Key differences between the current and prior KDIGO recommendations in children with CKD include that the prior KDIGO guideline made a recommendation for the initiation of antihypertensive medication when the of ce SBP or DBP is consistently above the 90th percentile for age, sex, and height, whereas in the current guideline, all children with CKD and MAP consistently above the 50th percentile should be treated. The use of medications is included in this update only as a practice point, as direct trial evidence supporting their use does not exist, and the prior recommendation was based on limited indirect evidence, primarily data from CKiD that showed better BP control with use of ACEi or ARB.371 Compared to standard-of-care therapy, ACEi in children with CKD did not lower BP or protect against GFR decline, although it has been reported to have a bene cial effect on proteinuria and left ventricular hypertrophy in small Practice Point 5.1: We suggest monitoring BP once a year with ABPM, and monitoring every 3 6 months with stan- dardized auscultatory of ce BP in children with CKD. Practice Point 5.2: In children with high BP and CKD, when ABPM is not available, manual auscultatory of ce BP obtained in a protocol-driven standardized setting target- ing achieved SBP <90th percentile for age, sex, and height of normal children is a reasonable approach. Practice Point 5.3: Use ACEi or ARB as rst-line therapy for high BP in children with CKD. These drugs lower pro- teinuria and are usually well tolerated, but they carry the risk of hyperkalemia and have adverse fetal risks for pregnant women. 