Background and Disease Burden
Chronic kidney failure requiring haemodialysis represents a significant global health burden, with a markedly increased risk of cardiovascular morbidity and mortality. Cardiovascular disease (CVD) remains the leading cause of death among patients on chronic haemodialysis, accounting for approximately 40-50% of fatalities. Despite this high risk, effective pharmacological strategies to improve cardiovascular prognosis in this population remain elusive. Mineralocorticoid receptor antagonists (MRAs), such as spironolactone, have shown cardiovascular benefit in heart failure populations without kidney failure, exerting anti-fibrotic, anti-inflammatory, and hemodynamic effects. However, their efficacy and safety in the dialysis setting have not been definitively established due to concerns about hyperkalaemia and limited robust clinical trial data. The ALCHEMIST trial was specifically designed to explore whether spironolactone could reduce adverse cardiovascular events in haemodialysis patients at high cardiovascular risk, addressing this critical unmet therapeutic need.
