GLA and chronic kidney disease: Finally, Politei et al35 reported a deterioration in renal function after the switch in his 2 patients: the first patient showed doubling of proteinuria 34 months after switch to agalsidase alfa with a stable eGFR; the other patient, who had a significant loss in eGFR of 6 mL/min over 4 years of therapy with agalsidase beta (progressing from chronic kidney disease stage 2 to 3), reported unchanged proteinuria and a significant progression of eGFR loss to stage 5 in 14 months after the switch to alfa, for which he started dialysis.35