This practice point reiterates a common expert opinion and may be a reasonable option for many patients treated with RASi. However, there is not a single trial that compared meaningful clinical outcomes in patients who were continuing versus dis- continuing versus reducing the dose of RASi upon a fast increase in serum creatinine by 10%, 20%, 30%, 40%, etc. Observational data relating acute changes in serum creatinine shortly after RASi initiation to subsequent long-term outcomes are equivocal An increase of <30% in serum creatinine from the baseline value does not mandate a dosage decrease or discontinuation of RASi, as long as the serum creatinine increase is not associated with other complications, such as hyperkalemia and uid retention. Practice Point 3.2.6: Consider reducing the dose or dis- continuing ACEi or ARB in the setting of either symp- tomatic hypotension or uncontrolled hyperkalemia despite medical treatment, or to reduce uremic symptoms while treating kidney failure (estimated glomerular ltration rate ). The dose of ACEi or ARBs should be reduced or dis- continued in patients with hyperkalemia after other measures have failed to achieve a normal serum potassium level. In general, similar efforts should be made to discontinue other concurrent BP medications before attempting to reduce the dose of ACEi or ARBs in patients who experience symp- tomatic hypotension and has a speci c indication for RASi, chapter 3 www.kidney-international.org such as severely increased albuminuria or heart failure. Which BP medication to discontinue or which ones to retain would depend on the relative indication of each medication. When these drugs are used in patients with eGFR <30 ml/ , close monitoring of serum potassium is required. 