The recommendation suggests that the majority of people would want the recommended course of action. This recom- mendation does not apply to patients with CKD who are receiving dialysis or have a kidney transplant. Key information Balance of bene ts and harms. Kidney bene ts of RASi in CKD without diabetes and severely increased proteinuria were demonstrated in the Ramipril Ef cacy In Nephropathy (REIN) study which compared ramipril to placebo to assess the effect of RASi on CKD progression independent of BP lowering. The Gruppo Italiano di Studi Epidemiologici in Nefologia (GISEN; [REIN Stratum-2]) study of 166 patients with proteinuria $3 g per 24 hours was stopped early due to ef cacy of ramipril in slowing eGFR decline.176 The monthly decline in GFR was signi cantly lower in the ramipril group (0.88 ml/min) than the placebo group (0.53 ml/min). The composite of doubling of serum creatinine or ESKD was reached in 18 versus 40 partici- pants (ramipril vs. placebo, P 0.02).176 In the REIN Stratum-1 of 186 patients with proteinuria of >1 to <3 g/d, the decline in GFR was not different, but ESKD events were less with ramipril chapter 3 www.kidney-international.org The Angiotensin-Converting Enzyme Inhibitors and Kidney Protection (AIPRI) trial compared benazepril to placebo in pa- tients with CKD mostly without diabetes to assess its effect on CKD progression (doubling of serum creatinine or ESKD as the primary outcome). 