Serum Cr ≥ 2.5mg/dL (males) or 2.0mg/dL (females), or eGFR \< 20 ml/min/1.73m2

Serum potassium ≥ 5.5 mEq/L

Transplant recipients of any kind

Fever \> 101.0

Severe lung disease (required home O2 or daily oral steroids)

Acute coronary syndrome within last 30 days

Major surgery within last 30 days

Known hypertrophic obstructive cardiomyopathy, pericardial constriction, or hemodynamically significant valvular disease

Life expectancy less than 12 months for any reason

Current treatment for any malignancy of any kind

Cardiogenic shock and/or requiring IV inotropic therapy

Pregnant or recently pregnant within last 90 days

Known intolerance to aldosterone antagonist

Inability to give appropriate written consent

Identification of Patient Phenotypes Associated With Elevated Aldosterone Levels