Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease
Abstract Background The influence of aldosterone breakthrough (ABT) on proteinuria reduction during renin‐angiotensin system (RAS) inhibition for spontaneous proteinuric chronic kidney disease (CKDP) has not been determined in dogs. Objectives Determine whether ABT occurs in dogs with CKDP and if it...
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| Format: | Article |
| Language: | English |
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Wiley
2022-11-01
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| Series: | Journal of Veterinary Internal Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/jvim.16573 |
| _version_ | 1828086638633287680 |
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| author | Marisa K. Ames Shelly L. Vaden Clarke E. Atkins Jean‐Sebastien Palerme Catherine E. Langston Gregory F. Grauer Sarah Shropshire Christina Bove Tracy Webb |
| author_facet | Marisa K. Ames Shelly L. Vaden Clarke E. Atkins Jean‐Sebastien Palerme Catherine E. Langston Gregory F. Grauer Sarah Shropshire Christina Bove Tracy Webb |
| author_sort | Marisa K. Ames |
| collection | DOAJ |
| description | Abstract Background The influence of aldosterone breakthrough (ABT) on proteinuria reduction during renin‐angiotensin system (RAS) inhibition for spontaneous proteinuric chronic kidney disease (CKDP) has not been determined in dogs. Objectives Determine whether ABT occurs in dogs with CKDP and if it is associated with decreased efficacy in proteinuria reduction during RAS inhibitor treatment. Animals Fifty‐six client‐owned dogs with CKDP and 31 healthy client‐owned dogs. Methods Prospective, multicenter, open‐label clinical trial. Dogs were treated with an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker alone or in combination at the attending clinician's discretion and evaluated at 5 time points over 6 months. Healthy dogs were used to determine the urine aldosterone‐to‐creatinine ratio cutoff that defined ABT. The relationship of ABT (present at ≥50% of visits) and proteinuria outcome (≥50% reduction in urine protein‐to‐creatinine ratio from baseline at ≥50% of subsequent visits) was evaluated. Mixed effects logistic regression was used to evaluate the relationship between clinical variables and outcomes (either successful proteinuria reduction or ABT). Results Thirty‐six percent (20/56) of dogs had successful proteinuria reduction. Between 34% and 59% of dogs had ABT, depending on the definition used. Aldosterone breakthrough was not associated with proteinuria outcome. Longer duration in the study was associated with greater likelihood of successful proteinuria reduction (P = .002; odds ratio, 1.6; 95% confidence interval [CI], 1.2‐2.2). Conclusions and Clinical Importance Aldosterone breakthrough was common in dogs receiving RAS inhibitors for CKDp but was not associated with proteinuria outcome. |
| first_indexed | 2024-04-11T04:58:06Z |
| format | Article |
| id | doaj.art-dc4e60376aa44cb88a6afb1190350ef1 |
| institution | Directory Open Access Journal |
| issn | 0891-6640 1939-1676 |
| language | English |
| last_indexed | 2024-04-11T04:58:06Z |
| publishDate | 2022-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Veterinary Internal Medicine |
| spelling | doaj.art-dc4e60376aa44cb88a6afb1190350ef12022-12-26T07:32:23ZengWileyJournal of Veterinary Internal Medicine0891-66401939-16762022-11-013662088209710.1111/jvim.16573Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney diseaseMarisa K. Ames0Shelly L. Vaden1Clarke E. Atkins2Jean‐Sebastien Palerme3Catherine E. Langston4Gregory F. Grauer5Sarah Shropshire6Christina Bove7Tracy Webb8Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USADepartment of Clinical Sciences North Carolina State University College of Veterinary Medicine Raleigh North Carolina USADepartment of Clinical Sciences North Carolina State University College of Veterinary Medicine Raleigh North Carolina USADepartment of Veterinary Clinical Sciences Iowa State University College of Veterinary Medicine Ames Iowa USADepartment of Veterinary Clinical Sciences The Ohio State University College of Veterinary Medicine Columbus Ohio USADepartment of Clinical Sciences Kansas State University College of Veterinary Medicine Manhattan Kansas USADepartment of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USADepartment of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USADepartment of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USAAbstract Background The influence of aldosterone breakthrough (ABT) on proteinuria reduction during renin‐angiotensin system (RAS) inhibition for spontaneous proteinuric chronic kidney disease (CKDP) has not been determined in dogs. Objectives Determine whether ABT occurs in dogs with CKDP and if it is associated with decreased efficacy in proteinuria reduction during RAS inhibitor treatment. Animals Fifty‐six client‐owned dogs with CKDP and 31 healthy client‐owned dogs. Methods Prospective, multicenter, open‐label clinical trial. Dogs were treated with an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker alone or in combination at the attending clinician's discretion and evaluated at 5 time points over 6 months. Healthy dogs were used to determine the urine aldosterone‐to‐creatinine ratio cutoff that defined ABT. The relationship of ABT (present at ≥50% of visits) and proteinuria outcome (≥50% reduction in urine protein‐to‐creatinine ratio from baseline at ≥50% of subsequent visits) was evaluated. Mixed effects logistic regression was used to evaluate the relationship between clinical variables and outcomes (either successful proteinuria reduction or ABT). Results Thirty‐six percent (20/56) of dogs had successful proteinuria reduction. Between 34% and 59% of dogs had ABT, depending on the definition used. Aldosterone breakthrough was not associated with proteinuria outcome. Longer duration in the study was associated with greater likelihood of successful proteinuria reduction (P = .002; odds ratio, 1.6; 95% confidence interval [CI], 1.2‐2.2). Conclusions and Clinical Importance Aldosterone breakthrough was common in dogs receiving RAS inhibitors for CKDp but was not associated with proteinuria outcome.https://doi.org/10.1111/jvim.16573mineralocorticoid receptor antagonistsnephrologyrenin‐angiotensin‐aldosterone systemurine aldosterone to creatinine ratio |
| spellingShingle | Marisa K. Ames Shelly L. Vaden Clarke E. Atkins Jean‐Sebastien Palerme Catherine E. Langston Gregory F. Grauer Sarah Shropshire Christina Bove Tracy Webb Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease Journal of Veterinary Internal Medicine mineralocorticoid receptor antagonists nephrology renin‐angiotensin‐aldosterone system urine aldosterone to creatinine ratio |
| title | Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease |
| title_full | Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease |
| title_fullStr | Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease |
| title_full_unstemmed | Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease |
| title_short | Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease |
| title_sort | prevalence of aldosterone breakthrough in dogs receiving renin angiotensin system inhibitors for proteinuric chronic kidney disease |
| topic | mineralocorticoid receptor antagonists nephrology renin‐angiotensin‐aldosterone system urine aldosterone to creatinine ratio |
| url | https://doi.org/10.1111/jvim.16573 |
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