猫慢性肾病中低剂量美洛昔康的效果。
Effects of low-dose meloxicam in cats with chronic kidney disease.
机构信息
Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA.
Blue Pearl Veterinary Partners, Tacoma, WA, USA.
出版信息
J Feline Med Surg. 2021 Feb;23(2):138-148. doi: 10.1177/1098612X20935750. Epub 2020 Jun 29.
OBJECTIVES
Meloxicam therapy may benefit cats with degenerative joint disease, and retrospective studies suggest it could slow kidney disease progression and increase survival. This study aimed to prospectively evaluate the renal effects of low-dose meloxicam treatment (0.02 mg/kg/day) over 6 months in cats with chronic kidney disease (CKD).
METHODS
Twenty-one cats with stable International Renal Interest Society stage 2 or 3 CKD were recruited and randomized to placebo or meloxicam groups. Cats were evaluated at baseline and at 1, 3 and 6 months, including blood pressure, chemistry, symmetric dimethylarginine (SDMA), glomerular filtration rate (GFR), urinalysis, urine protein:creatinine ratio (UPC), urine transforming growth factor-beta (β):creatinine ratio, urine clusterin, urine cystatin B and serum inosine.
RESULTS
No statistical difference was observed in systolic blood pressure, blood urea nitrogen, creatinine, SDMA, GFR, urine transforming growth factor-β:creatinine ratio, urine clusterin, urine cystatin B or serum inosine in cats receiving meloxicam vs placebo. Mean UPC was greater in the meloxicam group (0.33) than the placebo group (0.1) at 6 months ( = 0.006). Four cats had meloxicam discontinued owing to potential (mainly gastrointestinal) adverse effects.
CONCLUSIONS AND RELEVANCE
No decline in renal excretory function was observed when meloxicam was administered to cats with CKD. However, gastrointestinal adverse effects were observed, and cats that received meloxicam had greater proteinuria at 6 months than cats that received placebo. As proteinuria is associated with negative outcomes (progression of azotemia and hypertension) in cats with CKD, this finding suggests that meloxicam should be used with caution in cats with CKD and UPC monitored. Until further research is available, clinicians should weigh the risk of potential increased proteinuria against quality of life benefits when considering meloxicam for analgesia in cats with renal disease.
目的
美洛昔康治疗可能有益于退行性关节疾病的猫，并回顾性研究表明其可减缓肾脏病进展并提高生存率。本研究旨在前瞻性评估小剂量美洛昔康（0.02mg/kg/天）治疗 6 个月对慢性肾脏病（CKD）猫的肾脏影响。
方法
招募了 21 只患有稳定的国际肾脏病学会（ISN）2 期或 3 期 CKD 的猫，并将其随机分配到安慰剂或美洛昔康组。在基线和 1、3 和 6 个月时对猫进行评估，包括血压、生化、对称二甲基精氨酸（SDMA）、肾小球滤过率（GFR）、尿液分析、尿蛋白/肌酐比值（UPC）、尿转化生长因子-β（β）：肌酐比值、尿聚类素、尿胱抑素 B 和血清肌苷。
结果
接受美洛昔康治疗的猫与接受安慰剂的猫相比，收缩压、血尿素氮、肌酐、SDMA、GFR、尿转化生长因子-β：肌酐比值、尿聚类素、尿胱抑素 B 或血清肌苷均无统计学差异。6 个月时，美洛昔康组的平均 UPC（0.33）高于安慰剂组（0.1）（=0.006）。由于潜在的（主要是胃肠道）不良反应，4 只猫停止使用美洛昔康。
结论和相关性
在 CKD 猫中给予美洛昔康时，未观察到肾脏排泄功能下降。然而，观察到胃肠道不良反应，接受美洛昔康的猫在 6 个月时的蛋白尿多于接受安慰剂的猫。由于蛋白尿与 CKD 猫的氮血症和高血压进展的不良预后相关，因此这一发现表明，在 CKD 猫中使用美洛昔康时应谨慎，并监测 UPC。在进一步研究可用之前，临床医生在考虑使用美洛昔康治疗患有肾脏疾病的猫的镇痛时，应权衡潜在增加蛋白尿的风险与生活质量获益。
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