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Nephrology Dialysis Transplantation, Vol 13, Issue 11 2884-2889, Copyright © 1998 by Oxford University Press

ORIGINAL ARTICLES

Effect of enalapril on exaggerated erythropoietin response to phlebotomy in erythrocytosic renal transplant patients

C Usalan, Y Erdem, M Caglar, B Altun, M Arici, M Bakkaloglu, & Yasavul, C Turgan and S Caglar
Department of Internal Medicine and Nephrology, Hacettepe University, Faculty of Medicine, 06100 Syhhyye, Ankara, Turkey; Corresponding author

Background: Exaggerated erythropoietin (EPO) response to phlebotomy regardless of the baseline EPO levels have been shown in patients with post-transplant erythrocytosis (PTE) and administration of angiotensin-converting enzyme inhibitors (ACE-I) seems to be effective in controlling PTE. However, the mechanism of this ACE-I induced reduction in haematocrit (Hct) is not well known. Although some authors have suggested that ACE-I may reduce EPO secretion, this is still controversial. The aim of the present study was to assess the effect of a single dose ACE-I on exaggerated EPO response to phlebotomy. Methods: In this study, we compared serum EPO and renin (PRA) levels of 100 PTE patients, 10 non-PTE patients and 10 healthy blood donors before and after phlebotomy. The effects of a single dose of ACE-1 (enalapril, 5 mg p.o.) in PTE patients were also evaluated in the second phlebotomy. Results: While the mean basal serum EPO level was significantly higher in the PTE group than the other two groups (<0.01), the mean basal PRA levels did not differ significantly between these groups. Serum EPO and PRA levels increased significantly after the phlebotomy (P<0.001) and exaggerated EPO response to phlebotomy was suppressed by single dose enalapril (P<0.001) in the PTE patients. Conclusion: The present study has shown that the renin-angiotensin system plays an important role in EP formation and the Hct lowering effect of the ACE-I is through reduction of EPO in PTE patients. Key words: Angiotensin converting enzyme inhibitors; enalapril; phlebotomy; erythropoietin; post-transplant erythrocytosis
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