Please select the eligibility criteria that correspond to the clinical trial below.
Title: Subjects With Severe Heart Failure and End-Stage Renal Disease on Hemodialysis: A Pilot Study to Assess Safety and Tolerability of Spironolactone
Brief Summary: Cardiovascular disease is the leading cause of death and disproportionately prevalent in patients with kidney disease. Spironolactone has been shown to improve survival in the general population with heart failure by up to 30%. We wish to study the safety and tolerability of aldosterone blockade with spironolactone on cardiac function in a high risk population of patients on hemodialysis. We will study and closely monitor subjects over a period of 12 months, during which they will be receiving spironolactone for a period of 6 months.


Options:
A: 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
B: 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.
C: Inclusion Criteria:

* They must be at least 18 years of age.
* They must understand the study purpose and give their written informed consent.
* They must have been stable on chronic hemodialysis for at least three months before enrollment into the study.
* Hemodialysis subjects will be included if they have had a left ventricular ejection fraction measured within the past six months with a value no more than 45 percent. A repeat, standardized echocardiogram will be used to confirm left ventricular ejection fraction.

Exclusion Criteria:

* Subjects with primary operable valvular heart disease.
* Subjects with a congenital heart disease.
* Subjects with unstable angina.
* Subjects with primary hepatic failure.
* Subjects with active cancer or any life-threatening disease (other than heart failure or end-stage renal disease).
* Subjects who have undergone heart transplantation or who are awaiting heart transplantation are also ineligible.
* Subjects on a renal transplant list will be accepted into the study until the time of successful renal transplantation and termination of dialysis.
* Subjects with habitually difficult to control hyperkalemia (serum potassium \>6.0 meq/L) in the previous month while on dialysis will be excluded.
* The inability to complete the 6-minute walk test will not be a reason to exclude subjects from this study.
D: Inclusion Criteria:

* Patients who having been on PD continuously for one month, urine volume\>600 ml/d, residual renal function\>2ml/min/1.73m2, blood pressure\>120/70mmHg, serum potassium levels\<5.5mmol/l, stable clinical condition.

Exclusion Criteria:

* Patients with infectious systemic disease, peritonitis during the preceding 1 month, who had taken ACEI/ARBs in the 3 preceding months, spirolactone in the 2 preceding weeks, intolerance to ACEI/ARBs, CHF, MI, malignant hypertension and stroke within the preceding 6 months.

Answer: C