Telmisartan vs benazepril for feline proteinuria in chronic kidney disease — POSSIBLE

In proteinuric cats with chronic kidney disease, does telmisartan vs benazepril reduce urine protein:creatinine ratio more?

Shelf #247 · gate-verified and displayed under the developer's blinded-trial rule

POSSIBLE: Telmisartan is an effective antiproteinuric alternative to benazepril in cats with chronic kidney disease, on the strength of one large blinded randomised trial — but it has not been shown to lower proteinuria more than benazepril. In Sent 2015 (224 client-owned cats, prospective, multicenter, controlled, randomized, parallel group, blinded, noninferiority design), telmisartan 1 mg/kg once daily proved noninferior to benazepril 0.5–1.0 mg/kg once daily for control of proteinuria (CI, −0.035 to 0.268); at day 180 the urine protein-to-creatinine ratio had fallen significantly from baseline on telmisartan (−0.05 ± 0.31, P = .016) but not on benazepril (−0.02 ± 0.48, P = .136), a pattern seen at all assessment points. The claim on this shelf is proteinuria only — the trial reports no survival or kidney-progression comparison, no such claim is made, and this pack is therefore not Tier C (compare shelf #246, where benazepril vs placebo likewise supports a proteinuria claim only). Drafted Nov 10, 2026 (VetMed build, topic #247); all figures from abstracts fetched and verified at drafting.

Sent 2015: telmisartan proved noninferior to benazepril for proteinuria in 224 cats with CKD — and only telmisartan's fall from baseline was significant

Prospective, multicenter, controlled, randomized, parallel group, blinded clinical trial with noninferiority design (record's own wording)

Who: Cats: 224 client-owned adult cats with chronic kidney disease, in a prospective, multicenter, controlled, randomized, parallel group, blinded clinical trial with a noninferiority design — allocated 1:1 to telmisartan 1 mg/kg (n = 112) or benazepril 0.5–1.0 mg/kg (n = 112), each PO once daily. The primary endpoint was prospectively defined as the change in proteinuria (benazepril:telmisartan) based on a log transformed weighted average of urine protein-to-creatinine ratio (UP/C) change from baseline (AUC 0→t/t), compared using a confidence interval approach.

Result: Telmisartan proved noninferior to benazepril in controlling proteinuria (CI, −0.035 to 0.268). At day 180, UP/C compared with baseline in the telmisartan group was significantly lower (−0.05 ± 0.31; P = .016), whereas in the benazepril group the change (−0.02 ± 0.48) was not statistically significant (P = .136). Similar results were obtained at all assessment points, with a significant decrease in UP/C occurring with telmisartan but not benazepril. Both telmisartan and benazepril were well tolerated and safe.

Watch out: Noninferior is not superior: the trial was designed and analysed to show telmisartan is not worse than benazepril by more than the prespecified margin, and the significant-versus-not-significant contrast is a within-group comparison against each group's own baseline, not a head-to-head P value for the difference between drugs. The endpoint is proteinuria (UP/C), a laboratory measure — the record reports no survival, kidney-progression or clinical-outcome comparison, and none is claimed on this shelf. This is the neighbouring question to shelf #246 (benazepril vs placebo in feline CKD), not a duplicate of it.

Sent U, Gössl R, Elliott J, Syme HM, Zimmering T. Comparison of Efficacy of Long-term Oral Treatment with Telmisartan and Benazepril in Cats with Chronic Kidney Disease. J Vet Intern Med. 2015;29(6):1479-87. PMID: 26474314. Registry ID: none in the record. MeSH: Angiotensin II Type 1 Receptor Blockers · Angiotensin-Converting Enzyme Inhibitors · Animals · Benzazepines · Benzimidazoles · Benzoates · Cat Diseases · Cats · Drug Administration Schedule · Female · Male · Renal Insufficiency, Chronic · Telmisartan

Synthesis: one large blinded noninferiority trial — telmisartan is a proven alternative to benazepril for feline proteinuria, not a proven better one

Synthesis

Who: Synthesis of the card above: Sent 2015 (prospective, multicenter, controlled, randomized, parallel group, blinded noninferiority trial; 224 client-owned cats with chronic kidney disease, 112 per group).

Result: The trial answers the question it was built for: at 1 mg/kg once daily, telmisartan controls proteinuria in cats with chronic kidney disease at least as well as benazepril 0.5–1.0 mg/kg once daily (noninferiority CI −0.035 to 0.268), and proteinuria fell significantly from baseline on telmisartan at every assessment point (day 180: −0.05 ± 0.31, P = .016) while the benazepril fall did not reach significance (−0.02 ± 0.48, P = .136). A single trial, an active comparator, and a laboratory endpoint are why this shelf is POSSIBLE rather than higher: the evidence is moderate and direct for proteinuria, and silent on whether either drug changes the course of kidney disease in this head-to-head comparison.

Watch out: Both drugs were well tolerated in the trial. Whether to prefer the angiotensin receptor blocker or the ACE inhibitor for an individual proteinuric cat — for example a cat that is also hypertensive (shelf #248 covers telmisartan for feline hypertension) — is a clinical judgement this single proteinuria trial does not settle.

Synthesis of Sent U et al. PMID: 26474314. Registry ID as on the individual card.

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