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
Study Type

Interventional - Drug

Study Design

RCT with blinding

NO. of Countries


NO. of Sites


NO. of Participants


Study Period

2018 - 2024



Canadian Institutes of Health Research (CIHR)

MRFF - Asia Pacific Support

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