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.

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