Renin–angiotensin system inhibitors (RASi) are not nephrotoxic – they protect the kidneys and the heart

Healthcare professionals should not label medications as 'kidney toxins' unless this is actually the case, especially medications that instead confer clear prognostic benefit, such as renin-angiotensin system inhibitors (RASi). This is imperative when discussing treatments with people with long-term health conditions, for whom RASi significantly reduce death, progression of chronic kidney disease (CKD) and hospitalisation. RASi are fundamental to management of heart failure with reduced ejection fraction (HFrEF) and CKD with proteinuria, yet are frequently called 'nephrotoxic'. The association between RASi use and acute kidney injury (AKI) is too often mistaken for 'causation'; it is largely driven by the use of RASi to treat long-term conditions that increase AKI risk, such as HFrEF, CKD and diabetes mellitus. Mislabelling RASi as 'nephrotoxic' adversely affects vital decision making, driving a tendency for RASi avoidance, even when RASi use has clear prognostic benefit. Healthcare education must embed this clinically important change to convention.

Authors

Institutions

Publication Details

Journal
Clinical Medicine
Published
2026-03-31
DOI
https://doi.org/10.1016/j.clinme.2026.100577
Primary Topic
Renin-Angiotensin System Studies
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Renin–angiotensin system inhibitors (RASi) are not nephrotoxic – they protect the kidneys and the heart

Thomas Blakeman, Shelagh Bickerton, Karen Nagalingam, Stephen J McWilliam et al.
Clinical Medicine
Renin-Angiotensin System Studies
article

Renin–angiotensin system inhibitors (RASi) are not nephrotoxic – they protect the kidneys and the heart

Thomas Blakeman, Shelagh Bickerton, Karen Nagalingam, Stephen J McWilliam, Edward Kingdon, William McKane, Laurie A. Tomlinson, Jonathan Murray, Paul R. Kalra, Michael G. Wise, John Dean, Simon Sawhney, Alan Hancock, Claire Morlidge, Marlies Ostermann, William T. Hinchliffe, Darren Green, Andrew J.P. Lewington, Matthew T James, Paul Cockwell, Simon J. Smith, Nicholas M Selby, Nitin V Kohle, Dr. Lisa Anderson
article en

Abstract

Healthcare professionals should not label medications as 'kidney toxins' unless this is actually the case, especially medications that instead confer clear prognostic benefit, such as renin-angiotensin system inhibitors (RASi). This is imperative when discussing treatments with people with long-term health conditions, for whom RASi significantly reduce death, progression of chronic kidney disease (CKD) and hospitalisation. RASi are fundamental to management of heart failure with reduced ejection fraction (HFrEF) and CKD with proteinuria, yet are frequently called 'nephrotoxic'. The association between RASi use and acute kidney injury (AKI) is too often mistaken for 'causation'; it is largely driven by the use of RASi to treat long-term conditions that increase AKI risk, such as HFrEF, CKD and diabetes mellitus. Mislabelling RASi as 'nephrotoxic' adversely affects vital decision making, driving a tendency for RASi avoidance, even when RASi use has clear prognostic benefit. Healthcare education must embed this clinically important change to convention.

Clinical MedicineVol. 26(3)
University of London (GB), University of Nottingham (GB), University of Liverpool (GB), University of Calgary (CA), University of Aberdeen (GB), Guy's and St Thomas' NHS Foundation Trust (GB), Queen Elizabeth Hospital Birmingham (GB), Manchester Academic Health Science Centre (GB), County Durham and Darlington NHS Foundation Trust (GB), University Hospital of North Durham (GB), St George’s University Hospitals NHS Foundation Trust (GB), South Tees Hospitals NHS Foundation Trust (GB), National Institute for Health and Care Research (GB), London School of Hygiene & Tropical Medicine (GB), Portsmouth Hospitals NHS Trust (GB), Manchester University NHS Foundation Trust (GB), Alder Hey Children's NHS Foundation Trust (GB), Sheffield Teaching Hospitals NHS Foundation Trust (GB), East and North Hertfordshire NHS Trust (GB), Primary Health Care (QA), University Hospitals of Derby and Burton NHS Foundation Trust (GB), University Hospitals Sussex NHS Foundation Trust (GB), The Royal Wolverhampton NHS Trust (GB), Liverpool Womens NHS Foundation Trust (GB), East Lancashire Hospitals NHS Trust (GB)
Zero hunger
Openalex Percentile: Top 37%
Renin-Angiotensin System Studies
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.