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Dear Sir, The origin of anemia of chronic renal failure is multifactorial. The primary defect of this anemia is decreased erythropoiesis, but a number of other factors may play a contributory role. Virtually all patients undergoing renal replacement therapy treated with recombinant human erythropoietin (rHU-EPO) achieve a significant rise in hemoglobin concentration or hematocrit (HCT). However, certain patients with anemia of end-stage renal disease require higher doses and need longer to reach stabilization. Numerous medical disorders or drugs may cause resistance to rHU-EPO therapy. He-matological changes associated with angio-tensin-converting enzyme (ACE) inhibitors are well documented in healthy subjects, in patients with heart failure, and in patients with essential hypertension as well as chronic renal failure or renal transplants. Characteristically, these effects include a reduction in HCT levels which appears to be caused by a decrease in endogenous EPO production or activity. In anemic dialysis patients, therapy of hypertension or heart failure with ACE inhibitors may reduce the response to rHU-Epo therapy [1]. Angioten-sin II receptor antagonists are often used to treat cardiovascular disorders associated with end-stage renal disease, but their effects on hematological parameters are largely unknown. This prospective randomized controlled study was carried out to compare the effects of these drugs on renal anemia and the requirement of EPO therapy. Twenty-four anemic patients with end-stage renal disease receiving regular hemodi-alysis were selected from four outpatient di-alysis centers. They all gave informed consent to participate in the investigation. They all had normocytic-normochromic anemia, hypertension refractory to dialysis, and maintenance dialysis treatment for at least 6 months. The patients were matched according to demographic, biochemical, and treatment characteristics. The first patient of each pair was randomly assigned to one treatment group (captopril or losartan), the other patient of the pair received the alternative therapy. Deficiency of folic acid or vitamin B 12 , aluminum intoxication, severe hy-perparathyroidism, hypothyroidism, active gastrointestinal bleeding, hematological diseases , malignancy, or chronic inflammation were excluded by appropriate methods in these patients. None of the patients had hy-persplenism or a history of alcohol abuse, and they did not use immunosuppressive drugs affecting erythropoiesis. Captopril (37.5–150 mg/day) or losartan (25–50 mg/ day) were added to calcium antagonist based antihypertensive pharmacotherapy at doses to achieve adequate blood pressure control (! 140/90 mm Hg). All patients underwent conventional hemodialysis three times per week (4–5 h/session) using bicarbonate-buff-ered dialysate and biocompatible high-flux polysulfone or polyester-polymer membranes. Treatments were performed with volumetrically …

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Angiotensin-Converting Enzyme Inhibitors but Not Angiotensin II AT 1 Receptor Antagonists Affect Erythropoiesis in Patients with Anemia of End-Stage Renal Disease