What is the quality of the evidence for the use of antihypertensive therapies in patients with diabetes and CKD?
The overall quality of the evidence was rated as moderate, as the studies examining the use of RASi therapy exhibited study limitations with unclear allocation concealment for critical and important outcomes. The quality of the evidence was lower for CV outcomes, owing to there being fewer events and inconsistent reporting of these outcomes in trials (Supplementary Tables S21 S30). In the ADVANCE study of patients with CKD G1 G3, A2, the quality of evidence is low according to GRADE.260 The quality of the evidence was downgraded due to serious risk of bias, with unclear allocation concealment, and imprecision, as the beneficial results of diuretics were seen only in the CKD subgroups, when the results were negative in the entire cohort (Supplementary Table S27).