Does angiotensin converting enzyme-inhibitor therapy influence the prevalence and severity of anemia in predialysis renal failure patients?

Even though erythropoietin (EPO) deficiency is the main factor implicated i n the anemia secondary to renal failure, many other factors can influence i ts severity. Among these factors, ACE-inhibitors have been shown to aggrava te the anemia or to cause resistance to rHuEPO therapy. This study was designed to determine if ACE-inhibitors play any independent and significant role in the severity of the anemia in advanced renal failu re patients. The study group consisted of 134 patiens with creatinine clear ance less than 30 ml/min who had never been treated with rHuEPO or dialysis . Multiple logistic regression analysis was utilized to establish the best determinants for a hematocrit (Hct) less than 30% or Hct less than 25%. The variables included in the model were: demographics, Ccr, albumin, bicarbon ate, ferritin, transferrin saturation, PTH, 24 h. urine protein excretion, the diagnosis of glomerulopehritis vs other, diabetes vs other, polycystic kidney disease vs other, vascular renal disease vs other, ACE-inhibitors, s tandarized dose of ACE-inhibitors, calcium-channel blockers, diuretics, ant iplatelet or anticoagulant prescriptions. The mean Hct was 31,0 +/- 5,4%. Fifteen patients had Hct less than 25%, and in 55 the Hct was less than 30%. Sixty-seven patients were on ACE-inhibito rs. The main determinants for a Hct less than 25% was the 24 h. urinary pro tein excretion in mg (odds ratio: 1,0002; p = 0.019). The main variable whi ch fitted the best equation for a Hct less than 30%; was the diagnosis of r enal vascular disease (odds ratio: 0. 143; p = 0.0042). The prescription or dosage of ACE-inhibitors were not related the severity of anemia in the wh ole group or in each subgroup according to the cause of renal failure. In conclusion, ACE-inhibitor prescription does not appear to play any signi ficant role in the severity of the anemia, of end-stage renal failure patie nts when it is weigthed against other potential influences.