Nephrol Dial Transplant (1999) 14: 1836-1841
© 1999 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
The role of ACE inhibitors and angiotensin II receptor blockers in the response to epoetin
Department of Renal Medicine, King's College Hospital, London, UK
Correspondence and offprint requests to: Dr Iain C. Macdougall, Consultant Nephrologist, Renal Unit, King's College Hospital, East Dulwich Grove, London SE22 8PT, UK.
Introduction
Both angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers are widely used in renal failure patients in the treatment of hypertension [1], left ventricular dysfunction [2], and diabetic nephropathy [3]. Their efficacy in these conditions is well established, and generally both classes of drugs are well tolerated, with a low incidence of side effects [4]. Thus, ACE inhibitors may induce skin rashes, angioneurotic oedema, diarrhoea, cough, and dizziness [5], while the angiotensin II blockers have a side effect profile not dissimilar to placebo.
Recently, however, much interest has focused on the potential for both classes of drugs to suppress erythropoiesis, and thereby exacerbate anaemia [6,7]. Moreover, much controversy has also been generated over whether these drugs can induce some resistance to erythropoietin therapy, requiring the use of higher dosages with obvious economic implications [8
Possible mechanisms of action for suppressing erythropoiesis
Do ACE inhibitors or angiotensin II blockers inhibit the action of epoetin?
Studies supporting the hypothesis
Studies refuting the hypothesis
What can we conclude from these studies?
Guidelines for managing patients on epoetin and ACE inhibitors/angiotensin II blockers
Conclusions
References
CiteULike 
Connotea 
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