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A Journal on Internal Medicine

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Panminerva Medica 2003 March;45(1):59-62

language: English

The effect of high dose losartan on erythropoietin resistance in patients undergoing haemodialysis

Odabas A. R. 1, Cetinkaya R. 1, Selcuk Y. 1, Keles S. 2, Bilen H. 2

1 Department of Nephrology and 2 Department of Biochemistry, Ataturk University, School of Medicine, Erzurum, Turkey


Aim. In ­some of the ­patients under­going hae­mod­i­al­ysis, (HD) resis­tance ­might ­develop ­against recom­bi­nant ­human eryth­ro­poietin (rHuEPO) ­used for treat­ment of ­anaemia. Recently, angio­tensin-con­verting ­enzyme (ACE) inhib­i­tors ­that are ­used to ­treat hyper­ten­sion and con­ges­tive ­heart ­failure in HD ­patients ­have ­been sug­gested to con­tribute to ­anaemia as ­well by inhib­iting eryth­ro­poiesis. Our pur­pose in ­this ­study is to inves­ti­gate ­whether or not ­losartan, an angio­tensin II (­ATII) ­receptor antag­o­nist, is ­causing rHuEPO resis­tance.
Methods. In ­this pros­pec­tive ­study of 12 ­months, we com­pared the ­effects of ­high ­dose ­losartan (100 mg/day) and amlod­i­pine (10 mg/day) on rHuEPO require­ment in 40 hyper­ten­sive ­patients ­receiving rHuEPO for ­more ­than 12 ­months on main­te­nance HD. Twenty nor­mo­ten­sive rHuEPO depen­dent ­patients ­served as con­trol ­group. Iron defi­ciency, hyper­pa­rath­yr­oi­dism, alu­minium intox­i­ca­tion, infec­tions and inflam­ma­tions ­were ­excluded in all ­patients.
Results. The ­mean hae­mog­lobin ­level was ­found >8 g/dl in all ­groups. The ­mean ­weekly rHuEPO ­dose ­increased in the ­losartan ­group (p<0.0001 vs ­before) and ­remained con­stant in the ­other ­groups. No sig­nif­i­cant dif­fer­ences ­were ­found ­with PTH, ­iron ­status, aetio­lo­gies of ­renal ­failure in all ­groups.
Conclusion. High-­dose ­losartan ­increases rHuEPO require­ment and ­should be ­reserved for dial­ysis ­patients ­with hyper­ten­sion uncon­trol­lable ­with ­other anti­hy­per­ten­sive med­i­ca­tions.

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