ACE inhibitors do not induce recombinant human erythropoietin resistance in hemodialysis patients

Angiotensin-converting enzyme (ACE) inhibitors may exacerbate anemia in pat ients with chronic renal failure, as well as in dialysis patients. To bette r answer this question, a prospective, crossover study was conducted to eva luate the effect of ACE inhibitors on recombinant human erythropoietin (rHu EPO) requirements in hemodialysis patients. Patients administered an ACE in hibitor when entering the study remained on this drug for the initial 4 mon ths and were then switched to another antihypertensive agent for 4 more mon ths. Patients not initially administered an ACE inhibitor were switched to lisinopril at 4 months. rHuEPO doses were adjusted using a sliding scale ba sed on weekly laboratory hematocrit values. The inclusion criteria were met by 51 patients undergoing dialysis. Demographics were as follows: 61% were women, 64% were black, 46% had diabetes, average age was 53.2 +/- 13.3 yea rs, and time on hemodialysis was 38.0 +/- 44.5 months. Thirty-three patient s completed the study. Hematocrit averaged 32.7% +/- 1.9% while on ACE inhi bitor therapy and 33.1% +/- 2.1% off ACE inhibitor therapy (P = 0.217). The re was no difference in rHuEPO dose per treatment during each period (3,500 +/- 1,549 U on ACE inhibitor therapy versus 3,312 +/- 1,492 U off ACE inhi bitor therapy; P = 0.300), No significant differences were found in degree of blood pressure control or various clinical and laboratory parameters tha t might be associated with rHuEPO resistance between the two periods. Simil arly, no differences were found in hospitalization days, duration of infect ions, or transfusion requirements. These findings suggest that ACE inhibito rs do not contribute to rHuEPO resistance in hemodialysis patients. (C) 200 0 by the National Kidney Foundation, Inc.