Recognition that BP-lowering could be achieved with much lower doses of spironolactone (12.5 50 mg/day) has led to renewed interest in aldosterone antagonists over the past decade.102 105 As a result, eplerenone, a miner- alocorticoid-receptor blocker without estrogen-like effects, has been developed. In CKD, the major emphasis has been on using aldosterone antagonists to reduce urine albumin levels and as an adjunct to other antihypertensive agents in treating resistant hypertension. Aldosterone antagonists are of proven benefit in non-CKD patients with heart failure, including heart failure after myocardial infarction. Because of the risk of hyperkalemia and reduction in GFR, they should be used with caution in CKD patients. Dose considerations in CKD patients. Impaired renal excretion of native drug or active metabolites of spirono- lactone and eplerenone and an increased risk of hyperkalemia may limit their use in patients with CKD. Plasma potassium levels and kidney function should be monitored closely during the introduction of aldosterone antagonists and during intercurrent illnesses, particularly those associated with a risk of GFR reduction, as occurs with dehydration. Indications for aldosterone antagonists. In patients without CKD, aldosterone antagonists are recommended for the treatment of severe cardiac failure that is resistant to other therapies and for use after acute myocardial infarction complicated by cardiac failure. These agents also have a place in the management of essential hypertension that is resistant to other therapies. It is unclear whether this information can be extrapolated to CKD patients, particularly those with advanced CKD in whom the risks associated with the use of aldosterone antagonists, particularly of hyperkalemia, may be increased. In patients with CKD, aldosterone antagonists have been shown to decrease urine albumin excretion when added to ACE-I or ARB therapy. 