A low-sodium diet has been shown to further reduce BP and urine albumin or protein levels in the short term in patients on ARBs63 66 and may be a consideration for those with high BP who have a poor response to ACE-Is or ARBs. Some forms of CKD may be associated with salt wasting from the kidney. Affected individuals may be at higher than usual risk of volume depletion and electrolyte disturbances potentiated by salt restriction. Volume and electrolyte status should thus be carefully monitored in patients with CKD undergoing salt restriction. Recent studies suggesting that low urinary sodium excretion (hence perhaps low dietary sodium intake) associates with higher mortality in diabetes have yet to be confirmed by others or explained.67,68 Since salt restriction is an inexpensive and important contributor to lowering BP in the generally population worldwide, this intervention was deemed a level 1 recom- mendation. But since the evidence base for CKD patients included only small, short-term RCTs involving special circumstances, Recommendation 2.3.2 was graded 1C. 2.3.3: We recommend undertaking an exercise program compatible with cardiovascular health and toler- ance, aiming for at least 30 minutes 5 times per RATIONALE Increased physical exercise has been linked to a broad range of positive health outcomes through a wide variety of mechanisms. A clear inverse relationship between exercise and average daily BP has been demonstrated by a large volume of previous epidemiological data in the general population, although exercise may lead to modest and acute physiological increases in BP during the time of the activity. The effects of exercise on BP in the context of RCTs have been systematically reviewed in the general population.53 Most of the 21 RCTs included in the review examined the efficacy of 3 to 5 weekly sessions of aerobic exercise lasting 30 to 60 minutes. 