EFFECT OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS ON HEMOGLOBIN LEVELS AMONG PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE: A RANDOMIZED CONTROL TRIAL

Abstract

Background: Anemia commonly occurs among patients with advanced stage chronic kidney disease (CKD) and has been associated with poor clinical outcomes. The role of angiotensin converting enzyme (ACE) inhibitors in aggravating the anemia of patients with CKD is controversial. Objective: To evaluate the effect of ACE inhibitors on hemoglobin levels among patients with advanced CKD. Method: Twenty-two patients with CKD stages IV or V and presenting stable hemoglobin levels over 12 weeks were randomly assigned either to receive enalapril (N=10) or amlodipine (N=12) among those whose blood pressure was controlled with antihypertensives other than ACE inhibitors. Hemoglobin level was monitored at 8 and 16 weeks after treatment. Results: Clinical characteristics were similar at baseline between the enalapril and amlodipine-treated groups, and no difference was observed in blood pressure control during follow-up. Enalapril exhibited no significant change in hemoglobin levels from 11.1 (IQR 11.1 to 11.5) g/dL at baseline to 11.4 (IQR 10 to 12) g/dL at 8 weeks and 10.7 (IQR 9.9 to 11.8) g/dL at 16 weeks of treatment. Hemoglobin levels during the 16-week follow-up declined on average by -0.3 (IQR -0.9 to 0.4) g/dL per 16 weeks in the enalapril group and by -0.1 (IQR-0.7 to 0.4) per 16 weeks in the amlodipine group (P=0.868). Conclusion: Administration of ACE inhibitors on blood pressure control was not associated with declining hemoglobin levels among patients with advanced CKD. Additional studies are necessary to confirm this result.