp":1781639780434,"version":"3.54.5"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:00:00Z","timestamp":1772841600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":38,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP24K23264"],"award-info":[{"award-number":["JP24K23264"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Pharm Health Care Sci"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Concomitant use of renin\u2013angiotensin system inhibitors (RASIs), diuretics, and nonsteroidal anti-inflammatory drugs (NSAIDs), commonly referred to as the \u201ctriple whammy\u201d (TW), is known to increase the risk of acute kidney injury (AKI). However, the relative contribution of each drug component and the influence of their pharmacological subclasses remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A self-controlled case series (SCCS) study was conducted in Japan using a nationwide claims database (April 2014 to January 2024). Patients with at least one AKI episode (the International Classification of Diseases, 10th Edition code N17X) and prescriptions for RASIs, diuretics, or NSAIDs were included. The incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for AKI were estimated using conditional Poisson regression to compare the exposed and unexposed periods within individuals. Sensitivity analyses accounted for the time-varying nephrotoxic exposure to antibiotics, antiviral agents, and iodinated contrast media.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 92,880 eligible patients, 109,351 AKI events occurred during 129\u00a0million person-days of follow-up. The risk of AKI increased with the number of concomitant drug classes used. Concomitant use of two drug class combinations, that is, diuretics and NSAIDs, conferred the greatest risk, and during TW exposure, the risk was not significantly higher than that observed with diuretics and NSAIDs (IRR 1.01 [0.86\u20131.19]). The risk of AKI increased with both the number and type of diuretics used, with loop diuretics demonstrating the highest risk. No significant differences were found between angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, and the higher AKI risk observed with nonselective COX inhibitors compared with COX-2-selective agents disappeared after adjustment for time-dependent covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this nationwide SCCS study, the AKI risk associated with TW therapy was primarily driven by the concomitant use of diuretics and NSAIDs, rather than RASIs. The risk varied according to the number and type of diuretics used, emphasizing the importance of cautious prescription and close renal monitoring during periods of combined use of diuretics and NSAIDs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40780-026-00560-8","type":"journal-article","created":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T05:44:26Z","timestamp":1772862266000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Drug-specific risks of acute kidney injury associated with triple whammy therapy: a nationwide self-controlled case series study in Japan"],"prefix":"10.1186","volume":"12","author":[{"given":"Yuki","family":"Kunitsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rina","family":"Abe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiko","family":"Ikuta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Hira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsaku","family":"Nakagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Tsuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Terada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"560_CR1","doi-asserted-by":"publisher","first-page":"184","DOI":"10.5694\/j.1326-5377.2000.tb125548.x","volume":"172","author":"MC Thomas","year":"2000","unstructured":"Thomas MC, Diuretics. ACE inhibitors and NSAIDs\u2013the triple whammy. Med J Aust. 2000;172:184\u20135.","journal-title":"Med J Aust"},{"key":"560_CR2","doi-asserted-by":"publisher","first-page":"274","DOI":"10.5694\/j.1326-5377.2000.tb125642.x","volume":"173","author":"IW Boyd","year":"2000","unstructured":"Boyd IW, Mathew TH, Thomas MC. COX-2 inhibitors and renal failure: the triple whammy revisited. Med J Aust. 2000;173:274.","journal-title":"Med J Aust"},{"key":"560_CR3","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1111\/j.0306-5251.2004.2188.x","volume":"59","author":"KL Katarzyna","year":"2005","unstructured":"Katarzyna KL, Gillian MS. Drug combinations and impaired renal function \u2013 the \u2018triple whammy\u2019. Br J Clin Pharmacol. 2005;59:239\u201343.","journal-title":"Br J Clin Pharmacol"},{"key":"560_CR4","doi-asserted-by":"publisher","first-page":"e8525","DOI":"10.1136\/bmj.e8525","volume":"346","author":"F Lapi","year":"2013","unstructured":"Lapi F, Azoulay L, Yin H, Nessim SJ, Suissa S. Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: Nested case-control study. BMJ. 2013;346:e8525.","journal-title":"BMJ"},{"key":"560_CR5","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1038\/ki.2015.101","volume":"88","author":"T Dreischulte","year":"2015","unstructured":"Dreischulte T, Morales DR, Bell S, Guthrie B. Combined use of nonsteroidal anti-inflammatory drugs with diuretics and\/or renin-angiotensin system inhibitors in the community increases the risk of acute kidney injury. Kidney Int. 2015;88:396\u2013403.","journal-title":"Kidney Int"},{"key":"560_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7326\/0003-4819-133-1-200007040-00002","volume":"133","author":"SK Swan","year":"2000","unstructured":"Swan SK, Rudy DW, Lasseter KC, Ryan CF, Buechel KL, Lambrecht LJ, et al. Effect of cyclooxygenase-2 inhibition on renal function in elderly persons receiving a low-salt diet. A randomized, controlled trial. Ann Intern Med. 2000;133:1\u20139.","journal-title":"Ann Intern Med"},{"key":"560_CR7","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.nefroe.2015.05.010","volume":"35","author":"RMG Camin","year":"2015","unstructured":"Camin RMG, Cols M, Chevarria JL, Garc\u00eda Osuna R, Carreras M, Lisbona JM, et al. Acute kidney injury secondary to a combination of renin-angiotensin system inhibitors, diuretics and NSAIDS: The Triple Whammy. Nefrolog\u00eda (English Edition). 2015;35:197\u2013206.","journal-title":"Nefrolog\u00eda (English Edition)"},{"key":"560_CR8","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s40780-025-00485-8","volume":"11","author":"Y Kunitsu","year":"2025","unstructured":"Kunitsu Y, Hira D, Nakagawa S, Tsuda M, Morita SY, Yamamoto Y, et al. NSAID-Induced acute kidney injury risk in patients on renin-angiotensin system inhibitors and diuretics: nationwide cohort study. J Pharm Health Care Sci. 2025;11:77.","journal-title":"J Pharm Health Care Sci"},{"key":"560_CR9","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1248\/yakushi.19-00096","volume":"139","author":"Y Kunitsu","year":"2019","unstructured":"Kunitsu Y, Isono T, Hira D, Terada T. Chronic effects on kidney function by triple whammy (combination of renin and angiotensin type Inhibitor, diuretic drug and nonsteroidal anti-inflammatory drug). Yakugaku Zasshi. 2019;139:1457\u201362.","journal-title":"Yakugaku Zasshi"},{"key":"560_CR10","doi-asserted-by":"publisher","first-page":"e0263682","DOI":"10.1371\/journal.pone.0263682","volume":"17","author":"Y Kunitsu","year":"2022","unstructured":"Kunitsu Y, Hira D, Morikochi A, Ueda T, Isono T, Morita S-Y, et al. Time until onset of acute kidney injury by combination therapy with Triple Whammy drugs obtained from Japanese Adverse Drug Event Report database. PLoS ONE. 2022;17:e0263682.","journal-title":"PLoS ONE"},{"key":"560_CR11","doi-asserted-by":"publisher","first-page":"3282","DOI":"10.1093\/eurheartj\/ehx508","volume":"38","author":"F Ruschitzka","year":"2017","unstructured":"Ruschitzka F, Borer JS, Krum H, Flammer AJ, Yeomans ND, Libby P, et al. Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (prospective randomized rvaluation of celecoxib integrated safety versus ibuprofen or naproxen ambulatory blood pressure measurement) Trial. Eur Heart J. 2017;38:3282\u201392.","journal-title":"Eur Heart J"},{"key":"560_CR12","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1093\/ehjcvp\/pvac015","volume":"8","author":"S Obeid","year":"2022","unstructured":"Obeid S, Libby P, Husni E, Wang Q, Wisniewski LM, Davey DA, et al. Cardiorenal risk of celecoxib compared with naproxen or ibuprofen in arthritis patients: insights from the PRECISION trial. Eur Heart J Cardiovasc Pharmacother. 2022;8:611\u201321.","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"560_CR13","doi-asserted-by":"publisher","first-page":"2519","DOI":"10.1056\/NEJMoa1611593","volume":"375","author":"SE Nissen","year":"2016","unstructured":"Nissen SE, Yeomans ND, Solomon DH, L\u00fcscher TF, Libby P, Husni ME, et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med. 2016;375:2519\u201329.","journal-title":"N Engl J Med"},{"key":"560_CR14","doi-asserted-by":"publisher","first-page":"2291","DOI":"10.3390\/ph3072291","volume":"3","author":"WH H\u00f6rl","year":"2010","unstructured":"H\u00f6rl WH. Nonsteroidal anti-inflammatory drugs and the kidney. Pharmaceuticals. 2010;3:2291\u2013321.","journal-title":"Pharmaceuticals"},{"key":"560_CR15","first-page":"Cd009096","volume":"2014","author":"EC Li","year":"2014","unstructured":"Li EC, Heran BS, Wright JM. Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension. Cochrane Database Syst Rev. 2014;2014:Cd009096.","journal-title":"Cochrane Database Syst Rev"},{"key":"560_CR16","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1186\/s12933-025-02753-1","volume":"24","author":"W Zeng","year":"2025","unstructured":"Zeng W, Wang T, St\u00fcrmer T, He N, Shen P, Lin H, et al. Comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular outcomes in older adults with type 2 diabetes mellitus: a target trial emulation study. Cardiovasc Diabetol. 2025;24:194.","journal-title":"Cardiovasc Diabetol"},{"key":"560_CR17","doi-asserted-by":"crossref","unstructured":"Xie C, Chen R, Zhou S, Lin Y, Liu J, Su L, et al. Comparative effectiveness of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers: multidatabase target trial emulation studies. Hypertension. 2025.","DOI":"10.1161\/HYPERTENSIONAHA.125.25549"},{"key":"560_CR18","doi-asserted-by":"publisher","first-page":"e1001971","DOI":"10.1371\/journal.pmed.1001971","volume":"13","author":"F Catal\u00e1-L\u00f3pez","year":"2016","unstructured":"Catal\u00e1-L\u00f3pez F, Mac\u00edas Saint-Gerons D, Gonz\u00e1lez-Bermejo D, Rosano GM, Davis BR, Ridao M, et al. Cardiovascular and renal outcomes of renin-angiotensin system blockade in adult patients with diabetes mellitus: A systematic review with network meta-analyses. PLoS Med. 2016;13:e1001971.","journal-title":"PLoS Med"},{"key":"560_CR19","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1159\/000489913","volume":"43","author":"K Wang","year":"2018","unstructured":"Wang K, Hu J, Luo T, Wang Y, Yang S, Qing H, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality and renal outcomes in patients with diabetes and albuminuria: a systematic review and meta-analysis. Kidney Blood Press Res. 2018;43:768\u201379.","journal-title":"Kidney Blood Press Res"},{"key":"560_CR20","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.2215\/CJN.09630818","volume":"14","author":"DH Ellison","year":"2019","unstructured":"Ellison DH. Clinical pharmacology in diuretic use. Clin J Am Soc Nephrol. 2019;14:1248\u201357.","journal-title":"Clin J Am Soc Nephrol"},{"key":"560_CR21","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1111\/j.1524-6175.2004.03789.x","volume":"6","author":"DA Sica","year":"2004","unstructured":"Sica DA. Diuretic-related side effects: development and treatment. J Clin Hypertens (Greenwich). 2004;6:532\u201340.","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"560_CR22","doi-asserted-by":"publisher","first-page":"e048755","DOI":"10.1136\/bmjopen-2021-048755","volume":"12","author":"JK Fitzpatrick","year":"2022","unstructured":"Fitzpatrick JK, Yang J, Ambrosy AP, Cabrera C, Stefansson BV, Greasley PJ, et al. Loop and thiazide diuretic use and risk of chronic kidney disease progression: a multicentre observational cohort study. BMJ Open. 2022;12:e048755.","journal-title":"BMJ Open"},{"key":"560_CR23","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.3109\/0886022X.2014.917560","volume":"36","author":"X Wu","year":"2014","unstructured":"Wu X, Zhang W, Ren H, Chen X, Xie J, Chen N. Diuretics associated acute kidney injury: clinical and pathological analysis. Ren Fail. 2014;36:1051\u20135.","journal-title":"Ren Fail"},{"key":"560_CR24","doi-asserted-by":"publisher","first-page":"578","DOI":"10.5694\/mja12.11087","volume":"197","author":"S Hawken","year":"2012","unstructured":"Hawken S, Wilson KR. The self-controlled case series method for evaluating safety of vaccines. Med J Aust. 2012;197:578\u20139.","journal-title":"Med J Aust"},{"key":"560_CR25","doi-asserted-by":"publisher","first-page":"1768","DOI":"10.1002\/sim.2302","volume":"25","author":"HJ Whitaker","year":"2006","unstructured":"Whitaker HJ, Farrington CP, Spiessens B, Musonda P. Tutorial in biostatistics: the self-controlled case series method. Stat Med. 2006;25:1768\u201397.","journal-title":"Stat Med"},{"key":"560_CR26","doi-asserted-by":"publisher","first-page":"i4515","DOI":"10.1136\/bmj.i4515","volume":"354","author":"I Petersen","year":"2016","unstructured":"Petersen I, Douglas I, Whitaker H. Self controlled case series methods: an alternative to standard epidemiological study designs. BMJ. 2016;354:i4515.","journal-title":"BMJ"},{"key":"560_CR27","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1111\/joim.12186","volume":"275","author":"J Hallas","year":"2014","unstructured":"Hallas J, Potteg\u00e5rd A. Use of self-controlled designs in pharmacoepidemiology. J Intern Med. 2014;275:581\u20139.","journal-title":"J Intern Med"},{"key":"560_CR28","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s12874-016-0278-0","volume":"17","author":"N Gault","year":"2017","unstructured":"Gault N, Casta\u00f1eda-Sanabria J, De Rycke Y, Guillo S, Foulon S, Tubach F. Self-controlled designs in pharmacoepidemiology involving electronic healthcare databases: a systematic review. BMC Med Res Methodol. 2017;17:25.","journal-title":"BMC Med Res Methodol"},{"key":"560_CR29","doi-asserted-by":"crossref","unstructured":"Sato S, Sasabuchi Y, Okada A, Yasunaga H. Do orally disintegrating tablets facilitate medical adherence and clinical outcomes in patients with post-stroke dysphagia? Dysphagia. 2024.","DOI":"10.1007\/s00455-024-10737-8"},{"key":"560_CR30","first-page":"190","volume":"5","author":"A Okada","year":"2022","unstructured":"Okada A, Yasunaga H. Prevalence of noncommunicable diseases in Japan using a newly developed administrative claims database covering young, middle-aged, and elderly people. Jma j. 2022;5:190\u20138.","journal-title":"Jma j"},{"key":"560_CR31","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1053\/j.ajkd.2018.10.002","volume":"73","author":"E Macedo","year":"2019","unstructured":"Macedo E, Mehta RL. Recurrent acute kidney injury: can we differentiate from nonrecovery and CKD progression? Am J Kidney Dis. 2019;73:150\u20132.","journal-title":"Am J Kidney Dis"},{"key":"560_CR32","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1038\/nrneph.2017.2","volume":"13","author":"LS Chawla","year":"2017","unstructured":"Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017;13:241\u201357.","journal-title":"Nat Rev Nephrol"},{"key":"560_CR33","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1681\/ASN.2014121218","volume":"27","author":"ED Siew","year":"2016","unstructured":"Siew ED, Parr SK, Abdel-Kader K, Eden SK, Peterson JF, Bansal N, et al. Predictors of recurrent AKI. J Am Soc Nephrol. 2016;27:1190\u2013200.","journal-title":"J Am Soc Nephrol"},{"key":"560_CR34","doi-asserted-by":"publisher","first-page":"e001821","DOI":"10.1136\/bmjopen-2012-001821","volume":"2","author":"YJ Hwang","year":"2012","unstructured":"Hwang YJ, Shariff SZ, Gandhi S, Wald R, Clark E, Fleet JL, et al. Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission. BMJ Open. 2012;2:e001821.","journal-title":"BMJ Open"},{"key":"560_CR35","doi-asserted-by":"crossref","unstructured":"Clifford KM, Selby AR, Reveles KR, Teng C, Hall RG 2nd, McCarrell J, et al. The risk and clinical implications of antibiotic-associated acute kidney injury: a review of the clinical data for agents with signals from the Food and Drug Administration\u2019s Adverse Event Reporting System (FAERS) database. Antibiot (Basel). 2022;11.","DOI":"10.3390\/antibiotics11101367"},{"key":"560_CR36","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1053\/j.ajkd.2005.02.010","volume":"45","author":"H Izzedine","year":"2005","unstructured":"Izzedine H, Launay-Vacher V, Deray G. Antiviral drug-induced nephrotoxicity. Am J Kidney Dis. 2005;45:804\u201317.","journal-title":"Am J Kidney Dis"},{"key":"560_CR37","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1186\/s12882-024-03570-6","volume":"25","author":"Y Li","year":"2024","unstructured":"Li Y, Wang J. Contrast-induced acute kidney injury: a review of definition, pathogenesis, risk factors, prevention and treatment. BMC Nephrol. 2024;25:140.","journal-title":"BMC Nephrol"},{"key":"560_CR38","doi-asserted-by":"publisher","first-page":"3516","DOI":"10.1007\/s00330-020-06690-3","volume":"30","author":"W Cheng","year":"2020","unstructured":"Cheng W, Wu X, Liu Q, Wang HS, Zhang NY, Xiao YQ, et al. Post-contrast acute kidney injury in a hospitalized population: short-, mid-, and long-term outcome and risk factors for adverse events. Eur Radiol. 2020;30:3516\u201327.","journal-title":"Eur Radiol"},{"key":"560_CR39","doi-asserted-by":"publisher","first-page":"151466","DOI":"10.1016\/j.semnephrol.2023.151466","volume":"43","author":"A Batte","year":"2023","unstructured":"Batte A, Shahrin L, Claure-Del Granado R, Luyckx VA, Conroy AL. Infections and acute kidney injury: a global perspective. Semin Nephrol. 2023;43:151466.","journal-title":"Semin Nephrol"},{"key":"560_CR40","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1038\/s41581-023-00683-3","volume":"19","author":"A Zarbock","year":"2023","unstructured":"Zarbock A, Nadim MK, Pickkers P, Gomez H, Bell S, Joannidis M, et al. Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol. 2023;19:401\u201317.","journal-title":"Nat Rev Nephrol"},{"key":"560_CR41","first-page":"57","volume":"4","author":"F Ghane Shahrbaf","year":"2015","unstructured":"Ghane Shahrbaf F, Assadi F. Drug-induced renal disorders. J Ren Inj Prev. 2015;4:57\u201360.","journal-title":"J Ren Inj Prev"},{"key":"560_CR42","doi-asserted-by":"publisher","first-page":"665250","DOI":"10.3389\/fphar.2021.665250","volume":"12","author":"JY Chen","year":"2021","unstructured":"Chen JY, Tsai IJ, Pan HC, Liao HW, Neyra JA, Wu VC, et al. The impact of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers on clinical outcomes of acute kidney disease patients: a systematic review and meta-analysis. Front Pharmacol. 2021;12:665250.","journal-title":"Front Pharmacol"},{"key":"560_CR43","first-page":"e93707","volume":"17","author":"A Avula","year":"2025","unstructured":"Avula A, Johal LK, Ali F, Amir S, Yadav S, Murtuza M, et al. ACE inhibitors and ARBs in chronic kidney disease: a systematic review of randomized controlled trials on albuminuria reduction, eGFR decline, and safety. Cureus. 2025;17:e93707.","journal-title":"Cureus"},{"key":"560_CR44","doi-asserted-by":"publisher","first-page":"e70146","DOI":"10.1002\/pds.70146","volume":"34","author":"S Mitsuboshi","year":"2025","unstructured":"Mitsuboshi S, Imai S, Tsuchiya M, Kizaki H, Hori S. Accuracy of diagnostic coding for acute kidney injury in Japan-analysis of a Japanese hospital-based database. Pharmacoepidemiol Drug Saf. 2025;34:e70146.","journal-title":"Pharmacoepidemiol Drug Saf"}],"container-title":["Journal of Pharmaceutical Health Care and Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40780-026-00560-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40780-026-00560-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40780-026-00560-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:32:32Z","timestamp":1781638352000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40780-026-00560-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,7]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["560"],"URL":"https:\/\/doi.org\/10.1186\/s40780-026-00560-8","relation":{},"ISSN":["2055-0294"],"issn-type":[{"value":"2055-0294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,7]]},"assertion":[{"value":"7 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the principles of the Declaration of Helsinki. According to the Japanese Ethical Guidelines for Medical and Biological Research Involving Human Subjects, the use of fully anonymized secondary data was exempted from institutional review board approval and informed consent requirements. Therefore, informed consent and institutional review board approval were not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable, as the data we analyzed was anonymized data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"TT received speakers from DAIICHI SANKYO COMPANY, LIMITED and CHUGAI PHARMACEUTICAL CO., Ltd. The Authors have no financial interests to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"42"}}