Spironolactone Safety in Dialysis Patients

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.