Fu EL, Clase CM, Evans M, et al. - Because it remains unknown if among patients with advanced chronic kidney disease (CKD), initiating a renin-angiotensin system inhibitor (RASi) is superior to alternative antihypertensive agents such as calcium channel blockers (CCB), therefore, researchers performed this observational study in the Swedish Renal Registry, 2007-2017, to compare the risks of kidney replacement therapy (KRT), death and major adverse cardiovascular events (MACE) in correlation with initiating either RASi or CCB in patients with advanced CKD in routine nephrology practice. Participants included 2,458 new users of RASi and 2,345 CCB users, in whom estimated glomerular filtration rate (eGFR) was < 30 ml/min/1.73m² (CKD G4-5 without KRT). Experts also assessed new users of the same drugs with CKD G3 (eGFR 30-60 ml/min/1.73m²), as a positive control cohort. Following propensity score weighting, it was evident that new use of RASi vs new use of CCB resulted in a significantly lower risk of KRT, however, risks of death and MACE were similar. By evidence from real world clinical practice, kidney and cardiovascular benefits may be achieved by initiating RASi vs CCB in patients with advanced CKD.