Efficacy of telmisartan for the treatment of persistent renal proteinuria in dogs: A double‐masked, randomized clinical trial

Abstract

Background Information regarding efficacy of the angiotensin II receptor blocker, telmisartan, for treatment of proteinuria in dogs is limited. Objective To evaluate the antiproteinuric efficacy of telmisartan, as compared to enalapril, in dogs with chronic kidney disease and persistent, renal proteinuria. Animals Thirty‐nine client‐owned dogs with chronic kidney disease and urinary protein‐to‐creatinine ratio (UPC) > 0.5 (if azotemic) or ≥ 1.0 (if nonazotemic). Methods In this prospective, randomized, double‐masked clinical trial, dogs were block randomized, according to presence or absence of azotemia and systemic arterial hypertension, to receive telmisartan (1.0 mg/kg PO q24h), or enalapril (0.5 mg/kg PO q12h), and followed for 120 days. Up‐titration of study drug dosage on days 30 and 60, and addition of the other study drug at day 90, were performed if UPC > 0.5 was noted at these visits. Percentage change in UPC relative to baseline was calculated for all time points. Data are presented as median (range). Results Thirty‐nine (20 telmisartan‐treated, 19 enalapril‐treated) dogs were included. At day 30, percentage change in UPC was greater for telmisartan‐treated (−65% [−95% to 104%]) vs enalapril‐treated (−35% [−74% to 87%]) dogs ( P = .002). Among dogs persistently proteinuric at earlier visits, telmisartan remained superior to enalapril at days 60 ( P = .02) and 90 ( P = .02). No difference in percentage change in UPC between study groups was observed at day 120, when combination therapy was allowed. Combination therapy resulted in relevant azotemia in 4/13 (31%) dogs. Conclusions and Clinical Importance Telmisartan might be a suitable first‐line therapy for dogs with renal proteinuria.

Treatment of proteinuria in dogs with telmisartan: A retrospective study

“…[20][21][22][23][24][25][26][27][28][29][30][31] A recently published clinical trial in dogs showed that 31% of dogs developed significant increases in SCr requiring hospitalization for treatment, further supporting this argument. 18 Blockade at the angiotensin-II receptors by ARBs could offer a potential benefit over the use of ACEi, especially in dogs refractory to treatment, as was observed in a recent clinical trial. 18 We also cannot exclude that the 2 dogs in our study that had complete response with combination treatment after introduction of telmisartan could have had a similar response had the ACEi been gradually withdrawn or discontinued, as previously described in a case report.…”

“…18 Blockade at the angiotensin-II receptors by ARBs could offer a potential benefit over the use of ACEi, especially in dogs refractory to treatment, as was observed in a recent clinical trial. 18 We also cannot exclude that the 2 dogs in our study that had complete response with combination treatment after introduction of telmisartan could have had a similar response had the ACEi been gradually withdrawn or discontinued, as previously described in a case report. 17 Six dogs were treated with both telmisartan and mycophenolate, and a partial or complete response was observed for most of these dogs at the follow-up visits.…”

“…40,41 In a recently published clinical trial, however, no significant difference was noted when comparing percentage change relative to baseline in SCr and serum potassium concentration when comparing dogs being treated with telmisartan and to those treated with enalapril. 18 Thirty-one dogs (71%) had their blood pressure evaluated before treatment, and mean systolic blood pressure was in the low TOD category (140-159 mm Hg). 11 Blood pressure remained in an acceptable range (>120 mm Hg) 18 for all dogs at the various follow-ups.…”

“…18 Thirty-one dogs (71%) had their blood pressure evaluated before treatment, and mean systolic blood pressure was in the low TOD category (140-159 mm Hg). 11 Blood pressure remained in an acceptable range (>120 mm Hg) 18 for all dogs at the various follow-ups. Not all dogs had blood pressure measurements noted in their records at each follow-up for different reasons (eg, lack of dog compliance, financial restrictions, incomplete medical records).…”

Evaluation of Chronic Kidney Disease Progression in Dogs With Therapeutic Management of Risk Factors

“…The therapeutic management of RF started after CKD staging and substaging (20,22). Patients in stage I of the disease with persistent proteinuria were fed a renal therapeutic diet, 1 and an ACEI or ARA was incorporated to the medical management (13,(22)(23)(24). Patients in azotemic stages received a renal therapeutic diet and a phosphate binder with food every 12 h 2 .…”