The quality of evidence was graded as C because the RCT evidence is limited to inferred evidence from one trial. 6.2: We suggest that in children with CKD ND (parti- cularly those with proteinuria), BP is lowered to consistently achieve systolic and diastolic readings less than or equal to the 50th percentile for age, sex, and height, unless achieving these targets is limited by signs or symptoms of hypotension. (2D) RATIONALE The evidence for this recommendation comes largely from the which showed a benefit in slowing CKD progression by targeting 24-hour MAP by ABPM to less than percentile for age, height and sex. Secondary analysis of the data suggested the effect was stronger in proteinuric children with CKD. (See Supplementary Tables 63 64 online). Based largely on the ESCAPE results, the European Society of Hypertension guidelines recently recommended that in children with CKD, BP targets should be below the 50th percentile in the presence of proteinuria and below the 75th percentile in the absence of proteinuria.337 In the European Society of Hypertension guidelines, the rationale for choosing percentile as a threshold in children with CKD without proteinuria is based on a re-analysis of ESCAPE results, examining kidney outcomes according to achieved 24-hour mean BP level. Since the 75th percentile was not an original targeted intervention in the ESCAPE trial, and the trial was not powered to detect differences by levels of proteinuria in recruited subjects, we have not made a separate specific recommendation distinguishing between the presence and absence of proteinuria for target BP levels for children with CKD, but this is an important area for future study. Our guideline includes a statement of caution in aggressively pursuing low BP targets in children with CKD. 