Would you continue spironolactone in a patient who has recently progressed to ESKD on HD with oliguria and was diagnosed with primary hyperaldosteronism years ago?  

Although spironolactone does antagonize the effect of aldosterone in the colon, it is unlikely that spironolactone will be effective in treating primary hyperaldosteronism in a patient with ESKD with minimal urine output. Therefore, I would discontinue the spironolactone in such patients.