The risk of doubling of serum creatinine was reduced by 30% (RR: with a mean follow-up of 32 months and an absolute difference was not statistically signi cant.163,207,213,215,221,222 However, in patients with severely increased albuminuria, ACEi reduced doubling of serum creatinine by 42% (RR: 0.58; 95% CI: 0.37 ACEi also reduces albuminuria in the CKD population with diabetes. The risk of progression from moderately increased albuminuria to severely increased albuminuria decreased by from 17 studies with a mean follow-up of 34 months and an absolute difference of 123 fewer events per 1000 patients (95% Compared to placebo or standard of care in 8 studies of 4106 participants, ARBs did not show a difference in all-cause mortality in patients with diabetes and CKD (RR: 0.99; 95% CI: 0.85 1.16). Similarly, there was no bene t in CV mor- tality, MI, HF, stroke, or CV bene t in diabetes and CKD. There was a kidney bene t with a reduction of doubling of serum creatinine of 16% (RR: 0.84; 95% CI: 0.72 0.98) based on 3280 patients from 4 studies with a mean follow-up of 34 months (Supplementary Table S22162,200,234,235 ). There were no differences between ACEi and ARB for the discrete outcomes of all-cause mortality, CV mortality, MI, stroke, HF, and kidney function in people with diabetes and albuminuric or non-albuminuric CKD subpopulations (Supplementary Table S23217,236 239 ). When compared to placebo or standard of care, ACEi improves CVoutcomes, but for ARB, there is no improvement. Studies comparing ACEi to ARB in patients with CKD and diabetes may have had an insuf cient number of patients to nd a difference. 