Charytan C, Goldfarb-Rumyantzev A, Wang Y F, Schwenk M H, Spinowitz B S
Division of Nephrology and Hypertension, Department of Medicine, The New York Hospital Medical Center of Queens, Flushing, N.Y., USA.
Am J Nephrol. 1998;18(6):498-503. doi: 10.1159/000013394.
Erythropoietin (EPO) therapy is a common and effective treatment for the correction of anemia in patients with end-stage renal disease. Simultaneous treatment with angiotensin-converting enzyme (ACE) inhibitors for the control of hypertension and/or heart failure is often necessary. Recent reports in the literature have raised concern about a potential interaction between these drugs, with a resultant decreased EPO efficacy.
To investigate whether this interaction occurs in chronic dialysis patients, we retrospectively reviewed the records of 175 patients receiving chronic dialysis. All study patients were treated with EPO for at least 3 months, and had normal iron indices. Patients were treated with ACE inhibitors for at least 3 months, at a constant daily dose for at least 1 month (group 1, n = 32), or did not receive ACE inhibitors (group 2, n = 143). Patients with infections or overt iron deficiency were excluded. Total weekly EPO doses and hematocrit (Hct)/hemoglobin (Hgb) values in the two groups were compared. Variables known to affect response to EPO were compared, including ferritin, transferrin saturation, dialysis dose and serum aluminum.
Total weekly EPO dose was 17,358 +/- 6,871 units in group 1 and 17,612 +/- 7,744 units in group 2 (p = 0.854). The achieved Hct was 32.1 +/- 4.4% (group 1) and 30.5 +/- 4.0% (group 2) (p = 0.079). Similarly, Hgb, ferritin, transferrin saturation, Kt/V, and serum aluminum were not different. The dose or duration of ACE inhibitor therapy did not affect Hgb or Hct. Thus, ACE inhibitor therapy does not appear to affect response to EPO in chronic dialysis patients.
促红细胞生成素（EPO）疗法是纠正终末期肾病患者贫血的常用且有效的治疗方法。通常需要同时使用血管紧张素转换酶（ACE）抑制剂来控制高血压和/或心力衰竭。文献中最近的报道引发了对这些药物之间潜在相互作用的关注，这可能导致EPO疗效降低。
为了研究这种相互作用是否发生在慢性透析患者中，我们回顾性分析了175例接受慢性透析患者的记录。所有研究患者均接受EPO治疗至少3个月，且铁指标正常。患者接受ACE抑制剂治疗至少3个月，每日剂量恒定至少1个月（第1组，n = 32），或未接受ACE抑制剂（第2组，n = 143）。排除有感染或明显缺铁的患者。比较两组每周EPO总剂量和血细胞比容（Hct）/血红蛋白（Hgb）值。比较已知影响EPO反应的变量，包括铁蛋白、转铁蛋白饱和度、透析剂量和血清铝。
第1组每周EPO总剂量为17,358±6,871单位，第2组为17,612±7,744单位（p = 0.854）。达到的Hct分别为32.1±4.4%（第1组）和30.5±4.0%（第2组）（p = 0.079）。同样，Hgb、铁蛋白、转铁蛋白饱和度、Kt/V和血清铝无差异。ACE抑制剂治疗的剂量或持续时间不影响Hgb或Hct。因此，ACE抑制剂治疗似乎不影响慢性透析患者对EPO的反应。
