ALdosterone Antagonist Chronic HEModialysis Interventional Survival Trial

Inclusion Criteria: * Written informed consent. * Adult men and women on HD for at least 45 days for ESRD regardless of the etiology including diabetes, with at least 3 HD sessions per week * Presenting at least one of the follow comorbidities, cardiovascular abnormalities or CV risk factors: * Left ventricular hypertrophy defined by left ventricular mass \> 130 g/m2 in men and 100 g/m2 in women (echocardiography) * OR Cornell (RaVL + SV3) \>28 mm in men, \> 20 mm in women(ECG) * OR left ventricular ejection fraction \< 40% * OR large QRS \> 0.14 sec * OR Left bundle branch block (ECG) measured during the twelve months preceding inclusion; diabetes; * OR history of cardiovascular disease: coronary artery disease, symptomatic lower limb peripheral arterial disease, carotid or renal artery stenosis \> 50%, stroke, hospitalization for heart failure, permanent atrial fibrillation (AF), oral anticoagulant treatment for AF, valvular heart prosthesis, * OR CRP \> 5 mg/l for 3 months without infectious or neoplastic disease documented in progress Exclusion Criteria: * history of hypersensitivity to spironolactone or galactose intolerance * the Lapp lactase deficiency or malabsorption of glucose or galactose * hyperkalemia \> 5.5 mmol/l during the two weeks prior to enrolment * history of unscheduled hemodialysis for hyperkalemia during the last six months * hospitalization for hyperkalemia during the last six months * patients with imperative indication of a combination of ACEI and sartan or renin inhibitor (each being authorized separately), NSAIDS, Cox-2 inhibitors * kidney transplant scheduled within the year * symptomatic interdialytic hypotension * acute systemic disease * uncompensated hypothyroidism * acute hyperthyroidism * any prior or concomitant clinical condition compromising the inclusion, in the discretion of the investigator * cardiac transplant * severe uncontrolled arrhythmia * stroke within 3 months prior to enrolment * acute coronary syndrome in the previous month inclusion * recent (1 month) or planned coronary revascularization by angioplasty * recent (3 months) or planned cardiovascular surgery (excluding HD vascular access) * non menopausal women or without effective contraceptive methods * pregnancy, breastfeeding or planning a pregnancy within 2 years * non compliance * protected adult * SBP \> 200 mmHg and/or DBP \> 110 mmHg * Concomitant treatment can not be stopped by another potassium-sparing diuretic, a potassium supplements, AINS or Cox 2 inhibitors