It is likely that including the low-risk and high-risk groups together led to the lack of statis- tical signi cance for CV outcomes. Although it is tempting to extrapolate the bene cial CV effects of RASi to all people with diabetes, in the absence of high BP, CVrisks, and lower GFR (G3 and G4, A2 and A3), the evidence is weak at best. For treatment with RASi, there is, therefore, a gradation of evidence from strong in the CKD subpopulation with low eGFR and severely increased albuminuria, to weak or absent in the subpopulation with normal eGFR without albuminuria. Values and preferences. In the opinion of the Work Group, this recommendation for people with diabetes and CKD with severely increased albuminuria places higher value on the ability of RASi to prevent CV and CKD events, such as doubling of serum creatinine and dialysis. It places less value on the risks of hyperkalemia and AKI. Resource use and costs. The costs of the RASi medications are probably low in most countries. However, adding RASi to patients with diabetes and severely increased albuminuria will require more laboratory testing and visits to healthcare pro- viders, especially in those with low GFR. It will also likely lead to greater incidence of hyperkalemia and AKI hence the asso- ciated costs of monitoring and treating these complications. Considerations for implementation. There is insuf cient in- formation to differentiate between men and women for this recommendation, and there is insuf cient evidence that there are different outcomes by race. Rationale We issue a strong (1B) recommendation for treatment with ACEi or ARB for patients with diabetes, increased albuminuria, and normal-to-low GFR (G1 G4; A2 or A3), because their desirable bene ts in kidney and CV protection outweigh the adverse risks associated with therapy. 