We read with great interest the reply by Russo et al. [1], in which the authors addressed comments on their review of renal protection strategies in heart failure with reduced ejection fraction (HFrEF), particularly regarding the interpretation of renal function changes and clinical implementation of guideline-directed medical therapy in patients with concomitant chronic kidney disease [2,3]. Their clarification regarding the hemodynamic basis of early reductions in estimated glomerular filtration rate after initiation of renin–angiotensin system inhibitors, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium–glucose cotransporter-2 inhibitors provides an important perspective for clinicians managing complex cardiorenal interactions [4].
