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Control of post-transplant erythrocytosis by enalapril
K C Wong1, N S Bandler, P G Kerr
1Department of Nephrology, Monash Medical Centre, Clayton, VIC.
Objective:
To assess the erythropoietin response in patients with erythrocytosis after renal transplantation who were treated with enalapril.
Patients:
Fourteen patients with stable renal transplants (creatinine clearance, 74.4 +/- 24.6 mL/min) and a packed cell volume of 51% or more over six months and who had no other cause for their erythrocytosis.
Methods:
Patients were treated with enalapril for six months. Serum erythropoietin levels, creatinine clearance and packed cell volume were measured before and during the study; patients were reviewed each month.
Results:
All patients had erythropoietin levels inappropriate for their packed cell volume. After six months' therapy with enalapril their mean erythropoietin concentration of 21.3 +/- 5.0 U/L fell to 7.4 +/- 1.3 U/L (P < 0.02) although the concentration increased in two patients. The mean packed cell volume fell from 52.7% +/- 0.5% to 44.4% +/- 1.0% (P < 0.0001). There was no change in renal function.
Conclusion:
Low-dose enalapril controls post-transplant erythrocytosis, at least in part, by lowering serum erythropoietin levels.