Interventional - Drug
Globally more than two 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 ACHIEVE, a multicentre randomized controlled trial to determine if spironolactone reduces cardiac mortality and hospitalizations for heart failure in patients treated with dialysis.ACHIEVE Presentation - Download PDF
Interventional - Drug
RCT with blinding
2018 - 2024
Michael Walsh is a Principal Investigator in the Renal research program at PHRI, and an Assistant Professor, Department of Medicine (nephrology), McMaster University. His research activities are in the areas of the treatment of patients who require dialysis, severe glomerular disease, and perioperative acute kidney injury. He has published more than 70 papers and two book chapters.
He holds a Kidney Research Scientist Core Education and National Training (KRESCENT) Program New Investigator award through CIHR and the Kidney Foundation of Canada. He’s received multiple Top Abstract awards from the Canadian Society of Nephrology, the Chalmers Prize from the Society for Clinical Trials, and the Detweiller Traveling Scholar Award from the College of Physicians and Surgeons of Canada.
Jessica Tyrwhitt has more than 10 years’ experience in coordinating and managing large, international clinical trials. She oversees interventional trials, registries, and observational research studies looking at primary and secondary prevention of cardiovascular disease in a variety of therapeutic areas, including cardiology, thrombosis, nephrology, cardio-oncology and diabetes.
She holds an Honours Bachelor of Science Degree & Business from the University of Waterloo.
Courtney has more than eight years of experience working in both industry and academic research. She primarily manages large international drug trials that focus primarily on prevention of cardiovascular disease (TIPS-3, COMPASS and ORIGIN trials) and chronic kidney disease (ACHIEVE, RECORD and DISCO-RLS trials).
She holds an Honours Bachelor of Applied Sciences with a Major in Kinesiology and a Diploma in Fitness and Health Promotion from the University of Guelph-Humber.
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