Is systemic inflammation of hemodialysis patients improved with the use of enalapril? Results of a randomized, double-blinded, placebo-controlled clinical trial.
This study compared the effect of enalapril versus placebo on serum tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and C-reactive protein (CRP) in hemodialysis in a randomized, double- blinded, controlled clinical trial. Patients without infection or antiinflammatory drugs were randomly allocated to a study (n = 13, enalapril, 20 mg/day) or control (n = 12, placebo) group; all had arteriovenous fistula. Serum TNF-alpha, IL-6, and CRP were measured at 0, 1, and 3 months. Systolic blood pressure (baseline vs. final) was 151 +/- 25 vs. 135 +/- 19 mm Hg (p < 0.05) in the study group and 154 +/- 21 vs. 144 +/- 27 mm Hg in control group; diastolic blood pressure was 86 +/- 9 vs. 76 +/- 13 and 91 +/- 16 vs. 81 +/- 18 mm Hg, respectively; median (percentiles 25%-75%) IL-6 (baseline vs. final) was 4.2 (3-8) vs. 4.1 (2-9) pg/mL and 6.3 (3-9) vs. 6.7 (3-8) pg/mL; and CRP was 1.9 (1-7) vs. 3.0 (1-12) mg/L and 4.7 (1-16) vs. 3.9 (2-16) mg/L, respectively. TNF-alpha was detected in only two patients. Enalapril significantly reduced blood pressure in hemodialysis patients, but it did not decrease IL-6 and CRP compared with placebo.
Ordaz-Medina
Susan M
SM
Unit of Medical Research in Renal Diseases, Hospital de Especialidades, CMNO, Guadalajara, Mexico.
González-Plascencia
Juana
J
Martín del Campo
Fabiola
F
Rojas-Campos
Enrique
E
Montañez-Fernández
José L
JL
Espinoza-Gómez
Francisco
F
Cueto-Manzano
Alfonso M
AM
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000188:drug therapy*; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000187:drug effects
D000806:Angiotensin-Converting Enzyme Inhibitors; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D004656:Enalapril; D002097:C-Reactive Protein