Plasma Renin Activity and Aldosterone Concentrations in Hypertensive Cats with and without Azotemia and in Response to Treatment with Amlodipine Besylate

Jepson, Rosanne; Syme, H M; Elliott, Jonathan

doi:10.1111/jvim.12240

Cited by 47 publications

(79 citation statements)

References 58 publications

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“…The difference in plasma tMg between normotensive cats and cats with a (previous) diagnosis of systemic hypertension, however, was small, and therefore not directly clinically relevant. Increased plasma aldosterone is commonly observed in azotemic cats with systemic hypertension and not influenced by treatment with amlodipine besylate . It could be a possible link between hypomagnesemia and hypertension, because aldosterone stimulates urinary magnesium excretion whilst magnesium inhibits aldosterone release .…”

Section: Discussionmentioning

confidence: 98%

Prognostic importance of plasma total magnesium in a cohort of cats with azotemic chronic kidney disease

Broek

Chang

Elliott

et al. 2018

Veterinary Internal Medicne

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BackgroundHypomagnesemia is associated with increased mortality and renal function decline in humans with chronic kidney disease (CKD). Magnesium is furthermore inversely associated with fibroblast growth factor 23 (FGF23), an important prognostic factor in CKD in cats. However, the prognostic significance of plasma magnesium in cats with CKD is unknown.ObjectivesTo explore associations of plasma total magnesium concentration (tMg) with plasma FGF23 concentration, all‐cause mortality, and disease progression in cats with azotemic CKD.AnimalsRecords of 174 client‐owned cats with IRIS stage 2‐4 CKD.MethodsCohort study. Cats with azotemic CKD were identified from the records of two London‐based first opinion practices (1999–2013). Possible associations of baseline plasma tMg with FGF23 concentration and risks of death and progression were explored using, respectively, linear, Cox, and logistic regression.ResultsPlasma tMg (reference interval, 1.73–2.57 mg/dL) was inversely associated with plasma FGF23 when controlling for plasma creatinine and phosphate concentrations (partial correlation coefficient, −0.50; P < .001). Hypomagnesemia was observed in 12% (20/174) of cats, and independently associated with increased risk of death (adjusted hazard ratio, 2.74; 95% confidence interval [CI], 1.35–5.55; P = .005). The unadjusted associations of hypermagnesemia (prevalence, 6%; 11/174 cats) with survival (hazard ratio, 2.88; 95% CI, 1.54–5.38; P = .001), and hypomagnesemia with progressive CKD (odds ratio, 17.7; 95% CI, 2.04–154; P = .009) lost significance in multivariable analysis.Conclusions and Clinical ImportanceHypomagnesemia was associated with higher plasma FGF23 concentrations and increased risk of death. Measurement of plasma tMg augments prognostic information in cats with CKD, but whether these observations are associations or causations warrants further investigation.

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Section: Discussionmentioning

confidence: 98%

Prognostic importance of plasma total magnesium in a cohort of cats with azotemic chronic kidney disease

Broek

Chang

Elliott

et al. 2018

Veterinary Internal Medicne

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“…[149][150][151] A study investigating PRA and aldosterone concentration in normotensive azotemic CKD and non-azotemic age matched controls found no significant difference between these variables. 150 Experimental feline studies have demonstrated that administration of ACEi alters renal haemodynamics and reduces proteinuria with the latter observation also been observed in cats with naturally occurring CKD. 143,[152][153][154] However, to date, the survival advantage that we might anticipate from administration of an ACEi has not been demonstrated.…”

Section: Activation Of the Renin-angiotensin-aldosterone Systemmentioning

confidence: 99%

Current Understanding of the Pathogenesis of Progressive Chronic Kidney Disease in Cats

Jepson

2016

Veterinary Clinics of North America: Small Animal Practice

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Abstract:In cats with chronic kidney disease (CKD), the most common histopathological finding is tubulointerstitial inflammation and fibrosis. However, these changes reflect a non-specific response of the kidney to any inciting injury. The risk of development of CKD in a patient is likely to reflect genetic predispositions, ageing, environmental and individual factors that influence decline in renal function over the course of a cat's life. However, there is still relatively little information about exactly which risk factors predispose a cat to develop CKD and these will be explored. Whilst many cats diagnosed with CKD have stable disease for many years, some cats show overtly progressive disease.

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“…Hypertensive cats have lower plasma potassium concentrations than their normotensive counterparts . However, investigations into the activation of the renin–angiotensin–aldosterone system (RAAS) have reported heterogeneous results . As amlodipine is thought to produce its antihypertensive effects by reducing peripheral resistance, investigations into the factors influencing response to amlodipine could help elucidate the pathophysiologic mechanisms driving hypertension in cats with and without CKD.…”

mentioning

confidence: 99%

Factors Influencing the Relationship Between the Dose of Amlodipine Required for Blood Pressure Control and Change in Blood Pressure in Hypertensive Cats

Bijsmans

Doig²,

Jepson

et al. 2016

Veterinary Internal Medicne

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BackgroundHypertension is a common problem in elderly cats. In most cats, systolic blood pressure (SBP) of <160 mmHg is achieved in response to amlodipine besylate at either 0.625 or 1.25 mg q24h. The individual cat factors determining dose requirement dose have not been explored.AimsTo determine whether individual cat factors influence the dose of amlodipine required to achieve adequate blood pressure control and to determine whether factors other than the prescribed dose of drug alter the achieved plasma amlodipine concentrations.MethodsFifty‐nine hypertensive cats that required 0.625 mg (A) and 41 cats that required 1.25 mg (B) amlodipine to reach a target SBP of <160 mmHg were identified, and plasma amlodipine concentrations were determined. Comparisons were made between groups, and multivariable linear regression models were performed to investigate predictors of antihypertensive response.ResultsCats that required a greater dose of amlodipine had significantly higher SBP at diagnosis of hypertension (A: (median [25th, 75th percentile]) 182 [175,192] mmHg; B: 207 [194,217] mmHg, P < .001), but comparable blood pressure was achieved after treatment. Plasma amlodipine concentrations were directly related to the dose of amlodipine administered. At diagnosis, cats in group B had significantly lower plasma potassium concentration (A: 4.1 [3.8,4.5]; B: 3.8 [3.6,4.2] mEq/L, P < .01). Weight did not differ between groups. The decrease in SBP was directly and independently associated with the SBP at diagnosis and the plasma amlodipine concentration.Conclusions and Clinical ImportanceCats with higher blood pressure at diagnosis might require a greater dose of amlodipine to control their blood pressure adequately. Differences in amlodipine pharmacokinetics between cats do not seem to play a role in the antihypertensive response.

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Plasma Renin Activity and Aldosterone Concentrations in Hypertensive Cats with and without Azotemia and in Response to Treatment with Amlodipine Besylate

Cited by 47 publications

References 58 publications

Prognostic importance of plasma total magnesium in a cohort of cats with azotemic chronic kidney disease

Prognostic importance of plasma total magnesium in a cohort of cats with azotemic chronic kidney disease

Current Understanding of the Pathogenesis of Progressive Chronic Kidney Disease in Cats

Factors Influencing the Relationship Between the Dose of Amlodipine Required for Blood Pressure Control and Change in Blood Pressure in Hypertensive Cats

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