The Clinical Study Of The Effect Of Angiotentensin Receptor Blokers On EPO In The Treatment Of Maintenance Hemodialysis Patients

OBJECTIVES: To investigate the effect of angiotensin receptor blockers on the effection of Erythropoietin on the anemia in chronic renal failure patients with hemodiaysis and explore the possible mechanism.MATERIALS AND METHODS: Fifty-five patients receiving hemodialysis were enrolled in this study,who were clinically stable,with a hamglobin concentration70-100g/l.all patients complicated with iron deficiency or severe secondary hyperparathyroidism , alumiuium intoxcatiob, infection, drug abuse , intolerance or allergy to ACEI or ARB were excluded. Among whom 40 received EPO treatment were divided into A> B group, and the other 15 did not receive EPO treatment were divided into C, D group, all the patients stop using ACEI or ARB for 2 months before the test and the experiment lasted 6 months. Group A and group C received ARB treatment, Valsartan 80-240mg/d, group B and D received CCB treatment, Amlodipine 5-10mg/d. the concentration of Hb, Hct, EPO were observed before and after the test. Meanwhile, all the patients accepted rural HD and oral chalybeate, add calcium and VitD3.Group A and B continue their EPO project and in group C and D, there were no EPO. During the experiment, no blood transfusion. Hb, Hct, serum albumin , serum iron, BUN,Cr, Kt/V, potassium were detected at certain time, the actual dose of EPO were recorded.RESULTS:Fifty patients completed the study. 1.There were no significant difference in the clinical characteristics and in dislysis indexes (Kt/V\ PCR> URR) iPTHLHcUserum albumin and serum iron in 4 groups p>0.05. 2.EPO(mIU/L):There were no significant difference in EPO groups and healthy volunteer,.Average EPO concentration were 10.57 ±7.7vs 12.27 + 4.54 P>0.05 ;There were significant difference in no-EPO groups and healthy volunteer,.Average EPO concentration were 6.25 + 2.0vs 12.27 + 4.54 P<0.03; and hemodiaysis has no influence on the EPO concentration. Average EPO concenteation in the four group were: 10.4 + 7.5,11.7 + 7.5, 6.69 + 2.14, 6.20+1.73before and 9.9 + 6.5,11.5 + 7.2,5.41 + 1.78,6.54 + 1.82at 6 nomth in the An B, C, D groups respectively. There were no significant difference in A> B groups before and at 6 month, P=0.50 and 0.45, respectivelly; There were no significant difference inC> D groups before the study , P=0.66 and There were significant difference at 6 month P=0.04; There were no significant difference in group A B and D, P=0.28,0.46,0.82 respectivelly; and the concentration of EPO was decreased from6.69 + 2.14 to5.41 + 1.78 in group C, P< 0.01; 3. Hb (g/L) : Average Hb concentration were 105.8 + 9.9, 104.6 + 8.7, 83.6 + 7.6, 85.0 + 7.7 before and 104.5 + 9.3, 103.4+11.5 , 79.4 + 6.7, 86.9 + 6.3 at 6 nomth in the An B^ C, D groups respectively. There were no significant difference in A> B groups before and at 6 month, P=0.06; There were no significant difference in Cx D groups before the study P=0.57, and There were significant difference at 6 month P=0.02 ;the concentration of Hb was decreased at 6 month in A group, But there were no significant difference p=0.06, There were no significant difference inBN D groups before and at 6 month P>0.05, There were significant difference befor and at 6 month in C group P<0.03; (4)HCT: Average Hct concentration were 29.1% + 1.4%,29.4% + 2%,26.6% + 1.0%,27.1% + 1.2% before and 28.9% + 1.5%,28.7% + 2.6%,26.3%+1.3%,27.3%+ 1.3%at 6 nomth in theA, B, C> D groups respectively. There were no significant difference before and at 6 nomth in four groups. 4. The relationship of drug dose and correcting anemia.There were 17 cases completed the test in a group, in the 11 patients with decreased Hb, the average dosewere 167.3 ±244.1 mg; in the 6 patients without decreased Hb, the average dose were 106.7+144.8mg. 5) There were no serious complication occurred in all the selected patients.CONCLUSION: l.To hemodialysis patients in end-stage reneal disease with angiotensin receptor blockers, there was no effect on the exotic erythropoietin to this who lost most of their function of secrete erythropoietion and decreased the serum erythropoietin level to those who kept part function. 2. Routine dose of ARB has no influence on the effect of EPO in treatment of anemia, while large dose of ARB could effect the role of EPO,decreased Hb, aggravate anemia, thus increased the dose of EPO.3.The chronic renal failsure Patients were lack of the EPO, treated with rHuEPO so as to correct the anemia.