ACE-I / ARBs and Erythropoiesis

Q: Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) - (select one)

A) enhance erythropoiesis
B) inhibit erythropoiesis 


Answer: B

For reasons not fully understood ACE-I and ARBs inhibit erythropoiesis in patients and may increase the erythropoietin requirements during maintenance dialysis. Taking advantage of this side effect these drugs can be utilized to treat posttransplant erythrocytosis (PTE) which may occur in up to 15 percent of post-kidney transplant patients with hemoglobin concentration >17 g/dL (hematocrit >51 percent). It usually manifests within first few months of transplantation. 

#transplantation
#pharmacology
#hematology


References:

1. Vlahakos DV, Marathias KP, Agroyannis B, Madias NE. Posttransplant erythrocytosis. Kidney Int 2003; 63:1187.

2. Perazella M, McPhedran P, Kliger A, et al. Enalapril treatment of posttransplant erythrocytosis: efficacy independent of circulating erythropoietin levels. Am J Kidney Dis 1995; 26:495.

3.  Yildiz A, Cine N, Akkaya V, et al. Comparison of the effects of enalapril and losartan on posttransplantation erythrocytosis in renal transplant recipients: prospective randomized study. Transplantation 2001; 72:542. 

4. Gossmann J, Thürmann P, Bachmann T, et al. Mechanism of angiotensin converting enzyme inhibitor-related anemia in renal transplant recipients. Kidney Int 1996; 50:973.