Grant: Project Grant

Almost 3 million people worldwide need dialysis to sustain their lives after their kidneys fail and this number is projected to double in the next 15 years. Almost half of patients that require dialysis for kidney failure die within three years mostly due to heart disease. This occurs because the heart becomes increasingly scarred in patients with kidney failure and these scars cause heart failure. Aldosterone is a hormone produced by the body that is known to increase the rate of scarring of the heart and other organs. Aldosterone is increased in patients with kidney failure and may explain their higher risk of heart related deaths. Spironolactone is a well known drug that blocks the actions of aldosterone. Spironolactone is very effective at reducing heart related deaths and hospitalizations in patients with heart failure that do not also have kidney failure. It makes sense that spironolactone might protect the hearts of patients with kidney failure. However, there are no high quality studies to tell us if spironolactone will work. It is important to determine if spironolactone works specifically in patients with kidney failure because the way in which their hearts develop scars is slightly different than in other types of patients. We will perform a large study in several countries that will give physicians and patients the information they need to determine if spironolactone reduces heart related deaths and hospitalizations. We call this study the Aldosterone bloCkade for Health Improvement EValuation in End-stage renal disease (ACHIEVE) Trial. If spironolactone works in patients receiving dialysis, it will represent the first treatment for heart deaths in this fragile population.