Studies comparing ACEi to ARB in patients with CKD and diabetes may have had an insuf cient number of patients to nd a difference. There has been little evidence to support the use of other agents such as MRA, beta-blockers, and CCBs as the initial therapy in patients with diabetes and albuminuria for CV or kidney protection beyond albuminuria reduction. For MRA compared to placebo, there were 3 small short-term studies powered for changes in albuminuria (Supplementary ). Albuminuria was lowered by MRA; however, in a meta-analysis by the ERT, there was no bene- cial effect in RCTs on all-cause mortality, MI, and stroke, and very few events to determine the effect on kidney out- comes. However, those trials were not powered for CV or kidney outcomes. Similarly, meta-analysis showed no evi- dence of bene ts on CV or kidney outcomes for beta-blockers (Supplementary Table S25242 249 ) and CCBs (Supplementary ) compared to placebo or standard of care. However, the studies were not properly powered for kidney or CV outcomes. The importance of diuretic therapy for lowering BP is suggested by the ADVANCE study comparing treatment with a combination of an ACEi plus diuretic (perindopril plus inda- pamide) to usual care without a thiazide-type diuretic in 11,140 people aged $55 years with diabetes, CV risk, or increased albuminuria (A2 or A3) over a mean of 4.3 years.257 The main outcomes were death from CV disease, non-fatal stroke or non-fatal MI, and new or worsening kidney or dia- betic eye disease. 