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Adin D, Atkins C, Domenig O, Glahn C, DeFrancesco T, Meurs K. Evaluation of Renin-Angiotensin-Aldosterone System Components and Enzymes in Systemically Hypertensive Cats Receiving Amlodipine. Animals (Basel) 2023; 13:3479. [PMID: 38003097 PMCID: PMC10668637 DOI: 10.3390/ani13223479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/23/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Chronic renin-angiotensin-aldosterone system (RAAS) activation is harmful. Amlodipine activates RAAS in humans and dogs, but contradictory data exist for systemically hypertensive (SHT) cats. HYPOTHESIS Cats with SHT and chronic kidney disease treated with amlodipine (SHT/CKD-A) are RAAS activated. ANIMALS Client-owned cats: unmedicated normotensive (NT) cats (n = 9); SHT/CKD-A cats (n = 5) with median systolic blood pressure of 170 mmHg (vs. 195 mmHg, pre-treatment), chronic kidney disease, and receiving no RAAS-suppressive therapy. METHODS Serum was frozen (-80 °C) until RAAS analysis via equilibrium analysis. The RAAS variables (reported as median (minimum-maximum)) were compared between groups, using Mann-Whitney U test. RESULTS Angiotensin 1, angiotensin 1,7, angiotensin III, and angiotensin 1,5, and angiotensin-converting enzyme (ACE)-2 activity were higher in SHT/CKD-A cats compared to NT cats, while ACE activity was lower in SHT/CKD-A cats compared to NT cats (p < 0.05 all). A marker for alternative RAAS influence (ALT-S) was significantly higher (69; 58-73 pmol/pmol) in SHT/CKD-A cats compared to NT cats (35; 14-63 pmol/pmol; p = 0.001). Aldosterone concentrations were significantly higher (393; 137-564 pmol/L) in SHT/CKD-A cats compared to NT cats (129; 28-206 pmol/L; p = 0.007). CONCLUSION AND CLINICAL IMPORTANCE Circulating RAAS is activated in systemically hypertensive cats receiving amlodipine. Although this study did not parse out the individual contributions of SHT, chronic kidney disease, and amlodipine, the findings suggest that the use of concurrent RAAS-suppressant therapy, specifically aldosterone antagonism, in amlodipine-treated SHT cats with chronic kidney disease might be indicated.
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Affiliation(s)
- Darcy Adin
- College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Clarke Atkins
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA (K.M.)
| | | | | | - Teresa DeFrancesco
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA (K.M.)
| | - Kathryn Meurs
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA (K.M.)
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Brethel S, Locker S, Girens R, Rivera P, Meurs K, Adin D. The effect of taurine supplementation on the renin-angiotensin-aldosterone system of dogs with congestive heart failure. Sci Rep 2023; 13:10700. [PMID: 37400490 DOI: 10.1038/s41598-023-37978-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/30/2023] [Indexed: 07/05/2023] Open
Abstract
The role of taurine in the treatment of congestive heart failure (CHF) in dogs without systemic deficiency is unexplored. Taurine might have beneficial cardiac effects aside from deficit replacement. We hypothesized that oral taurine supplementation administered to dogs with naturally-occurring CHF would suppress the renin-angiotensin aldosterone system (RAAS). Oral taurine was administered to 14 dogs with stable CHF. Serum biochemical variables, blood taurine concentrations, and comprehensive analysis of RAAS variables were compared before and 2 weeks after taurine supplementation added to background furosemide and pimobendan therapy for CHF. Whole blood taurine concentrations increased after supplementation (median 408 nMol/mL, range 248-608 before and median 493 nMol/mL, range 396-690 after; P = .006). Aldosterone to angiotensin II ratio (AA2) was significantly decreased after taurine supplementation (median 1.00, range 0.03-7.05 before and median 0.65, range 0.01-3.63 after; P = .009), but no other RAAS components significantly differed between timepoints. A subset of dogs showed marked decreases in RAAS metabolites after supplementation and these dogs were more likely to have been recently hospitalized for CHF treatment than dogs that did not show marked decreases in classical RAAS metabolites. Overall, taurine only lowered AA2 in this group of dogs, however, response heterogeneity was noted, with some dogs showing RAAS suppression.
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Affiliation(s)
- Sara Brethel
- College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
- Charlotte Animal Referral and Emergency, Charlotte, NC, USA
| | - Seth Locker
- College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Renee Girens
- College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
- Summit Veterinary Referral Center, Tacoma, WA, USA
| | - Paulo Rivera
- College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Kathryn Meurs
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Darcy Adin
- College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
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Adin DB, Hernandez JA. Influence of sex on renin-angiotensin-aldosterone system metabolites and enzymes in Doberman Pinschers. J Vet Intern Med 2022; 37:22-27. [PMID: 36412252 PMCID: PMC9889697 DOI: 10.1111/jvim.16589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Estrogen modulates the renin-angiotensin-aldosterone system (RAAS) in women, but sex differences have not been fully explored in dogs. OBJECTIVE We hypothesized that the RAAS profile of intact female (IF) Doberman Pinschers (DP) would differ from spayed female (SF) and intact male (IM) DP. ANIMALS Eighteen healthy DP (6 IF, 6 SF, 6 IM). METHODS Absolute and indexed RAAS metabolites, angiotensin-converting enzyme (ACE) and ACE2 activities, and genotypes (pyruvate kinase dehydrogenase 4, titin, and ACE variants) were compared among sex groups using Kruskal-Wallis or chi-square tests, and linear regression controlling for age. Data are expressed as median (minimum, maximum) and P < .05 was considered significant. RESULTS The ACE activity was higher in IF DP (656 pmol/L; 436, 784) compared to SF DP (411 pmol/L; 287, 451; P = .01) and IM DP (365 pmol/L; 276, 1200; P = .04) after controlling for age. Angiotensin II, angiotensin I, and plasma renin activity marker (PRA-S) were higher in IF DP compared to SF DP, but not significantly (P ≤ .25). After controlling for age, angiotensin 1-7/angiotensin I was lower in IF DP compared to SF DP (P = .01). Genotypes did not differ among groups. Most DP (94%) were ACE variant positive. CONCLUSIONS AND CLINICAL SIGNIFICANCE Sex and reproductive status influenced the RAAS of DP, with IF DP showing genotype-independent higher ACE activity. These findings hold implications for sterilization practices in female dogs, and support sex and reproductive status as a source of variability in RAAS studies. Additionally, the frequency of the ACE gene variant was very high in this group of DP.
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Affiliation(s)
- Darcy B. Adin
- Department of Small Animal Clinical SciencesUniversity of Florida, College of Veterinary MedicineGainesvilleFloridaUSA
| | - Jorge A. Hernandez
- Department of Small Animal Clinical SciencesUniversity of Florida, College of Veterinary MedicineGainesvilleFloridaUSA
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Oyama MA, Adin D. Toward quantification of loop diuretic responsiveness for congestive heart failure. J Vet Intern Med 2022; 37:12-21. [PMID: 36408832 PMCID: PMC9889629 DOI: 10.1111/jvim.16590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
Diuretics, such as furosemide, are routinely administered to dogs with congestive heart failure (CHF). Traditionally, dose and determination of efficacy primarily are based on clinical signs rather than quantitative measures of drug action. Treatment of human CHF patients increasingly is guided by quantification of urine sodium concentration (uNa) and urine volume after diuretic administration. Use of these and other measures of diuretic responsiveness is associated with decreased duration of hospitalization, complication rates, future rehospitalization, and mortality. At their core, loop diuretics act through natriuresis, and attention to body sodium (Na) stores and handling offers insight into the pathophysiology of CHF and pharmacology of diuretics beyond what is achievable from clinical signs alone. Human patients with low diuretic responsiveness or diuretic resistance are at risk for difficult or incomplete decongestion that requires diuretic intensification or other remedial strategies. Identification of the specific etiology of resistance in a patient can help tailor personalized interventions. In this review, we advance the concept of loop diuretic responsiveness by highlighting Na and natriuresis. Specifically, we review body water homeostasis and congestion in light of the increasingly recognized role of interstitial Na, propose definitions for diuretic responsiveness and resistance in veterinary subjects, review relevant findings of recent studies, explain how the particular cause of resistance can guide treatment, and identify current knowledge gaps. We believe that a quantitative approach to loop diuretic usage primarily involving natriuresis will advance our understanding and care of dogs with CHF.
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Affiliation(s)
- Mark A. Oyama
- Clinical Sciences and Advanced MedicineUniversity of Pennsylvania, MJR‐VHUP‐CardiologyPhiladelphiaPennsylvaniaUSA
| | - Darcy Adin
- Large Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
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Ames MK, Vaden SL, Atkins CE, Palerme J, Langston CE, Grauer GF, Shropshire S, Bove C, Webb T. Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease. J Vet Intern Med 2022; 36:2088-2097. [DOI: 10.1111/jvim.16573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marisa K. Ames
- Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USA
| | - Shelly L. Vaden
- Department of Clinical Sciences North Carolina State University College of Veterinary Medicine Raleigh North Carolina USA
| | - Clarke E. Atkins
- Department of Clinical Sciences North Carolina State University College of Veterinary Medicine Raleigh North Carolina USA
| | - Jean‐Sebastien Palerme
- Department of Veterinary Clinical Sciences Iowa State University College of Veterinary Medicine Ames Iowa USA
| | - Catherine E. Langston
- Department of Veterinary Clinical Sciences The Ohio State University College of Veterinary Medicine Columbus Ohio USA
| | - Gregory F. Grauer
- Department of Clinical Sciences Kansas State University College of Veterinary Medicine Manhattan Kansas USA
| | - Sarah Shropshire
- Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USA
| | - Christina Bove
- Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USA
| | - Tracy Webb
- Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USA
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Giorgi ME, Mochel JP, Yuan L, Adin DB, Ward JL. Retrospective evaluation of risk factors for development of kidney injury after parenteral furosemide treatment of left-sided congestive heart failure in dogs. J Vet Intern Med 2022; 36:2042-2052. [PMID: 36254646 DOI: 10.1111/jvim.16571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 10/07/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Kidney injury (KI) has been documented in dogs treated with furosemide for left-sided congestive heart failure (CHF). HYPOTHESIS/OBJECTIVES Determine risk factors for development of KI in furosemide-treated dogs and determine the effect of KI on survival. ANIMALS Seventy-nine client-owned dogs receiving parenteral furosemide for CHF. METHODS Serum creatinine (sCr) and electrolyte concentrations were determined during hospitalization and at first outpatient reevaluation to detect and stage KI (increase in sCr ≥0.3 mg/dL). Furosemide dosage administered between timepoints was calculated. Multivariable modeling was performed to identify predictors of KI and percent change in serum biochemistry results over time. RESULTS Kidney injury was identified in 38/79 (48%) dogs and mostly occurred during hospitalization. Kidney injury was Grade I in 25 dogs, Grade II in 9 dogs, and Grade III in 4 dogs. Higher blood pressure was associated with acute KI during hospitalization (odds ratio, 1.03; 95% confidence interval [95% CI] 1.01-1.07; P = .03) whereas PO furosemide dosage was associated with KI after hospital discharge (odds ratio, 7.77; 95% CI, 2.05-68.6; P = .02). Baseline sCr and use of a furosemide continuous rate infusion were not associated with increased risk of KI. Kidney injury was not associated with long-term outcome. Of 13 dogs with Grade II-III KI, azotemia was reversible in 9 dogs, and 6 dogs survived >1 year after KI. CONCLUSIONS AND CLINICAL IMPORTANCE In this cohort of dogs receiving parenteral furosemide for CHF, KI was common, mostly nonazotemic (Grade I), and did not impact survival.
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Affiliation(s)
- Maria E Giorgi
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jonathan P Mochel
- Department of Biomedical Sciences, SMART Pharmacology, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Lingnan Yuan
- Department of Biomedical Sciences, SMART Pharmacology, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Darcy B Adin
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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Roche-Catholy M, Paepe D, Devreese M, Broeckx BJG, Woehrlé F, Schneider M, de Salazar Alcala AG, Hellemans A, Smets P. Pharmacokinetic and pharmacodynamic properties of orally administered torasemide in healthy cats. Vet Med (Auckl) 2022; 36:1782-1791. [PMID: 35906901 PMCID: PMC9511087 DOI: 10.1111/jvim.16500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In people and dogs, torasemide has higher bioavailability, longer half-life, and longer duration of action than equivalent doses of furosemide but data regarding pharmacological properties of torasemide in cats are limited. OBJECTIVE To assess pharmacokinetic and pharmacodynamic parameters of torasemide in healthy cats, and to investigate the effects of a single administration of torasemide on indicators of diuresis, plasma creatinine concentration, blood pressure, electrolyte concentrations and markers of the renin-angiotensin-aldosterone system (RAAS). ANIMALS Six clinically healthy adult European shorthair cats. METHODS Randomized 4-period crossover design with 3 groups and 4 treatments. Pharmacokinetic parameters were obtained using a noncompartmental analysis, and the clinically effective dose was assessed using a Hill model. RESULTS Mean absolute bioavailability was estimated at 88.1%. Mean total body clearance was 3.64 mL/h/kg and mean terminal half-life was 12.9 hours. Urine output significantly increased after torasemide administration (P < .001). The urine sodium : potassium ratio (uNa : uK) paralleled and was statistically correlated to urine output (P < .001). Administration of a single torasemide dose led to a significant dose-dependent increase in urine aldosterone : creatinine ratio (uAldo : C; P < .001) and a transient decrease in plasma potassium concentration (P < .001) but did not affect blood pressure or plasma creatinine concentration. CONCLUSIONS AND CLINICAL IMPORTANCE A single torasemide dose leads to a significant increase in diuresis and renin-angiotensin-aldosterone system (RAAS) activation in healthy cats, with high absolute bioavailability, and without clinically relevant adverse effects. Pharmacokinetic parameters indicate that once daily dosing of 0.27 mg/kg may be appropriate in a clinical setting.
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Affiliation(s)
- Marine Roche-Catholy
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Mathias Devreese
- Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bart J G Broeckx
- Laboratory of Animal Genetics, Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | | | | | | | - Arnaut Hellemans
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Pascale Smets
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Ward JL, Guillot E, Domenig O, Ware WA, Yuan L, Mochel JP. Circulating renin‐angiotensin‐aldosterone system activity in cats with systemic hypertension or cardiomyopathy. J Vet Intern Med 2022; 36:897-909. [PMID: 35285549 PMCID: PMC9151484 DOI: 10.1111/jvim.16401] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 12/22/2022] Open
Abstract
Background Activity of the circulating renin‐angiotensin‐aldosterone system (RAAS) has not been comprehensively characterized in cats with systemic hypertension (SH) or cardiomyopathy (CM), and the effects of furosemide or amlodipine treatment on the RAAS have not been fully evaluated in cats. Hypothesis/Objectives To document RAAS activity in cats with SH or CM compared to healthy cats and determine how RAAS profiles change with furosemide or amlodipine treatment. Animals Sixty‐six client‐owned cats: 15 with SH (7 amlodipine‐treated, 8 untreated), 17 with advanced CM (7 furosemide‐treated, 10 not furosemide‐treated), and 34 healthy cats. Methods Equilibrium concentrations of RAAS peptides and aldosterone were quantified in serum samples by liquid chromatography‐mass spectrometry. Variables were compared between groups using Kruskal‐Wallis analysis with post hoc Holms‐corrected Dunn's testing. Results Compared with healthy cats, cats with CM had higher concentrations of angiotensin I, aldosterone, and plasma renin activity (all P < .01), and these differences remained significant (P < .03) after considering subgroups of untreated or furosemide‐treated cats. Compared with healthy cats, untreated cats with SH showed no differences in RAAS biomarkers, whereas amlodipine‐treated cats had higher concentrations of angiotensins I, II, III, IV, and 1‐7, aldosterone, and plasma renin activity (all P < .03). Multivariable analysis determined that furosemide and amlodipine treatments were independent predictors of increased RAAS biomarker concentrations. Conclusions and Clinical Importance Cats with CM had increased RAAS activity, whereas cats with untreated SH did not. Furosemide and amlodipine both led to nonspecific activation of both classical and alternative RAAS pathways in cats.
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Affiliation(s)
- Jessica L. Ward
- Department of Veterinary Clinical Sciences College of Veterinary Medicine, Iowa State University Ames Iowa USA
| | - Emilie Guillot
- Ceva Santé Animale Companion Animal Franchise Libourne France
| | | | - Wendy A. Ware
- Department of Veterinary Clinical Sciences College of Veterinary Medicine, Iowa State University Ames Iowa USA
| | - Lingnan Yuan
- Department of Veterinary Biomedical Sciences, SMART Pharmacology College of Veterinary Medicine, Iowa State University Ames Iowa USA
| | - Jonathan P. Mochel
- Department of Veterinary Biomedical Sciences, SMART Pharmacology College of Veterinary Medicine, Iowa State University Ames Iowa USA
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Bagardi M, Zamboni V, Locatelli C, Galizzi A, Ghilardi S, Brambilla PG. Management of Chronic Congestive Heart Failure Caused by Myxomatous Mitral Valve Disease in Dogs: A Narrative Review from 1970 to 2020. Animals (Basel) 2022; 12:ani12020209. [PMID: 35049831 PMCID: PMC8773235 DOI: 10.3390/ani12020209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Myxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease in dogs. The progression of the disease and the increasing severity of valvular regurgitation cause a volume overload of the left heart, leading to left atrial and ventricular remodeling and congestive heart failure (CHF). The treatment of chronic CHF secondary to MMVD in dogs has not always been the same over time. In the last fifty years, the drugs utilized have considerably changed, as well as the therapeutic protocols. Some drugs have also changed their intended use. An analysis of the literature concerning the therapy of chronic heart failure in dogs affected by this widespread degenerative disease is not available; a synthesis of the published literature on this topic and a description of its current state of art are needed. To the authors’ knowledge, a review of this topic has never been published in veterinary medicine; therefore, the aim of this study is to overview the treatments of chronic CHF secondary to MMVD in dogs from 1970 to 2020 using the general framework of narrative reviews. Abstract The treatment of chronic congestive heart failure (CHF), secondary to myxomatous mitral valve disease (MMVD) in dogs, has considerably changed in the last fifty years. An analysis of the literature concerning the therapy of chronic CHF in dogs affected by MMVD is not available, and it is needed. Narrative reviews (NRs) are aimed at identifying and summarizing what has been previously published, avoiding duplications, and seeking new study areas that have not yet been addressed. The most accessible open-access databases, PubMed, Embase, and Google Scholar, were chosen, and the searching time frame was set in five decades, from 1970 to 2020. The 384 selected studies were classified into categories depending on the aim of the study, the population target, the pathogenesis of MMVD (natural/induced), and the resulting CHF. Over the years, the types of studies have increased considerably in veterinary medicine. In particular, there have been 43 (24.29%) clinical trials, 41 (23.16%) randomized controlled trials, 10 (5.65%) cross-over trials, 40 (22.60%) reviews, 5 (2.82%) comparative studies, 17 (9.60%) case-control studies, 2 (1.13%) cohort studies, 2 (1.13%) experimental studies, 2 (1.13%) questionnaires, 6 (3.40%) case-reports, 7 (3.95%) retrospective studies, and 2 (1.13%) guidelines. The experimental studies on dogs with an induced form of the disease were less numerous (49–27.68%) than the studies on dogs affected by spontaneous MMVD (128–72.32%). The therapy of chronic CHF in dogs has considerably changed in the last fifty years: in the last century, some of the currently prescribed drugs did not exist yet, while others had different indications.
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Cheng CJ, Mandour A, Yoshida T, Watari T, Tanaka R, Matsuura K. Changes in renin-angiotensin-aldosterone system during cardiac remodeling after mitral valvuloplasty in dogs. J Vet Intern Med 2022; 36:397-405. [PMID: 34994485 PMCID: PMC8965262 DOI: 10.1111/jvim.16346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Information regarding changes in renin-angiotensin-aldosterone system (RAAS) during cardiac remodeling after mitral valvuloplasty (MVP) in dogs remains lacking. HYPOTHESIS/OBJECTIVES To assess the longitudinal effects of MVP on circulating RAAS activity. ANIMALS Eight client-owned dogs receiving MVP for myxomatous mitral valve disease (MMVD). METHODS This is a cohort study. Plasma renin activity (PRA), angiotensin II (AT2), aldosterone (PAC), blood urea nitrogen (BUN), and creatinine concentrations, were measured in these dogs before (baseline) and at 3 consecutive monthly follow-ups (Post-1M, Post-2M, Post-3M). Echocardiography was concomitantly used to assess the process of cardiac recovery after MVP. RESULTS The echocardiography revealed a significant decrease in LVIDDN, LA/Ao, FS, E velocity, E/A, E' sep, S' lat, E' lat, and A' lat after MVP compared with baseline (P < .05). There was a significant reduction in the PRA (2.45, 3.05, 2.74 vs 8.8 ng/mL/h; P = .002), AT2 (466, 315, 235 vs 1200 pg/mL; P = .009), and PAC (39.88, 47, 54.62 vs 179.5 pg/mL; P = .01), respectively at Post-1M, Post-2M, Post-3M compared to the baseline. Additionally, BUN and creatinine concentrations decreased from Post-1M. The RAAS variables showed significant, weak to moderate, relationship with selected echocardiographic variables. CONCLUSIONS AND CLINICAL IMPORTANCE Mitral valvuloplasty contributes to decreased RAAS activity in MMVD dogs, which paralleled the process of cardiac reverse remodeling up to Post-3M. This information facilitates formulating strategies to optimize clinical outcomes for dogs after MVP.
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Affiliation(s)
- Chieh-Jen Cheng
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, Japan.,Laboratory of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan.,VCA Japan Shiraishi Animal Hospital, Sayama, Saitama, Japan
| | - Ahmed Mandour
- Laboratory of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan.,Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Tomohiko Yoshida
- Laboratory of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan.,VCA Japan Shiraishi Animal Hospital, Sayama, Saitama, Japan
| | - Toshihiro Watari
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, Japan
| | - Ryou Tanaka
- Laboratory of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Katsuhiro Matsuura
- Laboratory of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan.,VCA Japan Shiraishi Animal Hospital, Sayama, Saitama, Japan
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Larouche‐Lebel É, Loughran KA, Huh T, Oyama MA. Effect of angiotensin receptor blockers and angiotensin converting enzyme 2 on plasma equilibrium angiotensin peptide concentrations in dogs with heart disease. J Vet Intern Med 2021; 35:22-32. [PMID: 33368659 PMCID: PMC7848346 DOI: 10.1111/jvim.16025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The pathophysiology of heart failure involves maladaptive angiotensin peptides (APs) and enzymes, including angiotensin 2 (AT2) and angiotensin converting enzyme (ACE), as well as recently described alternative components, such as angiotensin 1-7 (Ang1-7) and angiotensin converting enzyme 2 (ACE2). The relative effects of different neurohormonal-targeting drugs on balance of APs in dogs with heart disease are unknown. HYPOTHESIS/OBJECTIVES Plasma AP concentrations differ in dogs receiving angiotensin converting enzyme inhibitors (ACEIs) vs angiotensin receptor blockers (ARBs) and recombinant human ACE2 (rhACE2) will further increase these differences. ANIMALS Eight dogs with degenerative mitral valve disease (DMVD). METHODS Prospective open-label trial. Equilibrium concentrations of APs from plasma during PO ACEI treatment and then after 14 days of PO ARB treatment using telmisartan were measured using liquid chromatography-tandem mass spectroscopy before and after in vitro incubation with rhACE2. RESULTS Concentration of Ang1-7 was increased during ARB treatment (Ang1-7: 443 pg/mL; 95% confidence interval [CI] = 247-794 pg/mL) vs ACEI (Ang1-7: 182 pg/mL; 95% CI = 66.2-503 pg/mL; P = .01). Incubation with rhACE2 decreased traditional APs while increasing beneficial alternative APs, and Ang1-7 was significantly higher in the ARB + rhACE2 (880 pg/mL; 95% CI = 560-1383 pg/mL) vs ACEI + rhACE2 (455 pg/mL; 95% CI = 188-1104 pg/mL; P = .03) group. The most favorable theoretical AP profile was achieved in the ARB + rhACE2 group. CONCLUSIONS AND CLINICAL IMPORTANCE The AP profile during telmisartan treatment is associated with higher plasma Ang1-7 as compared with during ACEI. This favorable shift is potentiated in vitro by combination of ARB + rhACE2. These data support potential AP-targeting strategies and drugs in dogs with DMVD.
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Affiliation(s)
- Éva Larouche‐Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kerry A. Loughran
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Terry Huh
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Mark A. Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Institute for Translational Medicine and Therapeutics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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12
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Loughran KA, Larouche-Lebel É, Huh T, Testani JM, Rao VS, Oyama MA. Prediction and measurement of diuretic responsiveness after oral administration of furosemide to healthy dogs and dogs with congestive heart failure. J Vet Intern Med 2020; 34:2253-2264. [PMID: 33125814 PMCID: PMC7694836 DOI: 10.1111/jvim.15952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
Background In human patients, cumulative urine volume (uVol) and urine sodium (uNa) can be predicted using spot urine samples and these quantitative measures help detect low diuretic responsiveness (LDR). Hypothesis/objectives Formulas using spot urine samples predict cumulative uVol and uNa output after oral administration of furosemide to dogs. Animals Eight healthy dogs, 6 dogs with congestive heart failure (CHF). Methods Prospective interventional study. Spot urine samples at 180 and 270 minutes after furosemide (3 mg/kg PO) were used to predict cumulative uVol and uNa output over 7 hours. Differentiation of dogs fulfilling predefined criteria for LDR was examined using receiver operating characteristic (ROC) curves. Results Predicted uNa output at 180 minutes (rs = 0.763, [95% confidence interval [CI], 0.375‐0.923], P = .002) and 270 minutes (r = 0.816, [95% CI, 0.503‐0.940], P < .001) was highly correlated to 7‐hour uNa output. Predicted uVol at 180 minutes (r = 0.598, [95% CI, 0.098‐0.857], P = .02) and 270 minutes (r = 0.791, [95% CI, 0.450‐0.931], P < .001) was moderately correlated to 7‐hour uVol. Predicted uNa using 180‐minute (area under the curve [AUC], 0.933 [95% CI, 0.804‐1.000]) and 270‐minute (AUC, 0.911 [95% CI, 0.756‐1.000]) samples identified dogs with LDR (n = 5) with high accuracy. Conclusions and Clinical Importance Urinary Na excretion and uVol are complementary but distinct aspects of diuretic responsiveness in dogs. Quantification of diuretic responsiveness in the clinical setting opens new diagnostic, treatment, and monitoring strategies.
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Affiliation(s)
- Kerry A Loughran
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Éva Larouche-Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Terry Huh
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey M Testani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Veena S Rao
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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The gut microbiome in dogs with congestive heart failure: a pilot study. Sci Rep 2020; 10:13777. [PMID: 32792610 PMCID: PMC7426839 DOI: 10.1038/s41598-020-70826-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Compromised gut health and dysbiosis in people with heart failure has received a great deal of attention over the last decade. Whether dogs with heart failure have a similar dysbiosis pattern to what is described in people is currently unknown. We hypothesised that dogs with congestive heart failure have quantifiable dysbiosis compared to healthy dogs that are similar in sex and age. A total of 50 dogs (15 healthy dogs and 35 dogs with congestive heart failure) were prospectively recruited, and their faecal gut microbiome was assessed using 16S rRNA sequencing (Illumina MiSeq platform). There was no significant change in the microbial diversity and richness in dogs with congestive heart failure. However, there was an increase in abundance of Proteobacteria in the congestive heart failure group (p = 0.014), particularly due to an increase in the family Enterobacteriaceae (p = 0.002) and Escherichia coli (p = 0.033). We conclude that dogs with congestive heart failure have dysbiosis, and we show additional trends in our data suggesting that dogs may have a similar pattern to that described in people. The results of this study provide useful preliminary information and raise the possibility that dogs represent a clinically relevant animal model of dysbiosis in people with heart failure.
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Segar JL. Rethinking furosemide use for infants with bronchopulmonary dysplasia. Pediatr Pulmonol 2020; 55:1100-1103. [PMID: 32176837 DOI: 10.1002/ppul.24722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/01/2020] [Indexed: 12/27/2022]
Abstract
Diuretics are commonly administered to infants with bronchopulmonary dysplasia (BPD) to improve respiratory function despite the absence of prospective data demonstrating long term benefits. While many potentially adverse effects of furosemide are known to clinicians, its direct and indirect impact on multiple pathophysiological processes need to be understood. While furosemide likely has a role in the management of infants with BPD, clinicians are encouraged to recognize these potential complications associated with furosemide administration. Specifically, a deeper understanding of the impact of diuretics on sodium metabolism neurohumoral regulation of cardiopulmonary physiology is required.
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Affiliation(s)
- Jeffrey L Segar
- Division of Neonatology, Departments of Pediatrics and Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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15
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Dai X, Chen J, Li W, Bai Z, Li X, Wang J, Li Y. Association Between Furosemide Exposure and Clinical Outcomes in a Retrospective Cohort of Critically Ill Children. Front Pediatr 2020; 8:589124. [PMID: 33585362 PMCID: PMC7874070 DOI: 10.3389/fped.2020.589124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022] Open
Abstract
Furosemide is commonly prescribed in critically ill patients to increase the urine output and prevent fluid overload (FO) and acute kidney injury (AKI), but not supported by conclusive evidence. There remain conflicting findings on whether furosemide associates with AKI and adverse outcomes. Information on the impact of furosemide on adverse outcomes in a general population of pediatric intensive care unit (PICU) is limited. The aim of the cohort study was to investigate the associations of furosemide with AKI and clinical outcomes in critically ill children. Study Design: We retrospectively reviewed a cohort of 456 critically ill children consecutively admitted to PICU from January to December 2016. The exposure of interest was the use of furosemide in the first week after admission. FO was defined as ≥5% of daily fluid accumulation, and mean FO was considered significant when mean daily fluid accumulation during the first week was ≥5%. The primary outcomes were AKI in the first week after admission and mortality during PICU stay. AKI diagnosis was based on Kidney Disease: Improving Global Outcomes criteria with both serum creatinine and urine output. Results: Furosemide exposure occurred in 43.4% of all patients (n = 456) and 49.3% of those who developed FO (n = 150) in the first week after admission. Patients who were exposed to furosemide had significantly less degree of mean daily fluid accumulation than those who were not (1.10 [-0.33 to 2.61%] vs. 2.00 [0.54-3.70%], P < 0.001). There was no difference in the occurrence of AKI between patients who did and did not receive furosemide (22 of 198 [11.1%] vs. 36 of 258 [14.0%], P = 0.397). The mortality rate was 15.4% (70 of 456), and death occurred more frequently among patients who received furosemide than among those who did not (21.7 vs. 10.5%, P = 0.002). Furosemide exposure was associated with increased odds for mortality in a multivariate logistic regression model adjusted for body weight, gender, illness severity assessed by PRISM III score, the presence of mean FO, and AKI stage [adjusted odds ratio (AOR) 1.95; 95%CI, 1.08-3.52; P = 0.026]. Conclusion: Exposure to furosemide might be associated with increased risk for mortality, but not AKI, in critically ill children.
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Affiliation(s)
- Xiaomei Dai
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China
| | - Jiao Chen
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Wenjing Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China
| | - Zhenjiang Bai
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Xiaozhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China
| | - Jian Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Yanhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China.,Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
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