Patients in the highest ET-1 tertile in DAPA-HF had a significantly greater rate of decrease in eGFR compared with patients in tertile 1, suggesting that ET-1 might also play a role in the progressive decline in kidney function that occurs in many patients with HF.37 Ongoing clinical trials in patients with chronic kidney disease will define the future position of endothelin receptor antagonists in the management of chronic kidney disease.38,39. This evidence concerns the gene EDN1 and hydrops fetalis.