The upper limit of the normal range for children (5.6 mmol/l) was exceeded in 3.3% of tests. In all but 5 patients, medical management through adjustment of diet, addition of a diuretic, or prescription of potassium- exchange resins resulted in persistent normalization of serum potassium levels while the child remained on ACE-I therapy. ACE-Is and ARBs have similar hemodynamic effects in the kidney which leads to decrease in GFR. It has been stated that increases of the SCr level by up to 30% should be expected and tolerated after initiating therapy with ACE-Is or ARBs in adults with chronic kidney failure, but children have not been prospectively studied in this regard.88 Few direct comparisons of classes of anti-hypertensive agents have been performed in children with CKD. Extensive reviews of different drugs and classes of anti-hypertensive agents in children with CKD have recently been pub- There is no clear evidence that one second-line BP agent is superior to the another in children. In the calcium-channel blockers were used as first- choice anti-hypertensive co-medication (in 38% of patients), followed by diuretics (in 36%) and beta-blockers (in 26%), without differences between the randomization groups. Other guidelines suggest diuretics or calcium-channel block- ers as the most suitable second-line agents.353 LIMITATIONS In children with CKD, there is a dearth of RCTs; in fact, the recommendations in this chapter are largely based on a single trial, ESCAPE, which limits the quality of the evidence and the strength of the recommendations. The ESCAPE trial was performed in a predominantly Caucasian population. There- fore, the generalization of these findings to other populations is uncertain. 