MiREnDaSpironolactone for Cardioprotection in Hemodialysis Patients with End Stage Renal Disease

Patients with end stage renal disease (ESRD) often face high mortality rates, with nearly half of these cases caused by cardiovascular issues. A common condition in ESRD patients undergoing dialysis is increased left ventricular mass (LVM), which independently predicts survival. Currently, there's no established medical treatment to decrease cardiovascular morbidity and mortality in ESRD patients on hemodialysis. This study explores the potential of a mineralocorticoid receptor antagonist (MRA) called spironolactone. This drug has shown promise in heart failure patients and has recently been found to reduce LVM in patients with mild-to-moderate chronic kidney disease (CKD). The researchers believe that spironolactone treatment could protect the heart by reducing LVM in ESRD patients on dialysis. This phase 2 interventional trial aims to evaluate the efficacy and safety of spironolactone in hemodialysis patients. Participants will receive spironolactone treatment, and the study will measure its impact on the left ventricular mass index. This will be assessed using cardiac MRI, a non-invasive imaging technique that provides detailed pictures of the heart. The primary outcome of the study is to determine if spironolactone can reduce the left ventricular mass index in these patients, potentially offering a new treatment option for this high-risk population.