The purpose of the Spin-D trial is to test the safety, tolerability, and efficacy of spironolactone for patients with kidney failure on chronic hemodialysis. Spironolactone is a drug that has been used for many years to reduce blood pressure. Recently the drug has been found to increase the life expectancy of patients with heart failure. People with kidney failure have an increased risk of heart failure due to thickening of the heart wall and an increased risk of abnormal heart rhythms. Although spironolactone has been approved for treating heart failure, it is not known whether this benefit occurs in patients with kidney failure.