Tsai CW, Huang HC, Chiang HY, et al. - Since there exists scarce evidence that links the first-year estimated glomerular filtration rate (eGFR) variability and longitudinal change scales concomitantly to the risk of developing end-stage renal disease (ESRD), acute coronary syndrome (ACS) and death after pre-ESRD program enrollment in chronic kidney disease (CKD), researchers performed this prospective cohort analysis including CKD patients (n = 5,092) who were undergoing multidisciplinary care between 2003 and 2015 and were examined during the follow-up for confirmation of ESRD, ACS, and death. Findings revealed the importance of the dynamics of eGFR alterations including both overall variability and longitudinal alterations, observed over the first year after pre-ESRD program enrollment, as prognostic factors for the risk of progression to ESRD, ACS and deaths in patients suffering from CKD. A new way for risk characterization in CKD care is a risk matrix integrating the first-year eGFR variability and longitudinal change scales after pre-ESRD enrollment. Randomized trials in CKD may be needed to determine comparable baseline eGFR dynamics.