Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats

Abstract

Objective-To determine whether a renal diet modified in protein, phosphorus, sodium, and lipid content was superior to an adult maintenance diet in minimizing uremic episodes and mortality rate in cats with stage 2 or 3 chronic kidney disease (CKD). Design-Double-masked, randomized, controlled clinical trial. Animals-45 client-owned cats with spontaneous stage 2 or 3 CKD. Procedures-Cats were randomly assigned to an adult maintenance diet (n = 23 cats) or a renal diet (22) and evaluated trimonthly for up to 24 months. Efficacy of the renal diet, compared with the maintenance diet, in minimizing uremia, renal-related deaths, and all causes of death was evaluated. Results-Serum urea nitrogen concentrations were significantly lower and blood bicarbonate concentrations were significantly higher in the renal diet group at baseline and during the 12- and 24-month intervals. Significant differences were not detected in body weight; Hct; urine protein-to-creatinine ratio; and serum creatinine, potassium, calcium, and parathyroid hormone concentrations. A significantly greater percentage of cats fed the maintenance diet had uremic episodes (26%), compared with cats fed the renal diet (0%). A significant reduction in renal-related deaths but not all causes of death was detected in cats fed the renal diet. Conclusions and Clinical Relevance-The renal diet evaluated in this study was superior to an adult maintenance diet in minimizing uremic episodes and renalrelated deaths in cats with spontaneous stage 2 or 3 CKD.

Current Understanding of the Pathogenesis of Progressive Chronic Kidney Disease in Cats

“…[115][116][117] Perhaps the most convincing evidence that there is likely to be a role for phosphorus homeostasis in the progression of CKD comes from the studies that have demonstrated improved survival in those cats that are fed a phosphate restricted diet with evidence of modulation of these important regulatory hormones. 114,190,191 …”

Evaluation of the Effects of a Therapeutic Renal Diet to Control Proteinuria in Proteinuric Non‐Azotemic Dogs Treated with Benazepril

“…Protein restriction is a common dietary modification in therapeutic RDs,22, 23, 24, 25 and can reduce proteinuria in dogs with glomerulopathies 20. However, if protein restriction is too severe (1.83 g of protein/100 kcal of digestible energy), protein malnutrition can occur 20.…”

“…Compared to maintenance diets (MDs), therapeutic RDs may be modified in some or all of the following ways: reducing protein, phosphorus, and sodium content; increasing B‐vitamin content, caloric density, and soluble fiber; a neutral effect on acid‐base balance; supplementing with omega‐3 PUFAs and potassium (feline diets); and adding antioxidants 22, 23. These diets reduce the incidence of uremic crisis and mortality in dogs and cats with azotemic CKD compared with MDs 24, 25. Although RDs have been used in the management dogs with proteinuria,13, 19, 20 their possible benefits in the control of proteinuria in non‐azotemic dogs are unknown.…”

Staging and management of feline chronic renal insufficiency

“…Είναι γενικά παραδεκτό ότι τον ακρογωνιαίο λί θο στην αντιμετώπιση της ΧΝΑ αποτελεί η λήψη ειδι κών διαιτητικών μέτρων (Adams et al 1993, Elliott et al 2000, Elliott 2006, Ross et al 2006a, Ross et al 2006b, Plotnick 2007, αν και ορισμένες σχετικές με λέτες καταλήγουν σε αντιφατικά αποτελέσματα (Adams et al 1994, Fineo et al 1998. Η μειωμένη πε ριεκτικότητα της τροφής σε πρωτεΐνες που πρέπει να έχουν υψηλή βιολογική αξία αποτελεί τον κΰριο στόχο της διαιτητικής αγωγής (Adams et al 1993, Elliott et al 2000, Polzin et al 2000, Elliott 2006, Ross et al 2006a, Plotnick 2007.…”

“…Λέξεις ευρετηρίασης: χρόνια νεφρική ανεπάρκεια, σταδιοποίηση, θεραπεία, γάτα ΕΙΣΑΓΩΓΗ Η χρόνια νεφρική ανεπάρκεια (ΧΝΑ) της γάτας προσβάλλει κυρίως μεσήλικα και υπερήλικα ζώα και χαρακτηρίζεται από μη αναστρέψιμες βλάβες στους νεφρούς, με επακόλουθο την αδυναμία τους να απεκκρίνουν τα κατάλοιπα του μεταβολισμού, να εκ κρίνουν και να ανταποκρίνονται στη δράση διαφόρων ορμονών, καθώς και να ρυθμίζουν το ισοζύγιο του νε ροΰ, τη συγκέντρωση ορισμένων ηλεκτρολυτών και την οξεοβασική ισορροπία (Lees 2004, Ross et al 2006a, Ross et al 2006b, Glassock 2008. Για την πρό κληση της ενοχοποιούνται διάφορες αιτίες, αν και στα περισσότερα περιστατικά η αιτιολογία της παραμένει αδιευκρίνιστη (Sturgess 2003, Ross et al 2006a.…”