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Benazepril in cats with Chronic Kidney Disease

Clinical Scenario

Charlie is a 16 year old domestic shorthair cat that you have diagnosed with IRIS late stage II chronic kidney disease (CKD). He is not proteinuric and his blood pressure is normal. You have stabilised his azotaemia and he is eating the renal diet very well. You are new to the practice and it is practice policy to put all cats with CKD on benazepril. Charlie’s owner has limited finances but she wants to do what is right for Charlie and keep him for as long as possible. You wonder if benazepril will increase Charlie’s survival time...

3-Part Question (PICO)

In [cats with naturally occurring chronic kidney disease] does [benazepril compared to no benazepril] increase the [survival time] of affected cats?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR felis.mp. OR exp Cats/)

AND

(chronic renal failure.mp. OR chronic renal disease.mp. OR chronic renal insufficiency.mp. OR chronic kidney failure.mp. OR chronic kidney disease.mp. OR chronic kidney insufficiency.mp. OR exp Kidney Failure, Chronic/ OR exp Renal Insufficiency, Chronic/)

AND

(benazepril.mp. OR fortekor.mp. OR angiotensin converting enzyme inhibitor.mp. OR angiotensin converting enzyme inhibitors.mp. OR ACE inhibitor.mp. OR ACE inhibitors.mp. OR ACEi.mp. OR exp Angiotensin-Converting Enzyme Inhibitors/)

CAB Abstracts 1910 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR felis.mp. OR exp cats/)

AND

(chronic renal failure.mp. OR chronic renal disease.mp. OR chronic renal insufficiency.mp. OR chronic kidney insufficiency.mp. OR chronic kidney failure.mp. OR chronic kidney disease.mp. OR exp renal failure/ OR exp kidney disease/)

AND

(benazepril.mp. OR fortekor.mp. OR angiotensin converting enzyme inhibitor.mp. OR angiotensin converting enzyme inhibitors.mp. OR ACE inhibitor.mp. OR ACE inhibitors.mp. OR ACEi.mp.)

Search Outcome

MEDLINE

  • 18 papers found in MEDLINE search
  • 10 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 6 papers excluded as they are review articles/in vitro research/conference proceedings
  • 2 total relevant papers from MEDLINE

CAB Abstracts

  • 37 papers found in CAB search
  • 24 papers excluded as they don't meet the PICO question
  • 2 papers excluded as they are in a foreign language
  • 11 papers excluded as they are review articles/in vitro research/conference proceedings
  • 2 total relevant papers from CAB

Total relevant papers

2 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Mizutani et al. (2006) Japan.

Title:

Evaluation of the clinical efficacy of benazepril in the treatment of chronic renal insufficiency in cats.

Patient group:

Cats with chronic renal insufficiency, N= 61.

Study Type:

Randomised controlled trial

Outcomes:
  • Renal survival time to 180 days. The defined end point was deterioration that meant the cat required euthanasia/haemodialysis or death
  • Clinical condition
  • Appetite
  • Drinking behaviour
  • Quality of life
  • Plasma biochemistry
  • Complete blood count
  • Urinalysis including urine protein/urine creatinine ratio (UPC)
  • Adverse effects
Key Results:
  • There was no significant difference in survival to 180 days between groups (p=0.195).
  • One cat died in the benazepril group and three in the placebo group.
  • The UPC was significantly lower in the benazepril group compared with the placebo group at days 120 (p=0.034) and 180 (p=0.015).
  • There was a significant increase in UPC in the placebo group (p=0.015) but not in the benazepril group (p=0.69).
  • There was no significant difference in quality of life, appetite, vomiting or drinking between groups.
  • Three adverse events reported in the benazepril group and four in the placebo group.
Study Weaknesses:
  • Sample size was not justified/power calculation not done for all statistical tests.
  • Small sample size.
  • No p value for significance stated in methods.
  • Inclusion criteria were increased creatinine OR increased proteinuria AND low urine specific gravity. This may mean some cases were not azoteamic at enrolment and therefore in earlier stages of disease.
  • Basic data for both groups not given, so not possible to compare groups prior to or after interventions. However, it is stated in the results that cats were matched at baseline for clinical parameters.
  • Duration of clinical signs prior to enrolment not given.
  • Cats not allowed to be on renal prescription diets.
  • Clinical condition, appetite, and drinking behaviour scores not validated, published scales.
  • The methods for assessing quality of life were not given in enough detail to assess their validity.
  • Short treatment time – 6 months not that long.
Attachment:
No attachments.

King et al. (2006) USA

Title:

Tolerability and efficacy of benazepril in cats with chronic kidney disease.

Patient group:

Cats with chronic kidney disease, N=192

Study Type:

Randomised controlled trial

Outcomes:
  • Renal survival time median and mean, up to 3 years. The defined end point was either a need for parenteral fluid therapy or death/euthanasia because of renal failure.
  • Clinical examination findings
  • Plasma biochemistry
  • Complete blood count
  • Urinalysis
  • Quality of life
  • Appetite
  • Bodyweight
  • Adverse effects
Key Results:
  • There was no significant difference in renal survival time between groups (p=0.47).
  • Mean survival time in benazepril group was 637 +/- 480 days, and 520 +/- 323 days in the placebo group.
  • Median survival significantly better in benazepril group when compared to placebo if UPC >/=1 (n=13, p=0.037),
  • There was no significant difference in body weight (p=0.89), appetite (0.66) and quality of life (p=0.84) between groups during the treatment period.
  • 205 adverse events were reported in the benazepril group and 170 in the placebo group.
  • Compliance for medication was 96%.

 

Study Weaknesses:
  • Sample size was not justified/power calculation not done for all statistical tests.
  • Group size in subgroup analyses very small.
  • Duration of clinical signs prior to enrolment not given.
  • 96% of cats on renal prescription diet,  4% were not.
  • The methods for assessing quality of life, appetite and clinical status were not given in enough detail to assess their validity.
  • No details of the adverse events were given.
Attachment:
No attachments.

Comments

The duration and severity of renal disease in the cats in the groups was not given prior to intervention. The cats in the first trial were not allowed to be on a prescription diet whereas almost all were in the second trial. It is unknown if either trial was sufficiently powered for statistical significance to be relied upon. It is important to note that both studies looked at ‘renal survival’ (with similar definitions), not actual survival. These things make the results of the trials difficult to compare.

A third paper was identified that may also be of interest: King JN, Tasker S, Gunn-Moore DA, Strehlau G, BENRIC (benazepril in renal insufficiency in cats) Study Group (2007). Prognostic factors in cats with chronic kidney disease. Journal of Veterinary Internal Medicine 21: 906-916. This paper reported the same cats as King et al. (2006) and reported risk factors for survival of cats with chronic kidney disease.

Bottom line

The evidence would suggest that benazepril does not increase renal survival time in cats with chronic kidney disease.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Mizutani H, Koyama H, Watanabe T, Kitagawa H, Nakano M, Kajiwara K, King JN (2006) Evaluation of the clinical efficacy of benazepril in the treatment of chronic renal insufficiency in cats. Journal of Veterinary Internal Medicine 20: 1074-1079. 

 

King JN, Gunn-Moore DA, Tasker S, Gleadhill A, Strehlau G; Benazepril in Renal Insufficiency in Cats Study Group (2006) Tolerability and efficacy of benazepril in cats with chronic kidney disease. Journal of Veterinary Internal Medicine 20: 1054-1064.

About this BET

First author:
Rachel Dean
Second author:
Martin Downes
Institution:

CEVM, University of Nottingham

Search last performed:
2016-05-19 10:47:54
Original publication date:
2014-04-25 10:47:54
Last updated:
2016-05-19 10:47:54
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