ACE inhibitors or angiotensin II receptor blockers in dialysed patients and erythropoietin resistance.

Background: To examine whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are associated with a state of recombinant human erythropoietin (rHuEPO) resistance in hemodialyzed patients. Methods: Cross-sectional study involving all dialysis facilities in French-speaking Switzerland. All patients treated with rHuEPO in March 2001 were included. Demographic, clinical and laboratory data were collected in 515 patients treated with chronic hemodialysis (HD) and rHuEPO. Patients were classified into five groups according to their antihypertensive treatment. The main outcomes of the study were the mean rHuEPO dosage and the prevalence of erythropoietin EPO resistance among the groups. Erythropoietin resistance was defined as a weekly rHuEPO dosage >300 units/kg/wk. Results: The mean rHuEPO dosage and the prevalence of EPO resistance were similar in patients treated with ACEIs (n=138, mean EPO dosage 109 units/kg/wk, EPO resistance 12%), ARBs (n=59, mean EPO dosage 120 units/kg/wk, EPO resistance 7%), both (n=10, mean EPO dosage 109 units/kg/wk, EPO resistance 10%), other drugs (n=137, mean EPO dosage 110 units/kg/wk, EPO resistance 10%) and no antihypertensive treatment (n=171, mean EPO dosage 90 units/kg/wk, EPO resistance 9%). Differences were not statistically significant. Patients with rHuEPO resistance were characterized by a higher frequency of hospitalization and a more pronounced inflammatory state. There was no difference in the use of ACEIs and ARBs between patients with and without EPO resistance (37 vs. 41%, ns). Conclusions: Neither the use of ACEIs nor ARBs is associated with a state of rHuEPO resistance among hemodialyzed patients.