Estimated glomerular filtration rate slope and clinical outcomes: a narrative review

This review aims to synthesize current evidence on the association betweenestimated glomerular filtration rate (eGFR)slope and clinical outcomes. A narrative review was conducted based on a structured literature search of PubMed and Embase from inception to April 2026. Relevant studies examining eGFR slope in relation to kidney outcomes, cardiovascular events, and mortality were included, with emphasis on meta-analyses, randomized controlled trials, andcohort studies. Evidencedemonstratedthat eGFR slope isassociated with kidney failure outcomes, with three-year total slope showing high predictive validity. Observational and clinical studies consistently show that steeper declines in eGFR are linked to increased risks of end-stage kidney disease, cardiovascular events, hospitalization, and all-cause mortality across diverse populations. A U-shaped relationship between eGFR changes and mortality has also been observed. Several factors, including baseline kidney function, albuminuria, comorbidities, and variability in eGFR, influence its trajectory and prognostic value. Pharmacological interventions, particularly SGLT2 inhibitors, significantly slow eGFR decline and improve clinical outcomes. The eGFR slope is a validated and clinically meaningful surrogate endpoint that reliably predicts kidney and cardiovascular outcomes. Its integration into clinical practice and research may enhance risk stratification, improve trial efficiency, and support personalized management ofkidney disease.