EMPEROR-REDUCED, EMPEROR-PRESERVED, DAPA-HF and DELIVER all show reductions in the rate of kidney function decline with SGLT-2 inhibition compared to placebo, while in EMPEROR-REDUCED this reduction in rate of eGFR decline is present in the presence and absence of CKD and across the spectrum of albuminuria [8–12]. This evidence concerns the gene SLC5A2 and hydrops fetalis.