The evaluation of renin-angiotensin-aldosterone system blocking drugs use in hemodialysed patients

Abstract

Background Congestive heart failure (CHF) is common concomitant disease in hemodialysed patients (HD). Renin-angiotensin-aldosterone system (RAA) blockers are standard therapy in CHF, but there is lack of studies evaluating the effectiveness and safety of such treatment in HD patients. Many authors point at inadequate cardiovascular therapy in hemodialysed patients. The aim of the study was to analyze the prevalence of RAA blocking drugs use in HD patients and factors limiting this therapy.
Material and methods The study was cross-sectional analysis of 102 hemodialysed patients, aged 28-86 years (mean 59 ± 13). We investigated the prevalence of RAA blocking drugs use in respect to symptoms of CHF, blood pressure, potassium concentration and dialysis adequacy.
Results Symptoms of CHF were found in 46 (45%) HD patients. RAA blocking drugs (angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) were taken by 46 (45%) HD patients; in 57% patients with CHF and in 36% HD patients without symptoms of CHF, respectively (p < 0.05). Potassium concentration was lower in CHF patients treated with ACEI//ARB compared with patients without CHF treated with ACEI/ARB (5.4 ± 0.6 vs. 6.0 ± 0.6 mmol/l; p < 0.01). Hyperkalaemia and low arterial pressure were main contraindications for ACEI/ARB use in HD patients.
Conclusions The study confirmed high prevalence of congestive heart failure symptoms in hemodialysed patients. ACEI/ARB use in HD patients with CHF is associated with lower risk of hyperkalaemia than in HD patients without CHF. Lack of clinical studies results in many questions regarding optimal therapy of CHF in HD patients unresolved. Arterial Hypertension 2007, vol. 11, no 4, pages 310-317.