title: Association between erythropoietin requirements and antihypertensive agents.
abstract: BACKGROUND
  Angiotensin-converting enzyme inhibitors (ACI) and angiotensin II receptor blockers (ARB) have been reported to increase recombinant human erythropoietin (rHuEPO) requirements. We performed a cross-sectional study to investigate an association of antihypertensive agents including these two with the rHuEPO dose in chronic hemodialysis patients.
  
  
  METHODS
  We studied 625 patients undergoing hemodialysis therapy in 11 dialysis units. The association between the rHuEPO dose and antihypertensive agents was statistically analyzed.
  
  
  RESULTS
  The mean hemoglobin (Hb) level and rHuEPO dose corrected by body weight were 10.5 g/dl and 95.2 U/kg/week, respectively. When the patients were subdivided into four groups according to the number of prescribed antihypertensive agents (G-0, G-1, G-2, and G-3; patients prescribed with no medication, 1, 2, and >3 drugs, respectively), a significantly low dose of rHuEPO was observed in G-0 compared to the other groups. Unpaired t test showed a higher dose of rHuEPO in the presence of ARB, alpha-blockers, or calcium channel blockers (CCB). The rHuEPO dose was higher in the elderly, in females, and in patients with diabetes or hypertension. In multiple regression analysis, age, sex, rHuEPO dose, serum albumin level, and duration of dialysis therapy but not antihypertensive drugs were independent factors for the Hb level. In contrast, the rHuEPO dose was significantly associated with a low level of Hb, age, females, and CCB use. However, since CCB use was strongly associated not only with rHuEPO dose but also with systolic blood pressure and the use of alpha-blockers and ARB, these findings might be caused by erythropoietin (EPO)-induced hypertension.
  
  
  CONCLUSIONS
  There was an association between the number of antihypertensive agents and rHuEPO dose in chronic hemodialysis patients. However, no significant relation was indicated between ARB/ACI use and EPO requirements.
authors.affiliation: Shimane Dialysis and Metabolism Study Group, Shimane, Japan. syano@med.shimane-u.ac.jp
authors.forename: Shozo
authors.initials: S
authors.lastname: Yano
authors.forename: Keiko
authors.initials: K
authors.lastname: Suzuki
authors.forename: Masataka
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Urushidani
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokogi
authors.forename: Masuo
authors.initials: M
authors.lastname: Kusakari
authors.forename: Akihiko
authors.initials: A
authors.lastname: Aoki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Sumi
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kitamura
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanematsu
authors.forename: Masaru
authors.initials: M
authors.lastname: Gohbara
authors.forename: Sadao
authors.initials: S
authors.lastname: Imamura
authors.forename: Toshitsugu
authors.initials: T
authors.lastname: Sugimoto
mesh_terms: D000740:Anemia / Q000453:epidemiology* / Q000517:prevention & control*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000517:prevention & control*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*
chemical_list: D000959:Antihypertensive Agents; D004921:Erythropoietin