Is hyperkalemia a concern in this protocol? Although there is evidence that aldo can facilitate potassium excretion, even in patients with renal failure (13) by increasing GI excretion, there have been several studies recently which demonstrate that spironolactone (14,15) or Eplerenone (16) can be given to renal failure/ dialysis patients without the development of hyperkalemia. Thus, it seems that these ARAs can be given to patients with chronic renal failure, including patients on dialysis, without hyperkalemia routinely developing. Nevertheless, in this protocol, plasma potassium will be regularly measured to minimize the development of hyperkalemia.