Serum creatinine greater than 2.0 mg/dl Serum K greater than 5.0 meq/L Patients who need to use spironolactone for some other reasons Life expectancy less than 1 year For this pilot phase of the study we will investigate 30 patients (see attached sample size calculation) equally divided into control and treatment groups. Patients will be randomly allocated to the different groups by using computer generated randomization sequence. After 3 months on study medication (or placebo) the study group of patients will be switched to the placebo group and vice versa. Thus each patient will be his own control. There will be a month of wash out period in between this change over.