Nephrol Dial Transplant (1999) 14: 1912-1916
© 1999 European Renal Association-European Dialysis and Transplant Association
The impact of withdrawing ACE inhibitors on erythropoietin responsiveness and left ventricular hypertrophy in haemodialysis patients
ehsuvar Ertürk
lu
Department of Nephrology, Ankara University School of Medicine, 
bn-i Sina Hospital, Ankara, Turkey
Correspondence and offprint requests to:
Dr ehsuvar Ertürk, Gokcek Sokak, 30/5, Gaziosmanpasa, Ankara, 06700, Turkey.
Background. Angiotensin-converting enzyme (ACE) inhibitors have the capability of decreasing left ventricular mass index (LVMI) in chronic haemodialysis (HD) patients. On the other hand, recent reports provide conflicting information regarding the impact of ACE inhibitors on responsiveness to recombinant human erythropoietin (rHuEpo), and there are no data about the effect of withdrawing ACE inhibitors both on rHuEpo response and LVMI in HD patients.
Methods. ACE inhibitors were switched to another antihypertensive medication in 23 out of 68 patients in our HD unit who were receiving both rHuEpo and an ACE inhibitor for more than 1 year. Blood pressure at the pre- and post-dialysis phases, haematocrit levels and rHuEpo doses were determined at the end of the first and of the third years, and the LVMI was determined at the end of the third year. Statistical analyses were done in 15 patients in whom the study could be completed.
Results. The mean (±SD) haematocrit level was increased from 26.3±6.4% to 29.8±6.3% at the first year (P<0.05), and to 29.4±6.5% at the third year (P<0.05 vs before), while the mean dose of rHuEpo was decreased from 208.3±99.0 UI/kg/week to 141.0±91.8 at the first year (P=0.01), and to 141.4±81.0 at the third year (P=0.01 vs before). Administration of rHuEpo had been stopped in two patients at the end of the first year. The mean blood pressure level and the mean LVMI were not changed (P>0.05 vs before). There were no significant changes in dialysis parameters, iron status, plasma renin activities, and levels of aldosterone, intact parathyroid hormone, aluminum and erythropoietin.
Conclusion. The findings of this small uncontrolled study indicate that withdrawl of ACE inhibitors in hypertensive chronic HD patients receiving rHuEpo may result in an increase in haematocrit level, and a decrease in dose of rHuEpo without any significant changes in the blood pressure level and LVMI. Controlled prospective studies are needed to clarify this issue.
Keywords: ACE inhibitors; anaemia; erythropoietin; haemodialysis; hypertension; left ventricular hypertrophy
Please see also the Editorial Comment by Macdougall (pp. 1836–1841 in this issue) and the Letter by Chew (pp. 2047–2049 in this issue).
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