Individuals receiving maintenance dialysis therapy have extraordinarily high rates of cardiovascular (CV) death1 and an absence of effective data-driven therapies capable of mitigating CV risks.2 Interest in identifying and testing novel approaches to the therapy of CV disease in the setting of chronic kidney disease is therefore intense. In this issue of AJKD, Quach et al3 review the evidence base, such as it is, regarding the safety and efficacy of a particularly promising therapy for patients requiring dialysis: mineralocorticoid receptor antagonists.