Dual Blockade of the Renin-Angiotensin System on Thirst in Hemodialysis Patients

Original Paper

Influence of Dual Blockade of the Renin-Angiotensin System on Thirst in Hemodialysis Patients
Anna Masajtis-Zagajewska, Michalstrok Nowicki

Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lstrokódzacute, Lstrokódzacute, Poland

Address of Corresponding Author

Nephron Clin Pract 2009;112:c242-c247 (DOI: 10.1159/000224790)

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* Angiotensin-receptor antagonists
* Angiotensin-converting enzyme inhibitors
* Xerostomia
* Chronic hemodialysis therapy

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Background/Aims: Angiotensin II promotes sodium retention and influences the central regulation of fluid intake. Clinical studies on the effect of an angiotensin-converting enzyme inhibitor (ACEI) on xerostomia and thirst in chronic hemodialysis (HD) patients were scarce and gave contradictory results. We hypothesized that a more effective inhibition of the renin-angiotensin-aldosterone axis with the combined ACEI and angiotensin receptor antagonist administration may reduce thirst and xerostomia,thereby decreasing interdialytic weight gain (IWG) in HD patients. Methods: Twenty-one chronic HD patients (16 men, 5 women, mean age 54 ± 13 years, time on dialysis 50 ± 58 months) who had been on chronic ACEI therapy were studied. In a double-blind, crossover study, all subjects received in a random order either losartan (50 mg/day) or placebo for two 4-week periods with a 7-day wash-out. Basic biochemistry, serum electrolytes, plasma aldosterone, measurements of salivary flow rate after stimulation with paraffin chewing, and subjective xerostomia and thirst questionnaires were collected before dialysis sessions both before and after each treatment period. IWG and blood pressure were assessed at each dialysis. Results: The volume of saliva increased after losartan (from 1.2 ± 0.7 to 1.5 ± 1.0 ml/min, respectively; p = 0.03), but this was reflected neither by the severity of the symptoms of xerostomia assessed by the patients on a visual analog scale (31 ± 9 vs. 31 ± 8 mm, respectively) nor by the intensity of thirst (final score 22 ± 5 vs. 21 ± 5 at baseline). No changes of the mean IWG were observed during the treatment with losartan (2.5 ± 0.6 kg before and 2.4 ± 0.8 kg at the end of the treatment). Plasma aldosterone decreased at the end of the losartan therapy (from 151 ± 86 to 111 ± 51 pg/ml; p = 0.02). Predialysis serum potassium did not change during the study. Conclusions: The addition of an angiotensin receptor blocker to chronic ACEI therapy is not effective in reducing thirst and thereby IWG in chronic HD patients.

Copyright © 2009 S. Karger AG, Basel

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Prof. Dr. med. Michalstrok Nowicki
Department of Nephrology, Hypertension and Kidney Transplantation
Medical University of Lstrokódzacute, University Hospital, Kopcinacuteskiego 22
PL-90-153 Lstrokódzacute (Poland)
Tel. +48 4267 76709, Fax +48 4267 83632, E-Mail nefro@wp.pl

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Received: September 8, 2008
Accepted: December 4, 2008
Published online: June 16; 2009
Number of Print Pages : 6
Number of Figures : 3, Number of Tables : 3, Number of References : 35

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