Drug Safety

, Volume 22, Issue 5, pp 350–360

Risk-Benefit Ratio of Angiotensin Antagonists versus ACE Inhibitors in End-Stage Renal Disease

  • Domenic A. Sica
  • Todd W.B. Gehr
  • Andrea Fernandez
Review Article

Abstract

The effective treatment of hypertension is an extremely important consideration in patients with end-stage renal disease (ESRD). Virtually any drug class — with the possible exception of diuretics - can be used to treat hypertension in the patient with ESRD. Despite there being such a wide range of treatment options, drugs which interrupt the renin-angiotensin axis are generally suggested as agents of choice in this population, even though the evidence in support of their preferential use is quite scanty.

ACE inhibitors, and more recently angiotensin antagonists, are the 2 drug classes most commonly employed to alter renin-angiotensin axis activity and therefore produce blood pressure control. ACE inhibitor use in patients with ESRD can sometimes prove an exacting proposition. ACE inhibitors are variably dialysed, with compounds such as catopril, enalapril, lisinopril and perindopril undergoing substantial cross-dialyser clearance during a standard dialysis session. This phenomenon makes the selection of a dose and the timing of administration for an ACE inhibitor a complex issue in patients with ESRD.

Furthermore, ACE inhibitors are recognised as having a range of nonpressor effects that are pertinent to patients with ESRD. Such effects include their ability to decrease thirst drive and to decrease erythropoiesis. In addition, ACE inhibitors have a unique adverse effect profile. As is the case with their use in patients without renal failure, use of ACE inhibitors in patients with ESRD can be accompanied by cough and less frequently by angioneurotic oedema. In the ESRD population, ACE inhibitor use is also accompanied by so-called anaphylactoid dialyser reactions.

Angiotensin antagonists are similar to ACE inhibitors in their mechanism of blood pressure lowering. Angiotensin antagonists are not dialysable and therefore can be distinguished from a number of the ACE inhibitors. In addition, the adverse effect profile for angiotensin antagonists is remarkably bland, with cough and angioneurotic oedema rarely, if ever, occurring. In patients with ESRD, angiotensin antagonists are also not associated with the anaphylactoid dialyser reactions which occur with ACE inhibitors. The nonpressor effects of angiotensin antagonists — such as an influence on thirst drive and erythropoiesis — have not been explored in nearly the depth, as they have been with ACE inhibitors. Although ACE inhibitors have not been compared directly to angiotensin antagonists in patients with ESRD, angiotensin antagonists possess a number of pharmacokinetic and adverse effect characteristics, which would favour their use in this population.

References

  1. 1.
    Greaves SC, Sharpe DN. Cardiovascular disease in patients with end-stage renal failure. Aust NZ J Med 1992; 22: 153–8CrossRefGoogle Scholar
  2. 2.
    Mailloux LU, Haley WE. Hypertension in the ESRD patient: pathophysiology, therapy, outcomes, and future directions. Am J Kidney Dis 1998; 32: 705–19PubMedCrossRefGoogle Scholar
  3. 3.
    Levey AS, Beto JA, Coronado BE, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? what do we need to learn? where do we go from here? Am J Kidney Dis 1998; 32: 853–906PubMedCrossRefGoogle Scholar
  4. 4.
    Eknoyan G. On the epidemic of cardiovascular disease in patients with chronic renal disease and progressive renal failure: a first step to improve the outcomes. Am J Kidney Dis 1998; 32Suppl. 3: 1S–4SCrossRefGoogle Scholar
  5. 5.
    Mailloux LU, Levey AS. Hypertension in patients with chronic renal disease. Am J Kidney Dis 1998; 32Suppl.3: 120S–141SCrossRefGoogle Scholar
  6. 6.
    Zucchelli P, Santoro A, Zuccala A. Genesis and control of hypertension in hemodialysis patients. Semin Nephrol 1988; 8: 163–7PubMedGoogle Scholar
  7. 7.
    Abraham PA, Opsahl JA, Keshaviah PR, et al. Body fluid spaces and blood pressure in hemodialysis patients during amelioration of anemia with erythropoietin. Am J Kidney Dis 1990; 16: 438–46PubMedGoogle Scholar
  8. 8.
    Luik AJ, Gladziwa U, Kooman JP, et al. Influence of interdialytic weight gain on blood pressure in hemodialysis patients. Blood Purif 1994; 12: 259–66PubMedCrossRefGoogle Scholar
  9. 9.
    Coomer RW, Schulman G, Breyer JA, et al. Ambulatory blood pressure monitoring in dialysis patients and estimation of mean interdialytic blood pressure. Am J Kidney Dis 1997; 29: 678–84PubMedCrossRefGoogle Scholar
  10. 10.
    Schalekamp MA, Beevers DG, Briggs JD, et al. Hypertension in chronic renal failure: an abnormal relationship between sodium and the renin-angiotensin system. Am J Med 1973; 55: 379–90PubMedCrossRefGoogle Scholar
  11. 11.
    Wilkinson R, Scott DF, Uldall PR, et al. Plasma renin and exchangeable sodium in the hypertension of chronic renal failure. West J Med 1970; 39: 377–94Google Scholar
  12. 12.
    Converse Jr RL, Jacobsen TN, Toto RD, et al. Sympathetic overactivity in patients with chronic renal failure. N Engl J Med 1996; 327: 1912–8CrossRefGoogle Scholar
  13. 13.
    Beretta-Piccoli C, Weidmann P, Schiffl H, et al. Enhanced cardiovascular pressor reactivity to norepinephrine in mild renal parenchymal disease. Kidney Int 1982; 22: 297–303PubMedCrossRefGoogle Scholar
  14. 14.
    Markewitz BA, Kohan DE. Role of intrarenal endothelin in the generation and maintenance of hypertension. Miner Electrolyte Metab 1995; 21: 342–52PubMedGoogle Scholar
  15. 15.
    Suzuki N, Matsumoto H, Miyauchi T, et al. Endothelin-3 concentrations in human plasma: the increased concentrations in patients undergoing hemodialysis. Biochem Biophys Res Commun 1990; 169: 809–15PubMedCrossRefGoogle Scholar
  16. 16.
    Vallance P, Leone A, Calver A, et al. Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure. Lancet 1992; 339: 572–5PubMedCrossRefGoogle Scholar
  17. 17.
    Raine AE, Bedford L, Simpson AW, et al. Hyperparathyroidism, platelet intracellular free calcium and hypertension in chronic renal failure. Kidney Int 1993; 43: 700–5PubMedCrossRefGoogle Scholar
  18. 18.
    Peixoto AJ, Sica DA. Ambulatory blood pressure monitoring in end-stage renal disease. Blood Press Monitor 1997; 2: 275–82Google Scholar
  19. 19.
    Wong KC, Woo KS, Lam WK, et al. Acomparison of the effect of enalapril and metoprolol on renal function, potassium balance, lipid profile, cardiac function, exercise tolerance and quality of life in hypertensive dialysis patients. Int J Artif Organs 1995; 18: 757–62PubMedGoogle Scholar
  20. 20.
    Kuntziger HE, Pouthier D, Bellucci A. Treatment of hypertension with lisinopril in end-stage renal disease. J Cardiovasc Pharmacol 1987; 10Suppl.: 57S–159SGoogle Scholar
  21. 21.
    Sica DA, Ripley E. Angiotensin converting enzyme inhibitors. In: Izzo JL, Black HR editors. Hypertension primer. 2nd ed. Baltimore (MD): Lippincott Williams & Wilkins, 1998: 372–6Google Scholar
  22. 22.
    Sica DA. Kinetics of angiotensin converting enzyme inhibitors in renal failure. J Cardiovasc Pharmacol 1992; 20Suppl. 10: 13S–20SGoogle Scholar
  23. 23.
    Sica DA, Cutler RE, Parmer RJ, et al. Comparison of the steady-state pharmacokinetics of fosinopril, lisinopril, and enalapril in patients with chronic renal insufficiency. Clin Pharmacokinet 1991; 20: 420–7PubMedCrossRefGoogle Scholar
  24. 24.
    Sica DA, Gehr TWB. The pharmacokinetics of angiotensin converting enzyme inhibitors in end-stage renal disease. Seminars Dialysis 1994; 7: 205–13CrossRefGoogle Scholar
  25. 25.
    Kaiser G, Ackermann R, Sioufi A. Pharmacokinetics of a new angiotensin converting enzyme inhibitor, benazepril hydrochloride, in special populations. Am Heart J 1989; 117: 746–50PubMedCrossRefGoogle Scholar
  26. 26.
    Hirakata H, Onoyama K, Iseki K, et al. Captopril (SQ 14225) clearance during hemodialysis treatment. Clin Nephrol 1981; 16: 321–3PubMedGoogle Scholar
  27. 27.
    Fujimara A, Kajiyama H, Ebihara A, et al. Pharmacokinetics and pharmacodynamics of captopril in patients undergoing continuous ambulatory peritoneal dialysis. Nephron 1986; 44: 324–8CrossRefGoogle Scholar
  28. 28.
    Drummer OH, Workman BS, Miach PJ, et al. The pharmacokinetics of captopril and captopril disulfide conjugates in uraemic patients on maintenance dialysis comparison with patients with normal renal function. Eur J Clin Pharmacol 1987; 32: 267–71PubMedCrossRefGoogle Scholar
  29. 29.
    Duchin K, Pierides A, Heald A, et al. Elimination characteristics of captopril in patients with renal failure. Kidney Int 1984; 25: 942–7PubMedCrossRefGoogle Scholar
  30. 30.
    Fruncillo RJ, Rocci ML, Vlasses PH, et al. Disposition of enalapril and enalaprilat in renal insufficiency. Kidney Int 1987; 31:Suppl.: 117S–122SGoogle Scholar
  31. 31.
    Lowenthal DT, Irvin JD, Merrill D, et al. The effect of renal function on enalapril kinetics. Clin Pharmacol Ther 1985; 38: 661–6PubMedCrossRefGoogle Scholar
  32. 32.
    Kelly JG, Doyle G, Donohue J, et al. Pharmacokinetics of enalapril in normal subjects and patients with renal impairment. Br J Clin Pharmacol 1986; 21: 63–9PubMedCrossRefGoogle Scholar
  33. 33.
    Gehr TWB, Sica DA, Duchin K, et al. Fosinopril pharmacokinetics and pharmacodynamics in maintenance hemodialysis. Eur J Clin Pharmacol 1993; 45: 431–6PubMedCrossRefGoogle Scholar
  34. 34.
    Gehr TWB, Sica DA, Grasela A, et al. Fosinopril pharmacokinetics and pharmacodynamics in chronic ambulatory peritoneal dialysis. Eur J Clin Pharmacol 1990; 41: 165–9Google Scholar
  35. 35.
    Kelly JG, Doyle GD, Carmody M, et al. Pharmacokinetics of lisinopril, enalapril, and enalaprilat in renal failure: effects of hemodialysis. Br J Clin Pharmacol 1988; 26: 781–6PubMedCrossRefGoogle Scholar
  36. 36.
    Stimple M. Moexipril. In: Messerli F, editor. Cardiovascular drug therapy. 2nd ed. Philadelphia: WB Saunders, 1996: 813–6Google Scholar
  37. 37.
    Sennesael J, Ali A, Sweny P, et al. The pharmacokinetics of perindopril and its effects on serum angiotensin converting enzyme activity in hypertensive patients with chronic renal failure. Br J Clin Pharmacol 1992; 33: 93–9PubMedCrossRefGoogle Scholar
  38. 38.
    Guerin A, Resplandy G, Marchais S, et al. The effect of haemodialysis on the pharmacokinetics of perindoprilat after long-term perindopril. Eur J Clin Pharmacol 1993; 44: 183–7PubMedCrossRefGoogle Scholar
  39. 39.
    Blum RA, Olson SC, Kohli RK, et al. Pharmacokinetics of quinapril and its active metabolite, quinaprilat, in patients on chronic hemodialysis. J Clin Pharmacol 1990; 30: 938–42PubMedGoogle Scholar
  40. 40.
    Wolter K, Fritschka E. Pharmacokinetics and pharmacodynamics of quinaprilat after low dose quinapril in patients with terminal renal failure. Eur J Clin Pharmacol 1993; 44Suppl. 1: 53S–56SCrossRefGoogle Scholar
  41. 41.
    Fillastre JP, Baguet JC, Dubois D, et al. Kinetics, safety, and efficacy of ramipril after long-term administration in hemodialyzed patients. J Cardiovasc Pharmacol 1996; 27: 269–74PubMedCrossRefGoogle Scholar
  42. 42.
    Wiseman LR, McTavish D. Trandolapril: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in essential hypertension. Drugs 1993; 48: 71–90CrossRefGoogle Scholar
  43. 43.
    Sica DA, Halstenson C, Gehr TWB, et al. The pharmacokinetics and pharmacodynamics of losartan in end stage renal disease. In pressGoogle Scholar
  44. 44.
    Sica DA, Marino MR, Hammett JL, et al. The pharmacokinetics of irbesartan in renal failure and maintenance hemodialysis. Clin Pharmacol Ther 1997; 62: 610–8PubMedCrossRefGoogle Scholar
  45. 45.
    Prasad P, Mangat S, Choi L, et al. Effect of renal function on the pharmacokinetics of valsartan. Clin Drug Invest 1997; 13: 207–14CrossRefGoogle Scholar
  46. 46.
    Kovacs SJ, Tenero DM, Martin DE, et al. Pharmacokinetics and protein binding of eprosartan in hemodialysis-dependent patients with end-stage renal disease. Pharmacotherapy 1999; 19: 612–9PubMedCrossRefGoogle Scholar
  47. 47.
    de Zeeuw D, Remuzzi G, Kirch W. The pharmacokinetics of candesartan cilexitil in patients with renal or hepatic impairment. J Hum Hypertens 1997; 11Suppl. 2: 37S–42SGoogle Scholar
  48. 48.
    McClellan KJ, Markham A. Telmisartan. Drugs 1998; 56: 1039–44PubMedCrossRefGoogle Scholar
  49. 49.
    Martin DE, Chapelsky MC, Ilson B, et al. Pharmacokinetics and protein binding of eprosartan in healthy volunteers and in patients with varying degrees of renal impairment. J Clin Pharmacol 1998; 38: 129–37PubMedGoogle Scholar
  50. 50.
    Sica DA, Shaw WC, Lo MW, et al: The pharmacokinetics of losartan in renal insufficiency. J Hypertens 1995; 13Suppl. 1: 49S–52SGoogle Scholar
  51. 51.
    Toto R, Shultz P, Jaij L, et al. Efficacy and tolerability of losartan in hypertensive patients with renal impairment. Hypertension 1998; 31: 684–91PubMedCrossRefGoogle Scholar
  52. 52.
    Cooper M, Anzalone D, Townes L, et al. Safety and efficacy of irbesartan in patients with hypertension and renal insufficiency [abstract]. Am JHypertens 1998; 11: 102ACrossRefGoogle Scholar
  53. 53.
    Gehr TWB, Sica DA, Pedro P, et al. The antihypertensive and neurohumoral effects of losartan in end-stage renal disease peritoneal dialysis patients [abstract]. Am J Hypertens 1998; 11: 103ACrossRefGoogle Scholar
  54. 54.
    Saracho R, Martin-Malo A, Martinez I, et al. Evaluation of the losartan in hemodialysis (ELHE) study. Kidney Int 1998; 54Suppl.68: 125–129CrossRefGoogle Scholar
  55. 55.
    Sica DA, Deedwania P. Cardiorenal implications of angiotensin-receptor antagonist therapy. Cong Heart Fail 1998; 4: 35–40.Google Scholar
  56. 56.
    Van Veldhuisen DJ, Genth-Zotz S, Brouwer J, et al. High versus low-dose ACE inhibition in chronic heart failure: a double-blind, placebo-controlled study of imidapril. J Am Coll Cardiol 1998; 32: 1811–8PubMedCrossRefGoogle Scholar
  57. 57.
    The ATLAS Investigators. Comparative effects of low-dose versus high-dose lisinopril on survival and major cardiac events in chronic heart failure [abstract]. Eur Heart J 1998; 19: 142Google Scholar
  58. 58.
    Graziani G, Badalamenti S, Del Bo A, et al. Abnormal hemodynamics and elevated angiotensin-II plasma levels in polydipsic patients on regular hemodialysis treatment. Kidney Int 1993; 44: 107–14PubMedCrossRefGoogle Scholar
  59. 59.
    Rogers PW, Kurtzman NA. Renal failure, uncontrollable thirst, and hyperenimenia: cessation of thirst with bilateral nephrectomy. J Am Med Inform Assoc 1973; 225: 1236–8Google Scholar
  60. 60.
    Yamamoto T, Shimizu M, Morioka M, et al. Role of angiotensin II in the pathogenesis of hyperdipsia in chronic renal failure. J Am Med Inform Assoc 1986; 256: 604–8Google Scholar
  61. 61.
    Oldenburg B, MacDonald GJ, Shelley S. Controlled trial of enalapril in patients with chronic fluid overload undergoing dialysis. BMJ 1988; 296: 1089–91PubMedCrossRefGoogle Scholar
  62. 62.
    Bastani B, Redington J. Lack of efficacy of angiotensin converting enzyme inhibitors in reducing interdialytic weight gain. Am J Kidney Dis 1994; 24: 907–11PubMedGoogle Scholar
  63. 63.
    Kuriyama S, Tomonari H, Sakai O. Effect of cilazapril on hyperdipsia in hemodialyzed patients. Blood Purif 1996; 14: 35–41PubMedCrossRefGoogle Scholar
  64. 64.
    Hirakata H, Onoyama K, Iseki K, et al. Worsening of anemia by long-term use of captopril in hemodialysis patients. Am J Nephrol 1984; 4: 355–60PubMedCrossRefGoogle Scholar
  65. 65.
    Hirakata H, Onoyama K, Hori K, et al. Participation of the renin-angiotensin system in the captopril-induced worsening of anemia in chronic hemodialysis patients. Clin Nephrol 1986; 26: 27–32PubMedGoogle Scholar
  66. 66.
    Yoshida A, Morozumi K, Suganuma T, et al. Angiotensin-converting enzyme inhibitor and anemia in a patient undergoing hemodialysis. Nephron 1991; 59: 334–5PubMedCrossRefGoogle Scholar
  67. 67.
    Onoyama K, Sanai T, Motomura K, et al. Worsening of anemia by angiotensin-converting enzyme inhibitors and its prevention by antiestrogenic steroids in chronic hemodialysis patients. J Cardiovasc Pharmacol 1989; 13Suppl. 3: 27S–30SCrossRefGoogle Scholar
  68. 68.
    Thervet E, Legendre C, Debure A, et al. Angiotensin-converting enzyme inhibitors have been reported to induce or worsen anemia in patients on hemodialysis [letter]. Am J Kidney Dis 1991; 18: 282–3PubMedGoogle Scholar
  69. 69.
    Miranda B, Selgas R, Oliet A, et al. Treatment with converting enzyme inhibitors can contribute to anemia in CAPD patients. Kidney Int 1990; 37: 1614Google Scholar
  70. 70.
    Gould AB, Goodman SA, de Wolf R, et al. Interrelation of the renin system and erythropoietin in rats. J Lab Clin Med 1980; 96: 523–34PubMedGoogle Scholar
  71. 71.
    Matsumura M, Nomura H, Koni I, Mabuchi H. Angiotensin-converting enzyme inhibitors are associated with the need for increased recombinant human erythropoietin maintenance doses in hemodialysis patients: risks of cardiac disease in dialysis patients study group. Nephron 1997; 77: 164–8PubMedCrossRefGoogle Scholar
  72. 72.
    Albitar S, Genin R, Fen-Chong M, et al. High dose enalapril impairs the response to erythropoietin treatment in hemodialysis patients. Nephrol Dial Transplant 1998; 13: 1206–10PubMedCrossRefGoogle Scholar
  73. 73.
    Charytan C, Goldfarb-Rumyantzev A, Wang YF, et al. Effect of angiotensin-converting enzyme inhibitors on response to erythropoietin therapy in chronic dialysis patients. Am J Nephrol 1998; 18: 498–503PubMedCrossRefGoogle Scholar
  74. 74.
    Schwenk MH, Jumani AQ, Rosenberg CR, et al. Potential angiotensin-converting enzyme inhibitor-epoetin alfa interaction in patients receiving chronic hemodialysis. Pharmacotherapy 1998; 18: 627–30PubMedGoogle Scholar
  75. 75.
    Morrone LF, Di Paolo S, Logoluso F, et al. Interference of angiotensin-converting enzyme inhibitors on erythropoiesis on kidney transplant recipients: role of growth factors and cytokines. Transplantation 1997; 64: 913–8PubMedCrossRefGoogle Scholar
  76. 76.
    Azizi M, Rousseau A, Ezan E, et al. Acute angiotensin-converting enzyme inhibition increases the plasma levels of the natural stem cell regulator N-acetyl-seryl-aspartyl-lysyl-proline. J Clin Invest 1996; 97: 839–44PubMedCrossRefGoogle Scholar
  77. 77.
    Hortal L, Fernandez A, Vega A, et al. Losartan versus ramipril in the treatment of postrenal transplant erythrocytosis. Transplant Proc 1998; 30: 2127–8PubMedCrossRefGoogle Scholar
  78. 78.
    Horn S, Holzer H, Horina J. Losartan and renal transplantation. Lancet 1998; 351: 111PubMedCrossRefGoogle Scholar
  79. 79.
    Schwarzbeck A, Wittenmeier KW, Hallfritzsch U. Anemia in dialysis patients as a side effect of sartanes. Lancet 1998; 352: 286PubMedCrossRefGoogle Scholar
  80. 80.
    Schiffl H, Lang SM. Angiotensin-converting enzyme inhibitors but not angiotensin II AT1 receptor antagonists affect erythropoiesis in patients with anemia on end-stage renal disease. Nephron 1999; 81: 106–8PubMedCrossRefGoogle Scholar
  81. 81.
    Israili ZH, Hall WD. Cough and angioneurotic edema associated with angiotensin converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med 1992; 117: 234–42PubMedGoogle Scholar
  82. 82.
    Hedner T, Samuelsson O, Lunde H, et al. Angio-oedema in relation to treatment with angiotensin converting enzyme inhibitors. BMJ 1992; 304: 941–6PubMedCrossRefGoogle Scholar
  83. 83.
    Vleeming W, van Amsterdam JGC, Stricker BH, et al. ACE inhibitor-induced angioedema: incidence, prevention, and management. Drug Saf 1998; 18: 171–88PubMedCrossRefGoogle Scholar
  84. 84.
    Cockcroft JR, Sciberras DG, Goldberg MR, et al. Comparison of angiotensin converting enzyme inhibition with angiotensin II receptor antagonism in the human forearm. J Cardiovasc Pharmacol 1993; 22: 579–84PubMedCrossRefGoogle Scholar
  85. 85.
    Pylypchuk GB. ACE inhibitor versus angiotensin II blocker induced cough and angioedema. Ann Pharmacother 1998; 32: 1060–6PubMedCrossRefGoogle Scholar
  86. 86.
    Acker CG, Greenberg A. Angioedema induced by the angiotensin-II blocker losartan [letter]. N Engl J Med 1995; 333: 1572PubMedCrossRefGoogle Scholar
  87. 87.
    Boxer M. Accupril® and Cozar®-induced angioedema in the same patient [letter]. J Allergy Clin Immunol 1996; 98: 471PubMedCrossRefGoogle Scholar
  88. 88.
    Sharma PK, Yium JJ. Angioedema associated with angiotensin II receptor antagonist losartan. S Med J 1997; 90: 552–3CrossRefGoogle Scholar
  89. 89.
    van Rijnsoever EW, Kwee-Zuiderwijk WJM, Feenstra J. Angioneurotic edema attributed to the use of losartan. Arch Intern Med 1998; 158: 2063–5PubMedCrossRefGoogle Scholar
  90. 90.
    Mackay FJ, Pearce GL, Mann RD. Cough and angiotensin II receptor antagonists: cause of confounding? Br J Clin Pharmacol 1999; 47: 111–4PubMedCrossRefGoogle Scholar
  91. 91.
    Benz J, Oshrain C, Henry D, et al. Valsartan: a new angiotensin II receptor antagonist: a double-blind study comparing the incidence of cough with lisinopril and hydrochlorothiazide. J Clin Pharmacol 1997; 37: 101–7PubMedGoogle Scholar
  92. 92.
    Lacourciere Y, Brunner H, Irwin R, et al. Effects of modulators of the renin-angiotensin-aldosterone axis on cough. J Hypertens 1994; 12: 1387–93PubMedGoogle Scholar
  93. 93.
    Larochelle P, Flack JM, Marbury TC, et al. Effects and tolerability of irbesartan versus enalapril in patients with severe hypertension. Am J Cardiol 1997; 80: 1613–5PubMedCrossRefGoogle Scholar
  94. 94.
    Tielemans C, Madhoun P, Lenaers M, et al. Anaphylactoid reactions during hemodialysis on AN69 membranes in patients receiving ACE inhibitors. Kidney Int 1990; 38: 982–4PubMedCrossRefGoogle Scholar
  95. 95.
    Verresen L, Fink E, Lemke HD, et al. Bradykinin is a mediator of anaphylactoid reactions during hemodialysis with AN69 membranes. Kidney Int 1994; 45: 1497–1503PubMedCrossRefGoogle Scholar
  96. 96.
    Brunet P, Jaber K, Berland Y, et al. Anaphylactoid reactions during hemodialysis and hemofiltration: role of associated AN69 membrane and angiotensin I-converting enzyme inhibitors. Am J Kidney Dis 1992; 19: 444–7PubMedGoogle Scholar
  97. 97.
    Petrie JJB, Campbell Y, Hawley CM, et al. Anaphylactoid reactions in patients on haemofiltration with AN69 membranes whilst receiving ACE inhibitors. Clin Nephrol 1991; 36: 264–5PubMedGoogle Scholar
  98. 98.
    Parnes EL, Shapiro WB. Anaphylactoid reactions in hemodialysis patients treated with the AN69 membrane. Kidney Int 1991; 40: 1148–52PubMedCrossRefGoogle Scholar
  99. 99.
    Pegues DA, Beck-Sague CM, Woolen SW, et al. Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors. Kidney Int 1992; 42: 1232–7PubMedCrossRefGoogle Scholar
  100. 100.
    Daguirdas JT, Ing TS, Roxe DM, et al. Severe anaphylactoid reactions to cuprammonium cellulose hemodialyzers. Arch Intern Med 1985; 145: 489–94CrossRefGoogle Scholar
  101. 101.
    Krieter D, Grude M, Lemke HD, et al. Anaphylactoid reactions during hemodialysis in sheep are ACE inhibitor dose-dependent and mediated by bradykinin. Kidney Int 1998; 53: 1026–35PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Domenic A. Sica
    • 1
  • Todd W.B. Gehr
    • 1
  • Andrea Fernandez
    • 1
  1. 1.Divisions of Clinical Pharmacology, Hypertension and NephrologyMedical College of Virginia of Virginia Commonwealth UniversityRichmondUSA

Personalised recommendations