Abstract: About half of the patients with maintenance hemodialysis die from cardiovascular diseases. Aldosterone receptor antagonists protect renal vessels and improve ventricular remodeling by acting on renal tubular epithelial cells and non-epithelial target organs such as brain, blood vessels, and heart, so as to significantly reduce cardiovascular event mortality and all-cause mortality. However, due to the risk of hyperkalemia resulting from aldosterone receptor antagonists, they have not been widely used clinically. Based on the analysis of published studies, we believe that low-dose of spironolactone (≤ 25 mg/d) is safe in hemodialysis patients.