Effects of the Renin-Angiotensin System Blockade on Hemoglobin Levels in Type 2 Diabetic Patients With Chronic Kidney Disease

Inoue, Akira; Babazono, Tetsuya; Iwamoto, Yasuhiko

doi:10.1038/ajh.2007.53

Cited by 15 publications

(20 citation statements)

References 32 publications

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“…Worsening chronic kidney disease (CKD) is frequently associated with declining Hgb levels, and several studies have found that ACEI or ARB drugs may contribute to or exacerbate anemia [4,7,18,22]. In the current study, the presence of baseline CKD was found to be associated with a decline in Hgb in both ACEI (−0.09 g/dL) and ARB (−0.31 g/dL) patients, but the effect of CKD was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, the presence of baseline CKD was found to be associated with a decline in Hgb in both ACEI (−0.09 g/dL) and ARB (−0.31 g/dL) patients, but the effect of CKD was not statistically significant. In 2008, Inoue et al [7] reported on a retrospective chart review of Japanese patients using ACEI/ARB and found that the use of ARB was associated with a decrease in Hgb in patients with diabetic nephropathy. Of note is the study selection of patients with GFR < 60 mL/min/1.73 m [2].…”

Section: Discussionmentioning

confidence: 99%

“…This is not a benign finding. Anemia contributes to the worsening of heart failure [3-5] and renal function [6,7] and in many instances the treatment of anemia becomes part of the management of the patient’s overall condition [8]. For example, the “Anemia Correction in Diabetes” (ACORD) trial demonstrated that correction of anemia prevented an additional increase in left ventricular mass, and was associated with a significant improvement in quality of life [8].…”

Section: Introductionmentioning

confidence: 99%

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Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on hemoglobin levels

et al. 2013

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BackgroundAngiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in the management of congestive heart failure (CHF), diabetes mellitus (DM) and hypertension (HTN). Use of these agents is reported to cause anemia.MethodsWe examined the association between standard care use of ACEI or ARB and subsequent change in hemoglobin (Hgb) in a population of 701 adult primary care patients with DM, CHF and/or HTN. Data analysis was conducted to adjust for baseline differences between the treatment groups.ResultsAfter adjusting for differences in covariates at baseline between the subjects who were prescribed ACEI (N = 519) and ARB (N = 182), as well as the associated odds of being prescribed ARB, the ACEIs were associated with lower mean Hgb [0.18 (0.02, 0.34) g/dL, p = 0.02] at follow up relative to ARBs. However, patients with CHF experienced an increase in Hgb while on treatment (0.42 g/dL), especially those treated with ACEIs (0.56 g/dL). Chronic kidney disease at baseline was not associated with a significant decrease in Hgb in either treatment group.ConclusionsSince ACEIs and ARBs are most frequently used in patients who are vulnerable to complications from anemia, such as patients with CHF, HTN and DM, these findings may be useful to clinicians in selecting medications and monitoring patients for the adverse effects of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on hemoglobin levels

et al. 2013

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“…Additionally, these medications increase the concentration of the tetrapeptide N-acetyl-seryl-aspartyllysyl-proline, which is a natural inhibitor of erythropoiesis [73]. However, Hayashi et al [74] did not demonstrate any correlation between Hb levels and the use of ACEI, whereas according to a more recent report, use of ARBs has better correlation with the severity of anemia in diabetic patients with CKD compared to ACEI [75].…”

Section: The Renin-angiotensin-aldosterone Systemmentioning

confidence: 99%

Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy

Παππά¹,

Dounousi

Duni

et al. 2015

Int Urol Nephrol

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Diabetes mellitus (DM) is currently considered a modern global epidemic, and diabetic nephropathy (DN) is the most common cause of chronic kidney disease (CKD). Anemia is one of the most significant complications of CKD, and it is mainly attributed to insufficient erythropoietin (EPO) production. However, anemia develops earlier in the course of CKD among patients with DM, and the severity of anemia tends to be more marked in these patients compared to nondiabetic subjects, regardless of the stage of CKD. In this review, we focus on the "less known" complex interacting mechanisms which are involved in the pathophysiology of anemia associated with DN. Although the major cause of anemia in DN is considered to be an inappropriate response of the plasma EPO concentration to anemia, several other possible mechanisms have been suggested. Glomerular hyperfiltration, proteinuria, renal tubular dysfunction and interstitial fibrosis are among the main culprits. On the other hand, systemic effects such as chronic inflammation, autonomic neuropathy and the renin-angiotensin system are also involved. Finally, several medications are considered to aggravate anemia associated with DN. Since anemia is an important predictor of quality of life and is implicated in the increased burden of cardiovascular morbidity and mortality, further research is required to elucidate its pathogenesis in diabetic patients.

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“…Previous reports demonstrated that Astragalus mongholicus and angelica root improve anemia (Wu et al, 2008a;Zhang and Wu, 2008). ACEI blocks RAAS system to reduce erythropoietin (Donnelly and Shah, 1999;Inoue et al, 2008), which may explain the insignificant hemoglobin improvement in the TCM + BEN group and the Ben group.…”

Section: Discussionmentioning

confidence: 93%

Optimized project of traditional Chinese medicine in treating chronic kidney disease stage 3: A multicenter double-blinded randomized controlled trial

Wang

Sun

et al. 2012

Journal of Ethnopharmacology

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Effects of the Renin-Angiotensin System Blockade on Hemoglobin Levels in Type 2 Diabetic Patients With Chronic Kidney Disease

Cited by 15 publications

References 32 publications

Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on hemoglobin levels

Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on hemoglobin levels

Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy

Optimized project of traditional Chinese medicine in treating chronic kidney disease stage 3: A multicenter double-blinded randomized controlled trial

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