Aldosterone bloCkade for Health Improvement EValuation in End-stage renal disease (ACHIEVE)

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.