title: The effect of high dose losartan on erythropoietin resistance in patients undergoing haemodialysis.
abstract: OBJECTIVE
  In some of the patients undergoing haemodialysis, (HD) resistance might develop against recombinant human erythropoietin (rHuEPO) used for treatment of anaemia. Recently, angiotensin-converting enzyme (ACE) inhibitors that are used to treat hypertension and congestive heart failure in HD patients have been suggested to contribute to anaemia as well by inhibiting erythropoiesis. Our purpose in this study is to investigate whether or not losartan, an angiotensin II (ATII) receptor antagonist, is causing rHuEPO resistance.
  
  
  METHODS
  In this prospective study of 12 months, we compared the effects of high dose losartan (100 mg/day) and amlodipine (10 mg/day) on rHuEPO requirement in 40 hypertensive patients receiving rHuEPO for more than 12 months on maintenance HD. Twenty normotensive rHuEPO dependent patients served as control group. Iron deficiency, hyperparathyroidism, aluminium intoxication, infections and inflammations were excluded in all patients.
  
  
  RESULTS
  The mean haemoglobin level was found >8 g/dl in all groups. The mean weekly rHuEPO dose increased in the losartan group (p<0.0001 vs before) and remained constant in the other groups. No significant differences were found with PTH, iron status, aetiologies of renal failure in all groups.
  
  
  CONCLUSIONS
  High-dose losartan increases rHuEPO requirement and should be reserved for dialysis patients with hypertension uncontrollable with other antihypertensive medications.
authors.affiliation: Department of Nephrology, Ataturk University, School of Medicine, Erzurum, Turkey. alirizao@yahoo.com
authors.forename: A R
authors.initials: AR
authors.lastname: Odabas
authors.forename: R
authors.initials: R
authors.lastname: Cetinkaya
authors.forename: Y
authors.initials: Y
authors.lastname: Selcuk
authors.forename: S
authors.initials: S
authors.lastname: Keles
authors.forename: H
authors.initials: H
authors.lastname: Bilen
mesh_terms: D000328:Adult; D017311:Amlodipine / Q000627:therapeutic use; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology*; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D019808:Losartan / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D017311:Amlodipine; D019808:Losartan