Worsening of anemia by angiotensin converting enzyme inhibitors and its prevention by antiestrogenic steroid in chronic hemodialysis patients.
The effects of angiotensin converting enzyme (ACE) inhibitors and their combined use with an antiestrogenic steroid on erythropoiesis were investigated in patients on chronic hemodialysis (CHD). Hematocrit was decreased by 10% or more in 6 of 12 patients who received either captopril or enalapril for 2-6 months. Erythropoietin (Epo) and angiotensin II (AII) were significantly reduced in these patients. When treatment with mepitiostane was combined with ACE inhibitor, anemia was significantly improved but without evidence of changes in circulating Epo concentrations or indices of renin-angiotensin activity. The reduction of AII and Epo formation by ACE inhibitors seems to play an important role in the worsening of anemia in patients on CHD; addition of an antiestrogenic steroid should be considered.
Onoyama
K
K
2nd Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka City, Japan.
Sanai
T
T
Motomura
K
K
Fujishima
M
M
D000732:Androstanols / Q000627:therapeutic use*; D000740:Anemia / Q000139:chemically induced*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D002216:Captopril / Q000009:adverse effects / Q000627:therapeutic use; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000097:blood; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D006435:Renal Dialysis; D012084:Renin-Angiotensin System / Q000187:drug effects
D000732:Androstanols; D000806:Angiotensin-Converting Enzyme Inhibitors; D004965:Estrogen Antagonists; D004921:Erythropoietin; D004656:Enalapril; D002216:Captopril; C006242:mepitiostane