Aldosterone bloCkade for Health Improvement EValuation in End-stage renal disease (ACHIEVE)
Project locations
The global burden of end-stage kidney disease (ESKD) has increased dramatically over the last 2 decades. Globally 2.5 million people receive dialysis for ESKD; however, outcomes for these patients are still poor. Therapies that improve outcomes in the dialysis population are urgently needed.
Cardiovascular disease, particularly heart failure, is the leading cause of death in dialysis patients. In the general population the use of mineralocorticoid antagonists, such as spironolactone, have been shown to reduce mortality and hospital admissions. However, this standard therapy is rarely used in patients with ESKD.
The ACHIEVE study is a multicentre double-blinded randomised, controlled trial that examines the effect of spironolactone (an aldosterone antagonist) compared to placebo. It will determine whether Spironolactone decreases cardiovascular death and heart failure in dialysis patients. This is an international collaboration with the Population Health Research Institute (based in Canada). To date, 2,477 patients have been randomised across North America, Europe, the UK, and the Asia-Pacific region. In Australia and New Zealand 196 patients have been randomised. The results will be available late 2025.
Diseases or conditions
Renal dialysis, Heart failureParticipating countries
About this study
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 medication 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.
Recruitment criteria
Inclusion
- Age
- ≥45 years or
- ≥18 with a history of diabetes
- On dialysis ≥ 90 days
- On either
- Haemodialysis prescribed at least 2 treatments per week or
- Peritoneal dialysis prescribed with at least 1 exchange daily
- On either
- Provides informed consent
What’s involved?
- This trial plans to recruit over 1,000 eligible patients across Australia, New Zealand, Malaysia and China.
- Participants will be randomly allocated to either take 25mg of spironolactone or identical placebo tablets.
- Participants will be followed up on a six-monthly basis through face-to-face/telephone interviews or mail-based/electronic questionnaires.