FF 84 ACHIEVE: Spironolactone flops in dialysis
From Freely Filtered, a NephJC Podcast by NephJC Team
November 2, 2025 · 1h 29m · Season 1 · Episode 84
About this episode
The episode discusses the ineffectiveness of spironolactone in dialysis patients and reviews various clinical trials related to heart failure and nephrology.
The Filtrate Joel Topf @kidneyboy.bsky.social Swapnil Hiremath @hswapnil.medsky.social AC @medpeedskidneys.bsky.social Special Guest Mike Walsh Associate Professor in the Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University as well as a Scientist at the Population Health Research Institute and a nephrologist at St. Joseph’s Healthcare Hamilton where he is the Chair of the Clinical Nephrology Research Group. Editing and Show Notes by Sophia Ambruso The Kidney Connection written and performed by Tim Yau Show Notes ALCHEMIST ( NephJC Shorts , Rossignol et al Lancet 2025) AC is in her 83rd year of med-peds fellowship. Joel’s monologue brings us all down. Prophylactic ICD therapy doesn’t improve sudden cardiac death or all-cause mortality in HD patients in the ICD2 trial ( Jukema JW et al . Circulation 2019) Initiation with statins do not impact MACE endpoints or atherosclerotic events (4D AURORA trial Fellstrom BC et al. NEJM 2009 & SHARP trial Baigent C et al. Lancet 2011) Mike tries to liven up the mood by mentioning positive outcomes with iron therapy in heart failure with the PIVOTAL trial ( Macdougall IC et al . NEJM 2018)…
People in this episode
Hosts: Joel Topf, Swapnil Hiremath
Guest: Mike Walsh
Topics covered
- dialysis
- spironolactone
- heart failure
- clinical trials
- nephrology
Keywords
- spironolactone
- dialysis
- heart failure
- clinical trials
- nephrology
- MACE outcomes
- iron therapy
Mentioned in this episode
Organizations: McMaster University, Population Health Research Institute, St. Joseph’s Healthcare Hamilton
Books & works: ALCHEMIST, PIVOTAL trial, TOPHAT trial, 4D AURORA trial, SHARP trial, ICD2 trial
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