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Early eGFR decline after SGLT2i initiation: knowns and unknowns. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve kidney and cardiovascular outcomes. SLGT2i initiation is accompanied by an acute decline in glomerular filtration rate. However, the clinical significance of this acute change remains unclear. In this issue of Kidney International, Kraus et al. examined the factors associated with an initial decline in estimated glomerular filtration rate after starting empagliflozin or placebo, subsequent kidney function trajectory, and the associations of odds of initial estimated glomerular filtration rate dip with long-term cardiovascular and kidney outcomes.