Lack of efficacy of angiotensin-converting enzyme inhibitors in reducing interdialytic weight gain.

Abstract

Angiotensin-converting enzyme inhibitors (ACEIs) have been suggested to reduce interdialytic fluid weight gain, presumably via suppression of the dipsogenic angiotensin II. We retrospectively studied 25 (76% black) chronic hemodialysis patients who received ACEIs for blood pressure control. The mean arterial blood pressure decreased from 115.4 +/- 10.4 mm Hg to 112.7 +/- 9.0 mm Hg (mean +/- SD; P = NS) and there was no change in the interdialytic weight gain (3.74 +/- 1.5 kg v 3.72 +/- 1.5 kg; P = NS). Only 10 (40%) patients had some reduction in their interdialytic weight gain; in four of them the reduction was more than 20% of the pre-ACEI weight gain. When nine patients who had no decline in blood pressure were excluded due to possible noncompliance, the mean arterial blood pressure in the remaining 16 patients (75% black) declined from 119.3 +/- 9.9 mm Hg to 111.6 +/- 9.9 mm Hg (P < 0.0001), but there was no change in the interdialytic fluid weight gain (3.7 +/- 1.4 kg v 3.8 +/- 1.4 kg; P = NS). There was no correlation between age, race, etiology of renal failure, or blood pressure response and change in the interdialytic weight gain after ACEI treatment. Our results do not support the previous report that ACEIs significantly decrease the interdialytic weight gain in chronic hemodialysis patients. The multifactorial nature of excessive fluid intake in the hemodialysis patients and the differences in patient population and study design may account for this discrepancy.