Anti-renin-angiotensin-system drugs and development of anemia in chronic kidney disease.
BACKGROUND
A variable inhibition of erythropoiesis has been reported in uremic patients with renal anemia receiving anti-renin-angiotensin-system (RAS) drugs (angiotensin-converting-enzyme inhibitors, and angiotensin-receptor-antagonists). The time to development of renal anemia before dialysis is still unknown.


METHODS
A retrospective cohort study (1 to 15 years) on records of 327 out-patients (217 males, 110 females) without anemia and with chronic renal insufficiency (creatinine clearance 16 to 75 mL/min) was conducted to estimate the time to development of renal anemia (Hb < 11.5 g/dL in females and Hb < 12.5 g/dL in men), and the time to decrease of Hb by 1 and 2 g/dL or more, irrespective of anemia development. Two treatment groups were analyzed: 142 patients with, and 185 without anti-RAS drugs.


RESULTS
Median survival time to development of anemia was 81 months, 59 months to the loss of Hb > 1 g/dL, and 94 months for the loss of Hb > 2 g/dL. Anemia developed significantly earlier in patients with initial Ccr < 40 mL/min and in those with initial Hb < 14 g/dL. In the multivariate analysis (Cox model), male gender, Ccr < 40 mL/min, and Hb < 14 g/dL, in increasing order of relative risk, significantly contributed to prediction of anemia development without any influence of the treatment with anti-RAS drugs. The same results were obtained considering survival to the loss of either Hb > 1 g/dL or Hb > 2 g/dL.


CONCLUSIONS
Development of renal anemia in mild to severe chronic kidney disease is not influenced by treatment with anti-RAS drugs.
Piccoli
Antonio
A
Department of Medical and Surgical Sciences, Nephrology Clinic, University of Padua--Italy. apiccoli@unipd.it
Pastori
Giordano
G
Pierobon
Erika
E
Torraca
Serena
S
Andreucci
Michele
M
Sabbatini
Massimo
M
Cianciaruso
Bruno
B
D000740:Anemia / Q000139:chemically induced*; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D015331:Cohort Studies; D004920:Erythropoiesis / Q000187:drug effects; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D016019:Survival Analysis
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors