Key result
ACE inhibitor therapy was associated with lower haemoglobin levels in haemodialysis patients (95.5 vs 97.4 g/l; p=0.02), particularly in those with the D/D genotype.
Why the study?
Does ACEi therapy and ACE gene I/D polymorphism affect haemoglobin levels and erythropoietin resistance in patients on maintenance haemodialysis?
Cross-Sectional (n=660)
Yes
Does ACEi therapy and ACE gene I/D polymorphism affect haemoglobin levels and erythropoietin resistance in patients on maintenance haemodialysis?
Absolute Event Rate: 95.5% vs 97.4%
p-value: p=0.02
ACE inhibitor therapy may worsen erythropoiesis and increase erythropoietin resistance in haemodialysis patients, particularly those with the ACE gene D allele.
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEis) improve survival; however, their effect on erythropoiesis remains a matter of debate in this population. Since insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene largely influences serum ACE activity, its effect on erythropoiesis is also anticipated. METHOD: In this multicentre, cross-sectional study of 660 patients on maintenance haemodialysis, we analysed the effect of ACEi use and ACE gene I/D polymorphism on haemoglobin levels and erythropoietin resistance. Patients were allocated in groups based on genotype and ACEi therapy. We identified 128 matched pairs with I/I and D/D genotypes. RESULT: There was no difference in haemoglobin levels between genotype groups. Haemoglobin levels were lower in patients on ACEi therapy in the entire cohort (95.5±12.1 g/l vs 97.4±13.4 g/l, p=0.02) and patients with I/D (95.2±11 g/l vs 98.2±11.9 g/l, p=0.04) and D/D (93.3±13.2 g/l vs 97.4±14.2 g/l, p=0.02) genotypes. In patient pairs treated with ACEi therapy, subjects with D/D genotype had lower Haemoglobin level (93.0±12.8 g/l vs 98.2±11.9 g/l, p=0.006) and higher erythropoietin resistance index (ERI) (199.1 vs 175.0, p=0.046) than individuals with I/I genotype. CONCLUSION: These results indicate that ACEi therapy may increase erythropoietin resistance and worsen erythropoiesis in haemodialysis patients with the D allele.
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Kiss et al. (2014) conducted a cross-sectional in maintenance haemodialysis (n=660). ACE inhibitor therapy vs. No ACE inhibitor therapy was evaluated on Haemoglobin levels (p=0.02). ACE inhibitor therapy was associated with lower haemoglobin levels in haemodialysis patients (95.5 vs 97.4 g/l; p=0.02), particularly in those with the D/D genotype.
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