Worsening of anemia induced by long-term use of captopril in hemodialysis patients.

During long-term captopril administration to hypertensive patients on maintenance hemodialysis, a decrease in hemoglobin, hematocrit, and red blood cell count was observed in 9 out of 12 cases. The maximum decrease in hemoglobin, on the average, was detected after 10.9 months of captopril treatment, when the average decrease was 20.5%. The average daily dose of the drug was 27.6 mg/day throughout the observation period. Mean corpuscular constants, reticulocyte count, serum iron, and total iron-binding capacity did not change significantly. Coombs' test was negative. Neither serum total protein nor body weight changed significantly. Fever, skin rashes, leukopenia, and eosinophilia were not observed. There was no significant correlation between the degree of decrease in hematological indices and the dose of captopril. After discontinuation of captopril administration, anemia improved to pretreatment levels. In 2 of the 3 patients who did not show worsening of anemia, an anabolic steroid was administered in association with captopril. It is suggested that captopril should be used with caution in hemodialysis patients.