Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effect of Add-on Spironolactone to Losartan Versus Losartan Alone on Peritoneal Membrane Among Continuous Ambulatory Peritoneal Dialysis Patients: An Open-Label Randomized-Controlled Trial
Brief Summary: The ESCAPE-PD (Effects of add-on SpironolaCtone to losartan versus Alone on Peritoneal mEmbrane among continuous ambulatory Peritoneal Dialysis patients) study is a randomized, open-label, single center, active-controlled clinical trial. Adults end-stage kidney disease patients 18 years or older undergoing continuous ambulatory peritoneal dialysis (CAPD) will be enrolled. A total 84 CAPD will be randomly assigned to either the combination of spironolactone and losartan (experimental arm) or losartan alone (control arm). The primary outcomes are the difference in peritoneal dialysate effluent cancer antigen-125 (CA-125) and peritoneal equilibration test (PET) indices (dialysate-to-plasma creatinine ratio, 4-hour ultrafiltration volume, and the concentration of glucose present in the solution at the start of the test). Secondary outcome measures include laboratory and mechanistic outcome measures, nutrition outcomes, health-related quality of life, physical function, clinical events, and safety profiles. Results will be disseminated to suggest a strategy to prevent the peritoneal membrane function among CAPD patients through peer-reviewed publications along with scientific meetings.


Options:
A: Inclusion Criteria:

* Age ≥18 years
* On hemodialysis \>90 days
* Prescribed target body weight within 1 kg of current for all dialysis sessions within 4 weeks prior to randomization
* Able to provide written informed consent to participate

Exclusion Criteria:

* Occurrence of documented clinically important hypotension (systolic blood pressure \<90 that required treatment) within 4 weeks of randomization
* Change in blood pressure medications within 4 weeks prior to randomization
* Occurrence of pre-dialysis serum potassium \>6.0 mmol/L in 4 weeks prior to randomization
* Currently treated with and cannot withdraw spironolactone or eplerenone due to medical necessity
* Known allergy or sensitivity to eplerenone
* Pregnancy
* Scheduled living related donor renal transplant within the next 6 months
B: Inclusion Criteria:

* Age ≥ 18 years or older (both male and female patients)
* Incidence or prevalent end-stage kidney disease patients undergoing CAPD
* Had standard dialysis prescription for at least 30 days before screening
* History of hypertension
* Stable clinical condition without any inflammation at least 4 weeks prior to enrolment
* Had an ability to understand and willingness to sign an informed consent statement

Exclusion Criteria:

* Serum potassium concentration of ≥ 5.5 milliequivalent /liter
* History of severe or active cardiovascular and/or cerebrovascular disease
* History of renal artery stenosis
* Uncontrolled hypertension
* Contraindication to angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers or mineralocorticoid receptor antagonists
* Pregnancy
* Recent PD-related peritonitis or exit-site and tunnel infection (within 2 months of screening)
* Had planned to have kidney transplantation or transfer to other PD centers with 6 months
* Prognosis for survival less than 12 months
* Any conditions (both mental or physical) that would interfere with the participant's ability to comply with the study protocol
* Any disease of the abdominal wall, such as injury or surgery, burns, hernia, dermatitis, inflammatory bowel diseases (Crohn's disease, ulcerative colitis or diverticulitis) that in the opinion of the Investigator would preclude the patient from being able to have PD
* Any intra-abdominal tumors or intestinal obstruction
* Current or recent (within 30 days) exposure to others investigational medicinal products
C: Inclusion Criteria:

* Age \>18 years
* Hemodialysis treatment for at least 3 months
* At least 3 dialysis sessions per week
* Written informed consent

Exclusion Criteria:

* Contraindications for cardiac magnet resonance imaging (CMR)
* Mineralocorticoid receptor antagonist treatment within the last 6 months
* Estimated life expectancy \< 12 months as judged by the nephrologist
* History of hyperkalemia, defined as pre-dialysis potassium \> 6.5 mmol/l occurring ≥ 3 times within the last 3 months prior to enrolment.
* High risk to develop hyperkalemia defined as pre-dialysis potassium \> 6.0 mmol/l
* Hypotension (systolic blood pressure \< 100 mmHg)
* Planned kidney transplantation (living donor) within the prospected study duration
* Any acute illness within the last 4 weeks precluding a study participation as judged by the nephrologist
* Non-amenorrheic women with child bearing potential without reliable contraception, pregnancy/lactation
* Allergy/hypersensitivity to spironolactone
* Non-compliance suspected or demonstrated
D: Inclusion Criteria:

The series will consist of:

1. Patients with at least 18 years of age,
2. Suffering from chronic kidney disease stage V on dialysis,
3. Mean blood pressure residential than 135 x 85 mm Hg and
4. Who present left ventricular mass indexed for height to the 2.7 power greater than 51 g/m2, 7.

Exclusion Criteria:

1. History or evidence of angina or myocardial infarction,
2. Heart failure,
3. Peripheral vascular disease,
4. Hyperkalemia
5. Previous valve atrial fibrillation,
6. Anemia (hemoglobin \<10 g/dl),
7. Doses of parathyroid hormone (PTH) greater than 300 pg/mL,
8. Patients being treated with spironolactone and
9. Patients who have suspended or initiated the use of inhibitors of angiotensin converting enzyme inhibitors, angiotensin receptor blockers (ARBs) renin blockers in the last six months.

Answer: B