Efficacy and Safety of Spironolactone in Pediatric Hemodialysis Patients With Anemia.

Inclusion Criteria: 1. Male or female patients with ages 6-18 years old undergoing regular hemodialysis (3 sessions per week for at least 6 months) 2. Pediatric patients weighing between 25 kg and 50 kg. 3. Patients with potassium level less than 5.5 mmol/L and produce urine. 4. Anemic patients "have Hb values between 9.5 and 12.5 g/dl, transferrin saturation (TSAT) less than 20%) 5. patients have been receiving stable rHuEpo therapy administered intravenously (IV) or subcutaneously (SC) for at least 8 weeks prior to randomization 6. Patients suffering from iron- restricted erythropoiesis - Exclusion Criteria: 1. Patients with acute renal insufficiency. 2. Patients with hyperkalemia (≥5.5 mmol/L) and hyponatremia (blood level less than135 mEq/L) 3. Patients with liver disease (AST \& ALT greater than 3times upper limit normal) 4. Patients with hypersensitivity to spironolactone. 5. Patients scheduled for a living donor kidney transplant within 6 weeks following consent. 6. Current or recently enrolled in another investigational drug study (within 30 days). 7. Uncontrolled pre-dialysis supine diastolic blood pressure greater than the 95th percentile for height, gender, and age on more than two occasions in the 2 weeks prior to screening. \-