April 22, 2026 · Mayo Clinic proceedings · DOI: 10.1016/j.mayocp.2026.01.010

Acute Estimated Glomerular Filtration Rate Decline After Initiation of Therapies That Slow Kidney Disease Progression: Clinical Practice Implications

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The authors investigate the implications of an acute decline in estimated glomerular filtration rate (eGFR) following the initiation of therapies aimed at slowing chronic kidney disease (CKD) progression in patients with type 2 diabetes. They find that while these therapies may cause an initial eGFR decline, this is typically reversible and linked to beneficial hemodynamic changes, suggesting that such declines should not deter treatment continuation. The review emphasizes that an acute eGFR decline of less than 30% is generally not indicative of adverse kidney effects and may even predict better long-term outcomes.

David Z I Cherney, Radica Z Alicic, Marc P Bonaca

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