Abstract
Angiotensin I converting enzyme inhibitor (ACEI) is known to worsen anemia in hemodialysis (HD) patients. The effect of rHuEPO on ACEI-induced worsening of anemia was evaluated in 19 hypertensive HD patients. Patients were subdivided into two groups according to rHuEPO administration, being rHuEPO (+) group (n=10, 56±4 years old, rHuEPO 1500 units, 3 times a week) and rHuEPO (-) group (n=9, 52±3 years old). Age, HD duration, blood pressure (BP) and hematocrit (Ht) before ACEI (lisinopril) were not significantly different between rHuEPO (+) and rHuEPO (-) group. Lisinopril was started with a dose of 2.5mg once a day in the morning on non-HD day. BP decreased significantly in both groups and adequately maintained throughout the study period. Ht decreased significantly in rHuEPO (-) group from 30±2 to 26±1% (p<0.05), whereas it remained unchanged in rHuEPO (+) group. The dose of lisinopril of 5.0±2.0mg/day in rHuEPO (+) group was significantly higher than that of 3.0±1.0mg/day in rHuEPO (-) group (p<0.05). Serum erythropoietin and plasma angiotensin II concentration decreased but the changes were not significant in both groups. Plasma angiotensin I converting enzyme activity decreased significantly from 51±5 to 30±4U/L only in rHuEPO (-) group (p<0.05). In conclusion, we suggest that the ACEI-induced worsening of anemia could be prevented by a concomitant use of rHuEPO in hypertensive HD patients. However, the higher dose of ACEI was required to control BP in rHuEPO-treated HD patients.
