Assessment of Enalapril Effect on Inducing Anemia In Non-Azotemic Diabetic Patients

S Seyrafian, L Kasaei, R Kosary


Background: Angiotensin converting enzyme inhibitors (ACEIs) are known to induce anemia following renal transplantation, dialysis and in renal failure patients. It seems that ACEIs cause anemia via inhibition of erythropoietin synthesis or inhibiting normal proliferation of early erythroid progenitors, which are normally stimulated by angiotensin converting enzyme. There are few reports on how ACEIs induce anemia in non-azotemic diabetic patients. We studied the effect of enalapril on inducing anemia in non-azotemic diabetic patients.
Methods: This study included 94 diabetic non-azotemic patients (serum creatinine (sCr) ?1.5 mg/dl by jaffe reaction). Patients were divided into two groups, the first; with clinical proteinuria (P+ ) having a 24 hour urine protein ?300 mg or positive urine dipstick for protein, at least on two of three times tested, with an interval of 1 month and the second group without any signs of clinical proteinuria (P- ). Only 32 patients completed the course of study; 17 as P+ and 15 as P-. Patients in both groups received 10 mg enalapril daily; and every 3 months, the dose was doubled until the dose of 40 mg/day was reached, unless any side effects emerged. Hemoglobin concentration (Hb), sCr and serum potassium (K+) were also checked regularly. Data were analyzed using t-Student test, paired t test, and chi-square test. A p value < 0.05 was considered as significant.
Results: Both groups of patients were matched from the standpoint of age and sex. The average baseline sCr in P+
and P- groups were 0.8 ± 0.19 mg/dl and 0.8 ± 0.18 mg/dl respectively.( p = 0.97) After the study was completed, the average baseline sCr rose to 0.99±0.19 and 0.92±0.22 mg/dl in P+ and P- groups respectively. In P+ group, mean Hb was 14.1 ±1.30 g/dl and 13.9 ± 0.99g/dl before and after the study respectively.(p = 0.28) The same parameter for the P- group was measured as 14.1±1.00 and 12.9±3.30 before and after the study respectively.(Conclusion: This study shows that enalapril has no significant effect on inducing anemia in non-azotemic diabetic patients.
Keywords: Enalapril, Anemia, Diabetes, Proteinuria

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