http://www.kidney-international.org chapter 4 & 2012 KDIGO Recommendation 4.1 applies to diabetic patients with CKD, , and normal albumin excretion (normoalbuminuria) prior to the use of BP- lowering drugs such as ACE-Is or ARBs. Several studies have shown that this is not a rare occurrence in patients with type For example, in the National Health and Nutrition Examination Survey (NHANES), 36% of adults with type 2 diabetes and a GFR o60 ml/min/1.73 m2 had normal urine albumin levels.195 A population-based study in Japan found 262 of 3297 people (7.9%) with type 2 had a normal AER. The diabetic patients with CKD but a normal AER were older and included a higher proportion of women and patients with hypertension, hyperlipidemia, and CVD but fewer smokers, compared with the diabetic patients with a normal AER and preserved GFR.217 A long-term follow-up study of participants with type 1 diabetes in the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complica- tions (DCCT/EDIC) study showed that 24% of those had an AER o30 mg per 24 hours at all previous evaluations,218 indicating that normoalbuminuric CKD is also an important entity in type 1 diabetes. RCTs. The Work Group could not identify any RCTs in which patients with CKD and normoalbuminuric diabetes had been randomized to various BP targets. Several trials have been completed in broader populations with diabetes, some of whom had CKD at study entry. These are summarized here. In the United Kingdom Prospective Diabetes Study patients with diabetes, a minority of whom also had nephropathy, were randomized to BP o150/ 85 mm Hg or o180/105 mm Hg. Tighter BP control was associated with a reduction in risk of diabetes-related death, stroke, and progression of retinopathy. 