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

Background: Angiotensin‐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. Objectives: To determine response rates to ACEi therapy and whether a positive response is associated with improved survival. Animals: Eighty‐five dogs with proteinuria (UPC > 2.0). Methods: Retrospective 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. Results: Thirty‐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 Importance: When 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). [ABSTRACT FROM AUTHOR]