The unique electrolytic and pathophysiological environment of hemodialysis patients, along with their increased cardiovascular risk and vulnerability, requires dedicated exploration of the therapeutic potentials of mineralocorticoid receptor agonists (MRAs). The presence of chronic kidney disease (CKD) often influences the decision to start, uptitrate, or discontinue possible lifesaving therapies, especially when it comes to patients with reduced left ventricular ejection fraction (HFrEF), the treatment approach needs to be carefully considered. Our goal is to outline the design and rationale of our pilot study, which investigates the impact of mineralocorticoid receptor blockers (MRAs), more precisely finerenone on changes in pulse wave velocity (PWV), arterial pressure, and heart -related deaths in patient undergoing hemodialysis. To be eligible for study entrollment patients must be at least three months on a chronic hemodialysis program, ACE inhibitors or angiotensin receptor blockers must be included in the therapy at maximum tolerable doses from the beginning, serum potassium level between two dialysis needs to be ≤ mmol/L, left ventricular ejection fraction needs to be ≤ 50%, pulse wave velocity higher than estimated for the age. Patients who meet the criteria will be randomized into two groups in a 1: 1 ratio. Randomized allocation was assigned by a permuted block design, stratified by center. The allocation notification to the group was conveyed through a study form signed by the patient during the initial examination. Group A = RAAS blockers and finerenone 10 mg. Group B: RAAS blockers with other conventional therapy and placebo. This pilot study addresses responses to whether changes in pulse wave and arterial pressure, through MRAs therapy, can reduce the number of heart -related deaths in dialysis patients. The findings aim to shed light on the potential impact of MRAs on cardiovascular outcomes in this population.The pilot study will be completed 12 months after the last enrolment.