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Nephrol Dial Transplant (1995) 10: 2316-2320
© 1995 European Renal Association-European Dialysis and Transplant Association

research-article

A randomized placebo-controlled study of enalapril in the treatment of erythrocytosis after renal transplantation

I. J. Beckingham1, G. Woodrow2,, M. Hinwood2, K. M. Rigg1, A. G. Morgan2, R. P. Burden2 and F. Broughton-Pipkin3

1Department of Surgery City Hospital, Nottingham 2Department of Renal Medicine City Hospital, Nottingham 3Department of Obstetrics and Gynaecology, University Hospital Nottingham

Correspondence and offprint requests to: Correspondence and offprint requests to: Dr G. Woodrow, Renal Unit, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK

BACKGROUND: Erythrocytosis is a common complication of renal transplantation with an incidence of up to 17%. It is associated with an increased risk of complications due to thromboembolic events and has traditionally been treated by intermittent venesection. More recently, angiotensin-converting enzyme inhibitors have been shown to cause a fall in haematocrit in a number of groups of subjects and some uncontrolled studies have shown these drugs to be of possible therapeutic benefit in post renal transplant erythrocytosis.

METHODS: We performed a randomized double-blind placebo-controlled study in 25 patients with post-transplant erythrocytosis. Subjects received either 2.5 mg of enalapril daily or a placebo for 4 months and all patients completed the study period without any serious adverse effects.

RESULTS: Haematocrit fell from 52.7 (±SEM 0.7) to 47.1 (± 1.8) at 1 month and 46.1 (± 1.2) after 4 months in patients receiving enalapril, with no change in the placebo group (P=0.004). We did not demonstrate any change in serum erythropoietin in either group.

CONCLUSION: Angiotensin-converting enzyme inhibitors are a safe and effective form of treatment for erythrocytosis developing after renal transplantation. The mechanism of action, however, is not mediated by changes in erythropoietin production and remains uncertain.

Keywords: placebo-controlled; erythrocytosis; renal transplantation


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