Aldosterone bloCkade for Health Improvement EValuation in End-stage Renal Disease

  • STATUS
    Recruiting
  • End date
    Sep 26, 2023
  • participants needed
    2750
  • sponsor
    Population Health Research Institute
Updated on 26 January 2021
Investigator
Jessica Tyrwhitt, B.A.
Primary Contact
Hopital du Sacre-Coeur de Montreal (5.1 mi away) Contact
+97 other location

Summary

Individuals receiving dialysis are at risk of heart failure and heart related death. There is an urgent need for treatments that reduce the risk of these problems in patients that require dialysis.

Spironolactone is a pill used to prevent heart failure and related deaths in patients that do not require dialysis. It works by blocking a hormone (aldosterone) in your body that causes high blood pressure and can damage the heart. Although spironolactone is very effective in patients that do not require dialysis, we do not know if spironolactone is effective in dialysis patients. Our research will help determine if spironolactone reduces heart failure and heart related deaths in dialysis patients.

The purpose of this study is to determine if spironolactone reduces death or hospitalization for heart failure and is well tolerated in patients that require dialysis.

Description

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).

Details
Condition Endstage Renal Disease
Treatment Placebo Oral Tablet, Spironolactone 25Mg Tablet
Clinical Study IdentifierNCT03020303
SponsorPopulation Health Research Institute
Last Modified on26 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

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

Exclusion Criteria

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
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