Response and survival of dogs with proteinuria (UPC > 2.0) treated with angiotensin converting enzyme inhibitors

Abstract

AbstractBackgroundAngiotensin‐converting enzyme inhibitors (ACEi) are a recommended treatment for glomerular proteinuria. Frequency of response to ACEi and the association of achieving proposed urine protein‐to‐creatinine ratio (UPC) targets on survival is unknown.ObjectivesTo determine response rates to ACEi therapy and whether a positive response is associated with improved survival.AnimalsEighty‐five dogs with proteinuria (UPC > 2.0).MethodsRetrospective study including dogs (UPC > 2.0) prescribed an ACEi for treatment of proteinuria. Baseline creatinine, albumin, cholesterol, UPC, and systolic blood pressure were recorded, and cases reviewed to track UPC. Treatment response was defined as achieving a UPC of <0.5 or reduction of ≥50% from baseline within 3 months. Outcome data were collected to determine overall and 12‐month survival.ResultsThirty‐five (41%) dogs responded to ACEi treatment. Treatment response was statistically associated with both median survival time (664 days [95% confidence interval (CI): 459‐869] for responders compared to 177 [95% CI: 131‐223] for non‐responders) and 12‐month survival (79% responders alive compared to 28% non‐responders). Baseline azotemia or hypoalbuminemia were also associated with a worse prognosis, with odds ratios of death at 12 months of 5.34 (CI: 1.85‐17.32) and 4.51 (CI: 1.66‐13.14), respectively. In the 25 dogs with normal baseline creatinine and albumin, response to treatment was associated with 12‐month survival (92% responders alive compared to 54% non‐responders, P = .04).Conclusions and Clinical ImportanceWhen the UPC is >2.0, achieving recommended UPC targets within 3 months appears to be associated with a significant survival benefit. Response to treatment is still associated with survival benefit in dogs with less severe disease (no azotemia or hypoalbuminemia).