Grant: Project Grant

Forty percent of patients that require dialysis for kidney failure die within three years mostly due to heart disease. In patients without kidney disease, spironlactone reduces heart scarring which reduces heart related deaths and hospitalizations. Kidney failure appears to trigger progressive changes in the heart that lead to heart scarring and ultimately heart related deaths. It therefore makes sense that spironolactone will help patients with kidney failure. Although spironolactone is promising, there are no large studies to tell us if it helps patients live longer or better lives. In addition, current dialysis does not effectively clear all toxins from the blood the way natural kidneys do. Some of the molecules that are not cleared build up and can affect the blood vessels and the heart. A new type of dialysis filter, the Theranova, effectively clears many of these potential toxins. However, it is not clear if removing these toxins will improve patient's lives or if there are potential negative consequences. We will perform a large study in several countries that will give physicians and patients the information they need to determine if spironolactone or the Theranova reduces heart related deaths and hospitalizations and/or reduce the symptoms of dialysis. We call this study the Aldosterone antagonism and enhanced Clearance for Health Improvement EValuation in End-stage renal disease (ACHIEVE).