The network meta-analysis that compared dual RASi with mono RASi exhibited moderate quality of the evidence because of concerns regarding inconsistency for all- cause mortality and CV events and serious imprecision for ESKD due to wide CIs that indicated appreciable bene ts and harms (Supplementary Table S32).169 The ERT review (including Cochrane reviews that were updated259,281 ) rated the quality of evidence to be moderate for studies that compared dual with mono RASi because of study limitations, with unclear reporting for Cochrane risk of bias282 domains, random sequence generation, and allocation concealment (Supplementary Table S31234,277 279,283,284 ). The ERT updated a Cochrane review protocol on the addition of aliskiren to RASi therapy with mono RASi.285 The quality of the evidence was moderate for most outcomes (Supplementary Table S29286 291 ). For CV mortality, ESKD, moderately increased albuminuria, and doubling of serum creatinine, the quality of the evidence was downgraded because of serious imprecision due to only 1 study reporting these outcomes, and all-cause mortality was downgraded due to wide con dence intervals that indicate appreciable bene ts and harms. Finally, for the serious adverse events, the quality of the evidence was downgraded to moderate because of study limitations (unclear random sequence generation, allocation concealment, and a lack of blinding of outcome assessors). Values and preferences. In the opinion of the Work Group, this recommendation places a higher importance on preventing hyperkalemia and AKI than on the bene ts in reduction of albuminuria. The signi cance of these bene cial effects on albuminuria is unclear, in view of the absence of effects in GFR, at least during the follow-up period of the trials. Although some bene t has been found for dual therapy in HF, this has not been con rmed so far in patients with CKD with or without diabetes. 