The addition of the 300 mg dose of aliskiren reduced the urinary albumin/creatinine ratio (ACR) by 20% as compared with the use of losartan alone. There were only small differences in BP between the two groups, and no differences between the rates of adverse or serious adverse events. Given the limited data available, the place of DRIs in the management of BP in CKD has yet to be determined. Indeed another trial involving the use of DRI combined with losartan in patients with diabetes and CKD has recently been terminated early due to an increased risk of adverse events and no evidence of benefit in the combination therapy group. Early termination of the Aliskiren Trial in Type 2 Diabetes Using Cardiovascular and Renal Disease Endpoints (ALTI- TUDE) trial casts doubt on the future use of DRIs in combination with ACE-Is or ARBs,113 and very recently the US FDA has counselled against this combination.114 Diuretics Salt and water retention are major factors contributing to high BP in CKD patients and to morbidity and mortality through systemic or pulmonary edema. Thus, diuretics potentially have an important role in the control of hypertension in this clinical setting. The pharmacology of diuretics and indications for their use have recently been Given that most CKD patients will require multiple drugs to control elevated BP, thiazides have a role, especially since their only major drawback is a propensity to induce or aggravate hyperglycemia and other features of the Thiazides. Of the currently available antihypertensive agents, thiazides and thiazide-like diuretics are most often used and have been assessed in many RCTs involving CKD patients, either as the primary investigational agent or as an add-on therapy. 