Association of prior Angiotensin receptor-neprilysin inhibitor use with the initial eGFR dip after…

Cohort studyClinical and experimental nephrology· Aug 2026

Association of prior Angiotensin receptor-neprilysin inhibitor use with the initial eGFR dip after initiation of SGLT2 inhibitors in patients with chronic kidney disease.

Yusuke Ushio, Hiroshi Kataoka, Rina Takahashi … Junichi Hoshino

NephrologyCohort studyTreatmentQ2IF 2.3

Prior angiotensin receptor-neprilysin inhibitors use associated with lower odds of eGFR dip after SGLT2 inhibitor start

Association of prior Angiotensin receptor-neprilysin inhibitor use with the initial eGFR dip after initiation of SGLT2 inhibitors in patients with chronic kidney disease.

Yusuke Ushio … Junichi Hoshino

Clinical and experimental nephrology · Aug 2026

Background

Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal protection; however, a transient decline in estimated glomerular filtration rate (eGFR), known as the ''initial dip'', is frequently observed after initiation.

Methods

We retrospectively evaluated the effect of prior angiotensin receptor-neprilysin inhibitors use on the initial dip following SGLT2 inhibitor initiation in 157 patients with chronic kidney disease who newly started SGLT2 inhibitors between 2022 and 2025.

n = 157 patients

Results

prior angiotensin receptor-neprilysin inhibitors use, not angiotensin receptor blocker, lowers odds of an eGFR dip

OR 0.30 (95% CI 0.10 to 0.89)

CI excludes the null - significant

More results

Prior angiotensin receptor-neprilysin inhibitors use was not significantly associated with longitudinal eGFR and urine protein changes at 1 year.

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Conclusion

Prior angiotensin receptor-neprilysin inhibitors use was associated with a lower risk of the initial eGFR dip following SGLT2 inhibitor initiation, although prospective studies are needed to confirm these findings.

Association of prior Angiotensin receptor-neprilysin inhibitor use with the initial eGFR dip after initiation of SGLT2 inhibitors in patients with chronic kidney disease.

Association of prior Angiotensin receptor-neprilysin inhibitor use with the initial eGFR dip after initiation of SGLT2 inhibitors in patients with chronic kidney disease.

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