Aldosterone BloCkade for Health Improvement EValuation in End-stage Renal Disease
2750 patients around the world
Available in Brazil, Uruguay
Globally, over 2 million people receive dialysis for end-stage renal disease (ESRD) and
650,000 new patients start dialysis each year. Furthermore, the number of patients
receiving dialysis is increasing as access to dialysis in the developing world improves
and the prevalence of diabetes and vascular disease rises. Despite technical advances in
dialysis, the outcomes for patients with ESRD are poor. Patients have frequent
hospitalizations, poor health related quality of life and strikingly, high mortality
rates.
The most common cause of death in patients receiving dialysis is cardiovascular disease,
accounting for >40% of all deaths. Observational studies suggest a causal pathway to
cardiovascular death that includes progressive ventricular hypertrophy and dilatation as
well as accelerated atherosclerosis. These changes result in myocardial ischemia and
cardiac fibrosis that, in turn, lead to heart failure, arrhythmias and cardiac arrest.
Strongly implicated in this pathophysiology is aldosterone. Mineralocorticoid receptor
antagonists (MRAs) in non-ESRD patients, prevent cardiovascular deaths and small
randomized controlled trials of MRAs in ESRD suggests they may reduce death and may be
safe.
Spironolactone is the most commonly used MRA worldwide. We will conduct a multicentre
randomized controlled trial (RCT) to determine if spironolactone reduces cardiac
mortality and hospitalizations for heart failure in patients treated with dialysis. This
trial is called the Aldosterone bloCkade for Health Improvement EValuation in End-stage
renal disease (ACHIEVE).
Population Health Research Institute
2750Patients around the world
Requirements for the patient
From 18 Years
All Gender
Medical requirements
Age
≥45 years or
≥18 with a history of diabetes
On dialysis ≥ 90 days
On either
Hemodialysis prescribed at least 2 treatments per week or
Peritoneal dialysis prescribed with at least 1 exchange daily
Provides informed consent
Hyperkalemia
Serum potassium >5.8 mmol/L in the 6 weeks prior to enrollment or
Serum potassium >6.0 mmol/L during active run-in
Currently taking and unable to withdraw a mineralocorticoid receptor antagonist (i.e. spironolactone or eplerenone).
Known sensitivity or allergy to spironolactone
Current or planned pregnancy or breastfeeding
Scheduled living related donor renal transplant
Life expectancy < 6 months in the opinion of a treating nephrologist.
Enrolled in another interventional trial testing a mineralocorticoid receptor antagonist or drug that has a known or likely interaction with spironolactone.
Treating physician believes either spironolactone is either absolutely indicated or absolutely contra-indicated