Learning Objectives:

1. Dapagliflozin reduces the risk of kidney failure in patients with CKD but can result in a reversible acute reduction in eGFR on initiation of treatment
2. DAPA-CKD trial found that patients who experienced an acute reduction in eGFR>10% after 2 weeks of treatment with dapagliflozin had slower rates of long-term eGFR decline compared with patients who experienced a less pronounced decline or increase in eGFR.
3. A modest acute reduction in eGFR on dapagliflozin initiation is not associated with higher rates of CKD progression and should not be a reason to discontinue this therapy in the majority of patients.