Ito 2014.

Study characteristics
Methods	Study design: parallel RCT Study duration: not reported Follow‐up period: 24 months
Participants	Setting: multicentre (12 sites) Country: Japan Relevant health status: CKD‐5D on PD; NYHA‐FC I and II Number: treatment group (78); control group (80) Mean age ± SD (years): treatment group (57.4 ± 12.3); control group (55.6 ± 14.4) Sex (M/F); treatment group (55/23); control group (58/22) Exclusion criteria: severe anaemia (Hb < 9.0 g/dL); NYHA‐FC III and IV heart failure; treatment with acid‐pH fluid dialysate; previous treatment with HD or transplantation within the preceding 3 years; pregnancy or suspected pregnancy
Interventions	Treatment group Spironolactone: 25 mg/day for 104 weeks Control group Standard care for 104 weeks
Outcomes	Death (any cause) Death (cardiovascular) Cardiovascular and cerebrovascular morbidity: acute MI Hyperkalaemia: K > 6.0 mEq/L Gynaecomastia LVM EF
Identification	Authors name: Yasuhiko Ito Institution: Nephrology and Renal Replacement Therapy, Nagoya University, Nagoya, Japan Email: yasuito@med.nagoya‐u.ac.jp Address: 65 Tsurumai‐cho, Showaku, Nagoya 466‐8550, Japan
Notes	Funding source: This study was supported in part by a Grant‐in‐Aid for Progressive Renal Disease Research, Research on Rare and Intractable Diseases, from the Ministry of Health, Labor and Welfare of Japan Complete follow‐up: treatment group (50/78, 64.1%); control group (58/80, 72.5%)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Only states the study was randomised, does not ensure how sequence generation done
Allocation concealment (selection bias)	Unclear risk	Only states the study was randomised, does not ensure how sequence generation done
Blinding of participants and personnel (performance bias) All outcomes	High risk	Open‐label study
Blinding of outcome assessment (detection bias) All outcomes	High risk	Open‐label study
Incomplete outcome data (attrition bias) All outcomes	High risk	Imbalance in numbers for missing data across intervention groups
Selective reporting (reporting bias)	Low risk	All prespecified outcomes have been reported in The University Hospital Medical Information Network Clinical Trials Registry as UMIN000492
Other bias	Low risk	This study was supported in part by a Grant‐in‐Aid for Progressive Renal Disease Research, Research on Rare and Intractable Diseases, from the Ministry of Health, Labor and Welfare of Japan