Hyperkalemia in hypertensive patients undergoing regular hemodialysis during enalapril and fosinopril therapy

摘要

Introduction. Hypertension is evident in 80%-85% of patients with chronic renal failure and antihypertensive therapy is needed in 25%-30% of patients. Apart from antihypertensive effect, ACEi’s decrease the left ventricular hypertrophy and mortality in dialysis patients. Even so, their use is limited due to hyperkalemia. Objective. The objective of the study was to compare the effect of fosinopril and enalapril on serum potassium level in hypertensive hemodialysis patients. Method. Prospective pilot study included 16 patients undergoing chronic hemodialysis, with mean age of 58.9±9.6 years and mean duration of hypertension 11.3±7.1 years. The effect of antihypertensive drugs of equivalent dose was followed during three periods (three months each): period 1 (therapy with enalapril), period 2 (therapy with fosinopril) and period 3 (therapy with enalapril). Dialysis conditions were constant and patients were without signs of catabolic state. Laboratory results were followed on monthly basis and mean values were compared by ANOVA-one way test. Difference between variables between periods was tested using Bonferoni method. Results. There was significant difference between mean serum potassium levels throughout three therapeutic periods (5.88±0.38 vs. 4.99±0.44 vs. 5.46±0.46mmol/l; p