Early eGFR and albuminuria shifts after starting a kidney drug may say little about the drug

The edition in brief

Early falls in eGFR and albuminuria after starting a kidney-protective drug are often read as signs that it is working in that patient. An individual-patient meta-analysis of 49 randomised trials and 66,449 participants found no relationship between trials' effects on early GFR and on albuminuria. Within patients, the link between falling GFR and falling albumin-to-creatinine ratio was almost the same in treatment and control arms (8.0% vs 6.6% per standard deviation). Early changes may therefore mostly reflect natural variation and the disease itself, and should not be used on their own to judge response or to stop a drug. A meta-analysis of 13 studies with 1,275 patients found fixing the peritoneal dialysis catheter during open placement sharply reduced displacement (OR 0.08) without significant differences in infection, bleeding, hernia or other complications, at the cost of about four minutes' extra operating time. A meta-analysis of 15 studies found AI models classified membranous nephropathy, IgA nephropathy and minimal change disease with sensitivity of 0.92 to 0.96 on biopsy images, though comparisons with pathologists were sparse and retrospective. Machine-learning models for predicting diabetic kidney disease showed high pooled discrimination, but most lacked external validation or calibration. The pearl covers the expected eGFR dip after starting RAS blockers or SGLT2 inhibitors.