There is emerging evidence that MRA have bene cial effects on clinical kidney outcomes. The FIDELIO-DKD study, an RCT of 5734 participants, demonstrated that nerenone, a nonsteroidal MRA, on the background of an ACEi or ARB in patients with diabetes, CKD, and albuminuria reduced the risk of composite primary endpoint of GFR decline, kidney failure, or renal death when added to standard of care.258 Finerenone also reduced the risk of CV events. However, its effect on SBP lowering was modest (2 3 mm Hg), and there was a higher risk of hyperkalemia-related events. At the writing of this guideline, nerenone has not been approved for clinical use. The trial was published after the evidence review cut-off for the guideline but will be assessed in future updates. Quality of evidence. The ERT updated a Cochrane system- atic review on antihypertensive therapies in patients with diabetes and CKD, A2 and A3.259 The overall quality of the evidence was rated as moderate, as the studies examining the use of RASi therapy exhibited study limitations with unclear allocation concealment for critical and important outcomes. The quality of the evidence was lower for CV outcomes, owing to there being fewer events and inconsistent reporting of these outcomes in trials (Supplementary Tables S21 S30). In the ADVANCE study of patients with CKD G1 G3, A2, the quality of evidence is low according to GRADE.260 The quality of the evidence was downgraded due to serious risk of bias, with unclear allocation concealment, and imprecision, as the bene cial results of diuretics were seen only in the CKD subgroups, when the results were negative in the entire cohort (Supplementary Table S27). 