Renin-Angiotensin System Blockage for Reduction of Plasma Adiponectin Level in Maintenance Hemodialysis Patients A Randomized Controlled Trial

Introduction. Plasma adiponectin level is markedly increased among patients on hemodialysis. This investigation aimed to evaluate the relationship between renin-angiotensin system blockade and serum adiponectin concentration in nondiabetic patients on hemodialysis. Materials and Methods. This randomized double-blind controlled trial was conducted on a group of nondiabetic patients on regular hemodialysis. The first group received losartan, 12.5 mg twice per day for the 1st week, 25 mg twice per day during the 2nd week, and 75 mg/d from the 3rd week to the end of the 16th week. Patients of the control group received placebo. Blood samples from all of the patients were collected at the beginning and at the end of the study to measure serum adiponectin. Results. Seventy-three hemodialysis patients were divided randomly into the losartan group (40 patients) and the control group (33 patients). The mean adiponectin level in all of the patients was 10.6 ± 3.9 μg/mL. A significant decrease of serum adiponectin level was observed after 4 months of treatment with losartan (8.86 ± 3.43 μg/mL for losartan group versus 10.71 ± 3.94 μg/mL for the control group; P = .04). None of the patients had a serum potassium value greater than 5 mg/dL or hypotension during the intervention. There was no significant difference in serum potassium levels between the two groups. Conclusions. The decrease in serum adiponectin level in nondiabetic patients on regular hemodialysis by losartan might offer a potential protective approach in these patients. Mechanisms responsible for this reduction remain to be investigated.