Early eGFR and albuminuria changes after starting treatment may say more about the disease than the drug

The edition in brief

An individual-patient meta-analysis of 49 randomised CKD trials and 66 449 participants found no relationship between treatments' average effects on early GFR change and on albuminuria. Within patients, a larger early GFR fall went with a larger albuminuria fall to a similar degree in both treatment and control arms, suggesting early shifts often reflect natural history rather than drug response. That argues against judging an individual's response, or stopping a proven drug, on early numbers alone. A meta-analysis of 63 observational studies comparing 5852 ABO-incompatible with 47 950 compatible kidney transplants found more overall rejection (RR 1.28) and antibody-mediated rejection (RR 2.14), more bleeding and surgical complications, similar 1-, 3- and 10-year survival, and a difference at five years favouring compatible grafts. Across 19 studies and 445 patients with relapsing or refractory lupus nephritis, rituximab-based therapy was associated with complete renal response in about 41% at 12 months. A post hoc TEMPO 3:4 analysis linked the early fall in urine osmolality on tolvaptan with later eGFR benefit in non-Japanese patients. The pearl covers the expected eGFR dip after starting RAS blockade or an SGLT2 inhibitor.