Effect of Angiotensin-Converting Enzyme Inhibitor on the Interdialytic Body Weight Gain of Patients on Maintenance Hemodialysis

Kim, M K; Yoon, T D; Su, D D; Lee, J Y; Kim, Y K; Lee, H G; Kim, T Y; Choi, Y S; Kong, J M

Abstract

OBJECTIVE
To determine the efficacy of ACE inhibitor on reducing the interdialytic HW gain of patients on maintenance hemodialysis.
METHODS
A randomized, double blind, placebo controlled crossover study, consisting of one 4-week baseline period and two 4-week treatment periods, which were interposed by a 2-week washout period, was conducted on 21 non-diabetic ESI4D patients on hemodialysis. During the treatment periods, patients were given either fosinopril 10 mg/day or a placebo. Interdialytic BW gain was recorded during the study period and BUN, plasma Na, osmolarity and the agiotensin II level were measured at the end of the baseline and treatment periods.
RESULTS
Eight patients were excluded from the study due to incompliance to medication and 13 patients remained in the study. During the baseline period, no correlation was found between interdialytic weight gain and BUN, Na, osmolarity and angiotens in II. There was no difference in the interdialytic weight. increment between the fosinopril-treated (1.0 +/- 0.1kg/day, mean +/- SE) and placebo-treated period (1.0 +/- 0.1), The weight increment in both periods was significantly less than that in the baseline period (1.2 +/- 0.2), suggesting a psychological influence of both medications on thirst. However, in 8 patients who gained 1.0 kg/day or more during the baseline period, the interdialytic HW increment in fosinopril-treated period (1.3 +/- 0.1) was significantly less than that in the placebo period (1.4 +/- 0.1, p<0.05 by paired t test). Of these patients, 6 patients gained less and 2 patients showed no difference in the fosinopril period compared with the placebo period.
CONCLUSION
ACE inhibitor may reduce interdialytic BW gain in hemodialysis patients with moderate to high interdialytic weight increment.