Plasma erythropoietin concentrations in dogs and cats: reference values and changes with anaemia and/or chronic renal failure

BackgroundFibroblast growth factor‐23 (FGF‐23) and parathyroid hormone (PTH) are commonly increased in cats with azotemic chronic kidney disease (CKD). Both are predictors of survival time in human patients, but these relationships have not previously been examined in the cat.ObjectivesTo investigate the relationship between plasma FGF‐23 and PTH concentrations at diagnosis of CKD in cats with survival time and with disease progression over 12 months.Animals214 azotemic, client‐owned cats (≥9 years).Methods Retrospective study: Biochemical and urinary variables at diagnosis of azotemic CKD, including plasma FGF‐23 and PTH concentrations were assessed as predictors of survival time (all‐cause mortality) using Cox regression, and as predictors of CKD progression over 12 months using logistic regression.ResultsIn the final multivariable Cox regression model, survival was negatively associated with plasma creatinine (P = .002) and FGF‐23 concentrations (P = .014), urine protein‐to‐creatinine ratio (P < .001) and age (P < .001). Survival was positively associated with PCV (P = .004). In the final multivariable logistic regression model, independent predictors of CKD progression included logFGF‐23 and age. Neither plasma phosphate nor PTH was found to be an independent predictor of survival time or of CKD progression.Conclusions and Clinical ImportancePlasma FGF‐23 concentration is a novel prognostic indicator in cats with CKD, independent of other factors including plasma creatinine and phosphate concentrations. Further work is required to assess if FGF‐23 contributes directly to CKD progression, but regardless these findings may make FGF‐23 a useful biomarker for predicting poorer outcomes in cats with CKD.

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 96%

Relationship between Plasma Fibroblast Growth Factor‐23 Concentration and Survival Time in Cats with Chronic Kidney Disease

Geddes

Elliott

Syme

2015

“…The anemia of CKD is believed to be multifactorial. A reduction or relative deficiency in erythropoietin production is considered the main cause because erythropoietin is produced by peritubular fibroblasts . In human patients, gastrointestinal blood loss, anemia of inflammatory disease, and hemolysis due to uremic toxins also are believed to be etiological factors.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Variables Predicting Progression of Azotemia in Cats with Chronic Kidney Disease

Chakrabarti

Syme

Elliott

2012

143

170

Background: Chronic kidney disease (CKD) is common in geriatric cats, but often appears to be stable for long periods of time.Objectives: To describe CKD progression and identify risk factors for progression in newly diagnosed azotemic cats. Animals: A total of 213 cats with CKD (plasma creatinine concentration > 2 mg/dL, urine specific gravity < 1.035) were followed up until progression occurred or for at least 1 year; 132, 73, and 8 cats were in International Renal Interest Society (IRIS) stages 2, 3, and 4, respectively.Methods: Progression was defined as a 25% increase in plasma creatinine concentration. Logistic regression was used to assess variables at diagnosis that were associated with progression within 1 year. Changes in IRIS stage during followup also were described. Cases that remained in stages 2 or 3, but did not have renal function assessed in the last 60 days of life, were excluded from analysis of the proportion reaching stage 4.Results: Of the cats, 47% (101) progressed within 1 year of diagnosis. High plasma phosphate concentration and high urine protein-to-creatinine ratio (UPC) predicted progression in all cats. Low PCV and high UPC independently predicted progression in stage 2 cats, whereas higher plasma phosphate concentration predicted progression in stage 3 cats; 19% (18/94) of cats diagnosed in stage 2; and 63% (34/54) of cats diagnosed in stage 3 reached stage 4 before they died.Conclusions: Proteinuria, anemia, and hyperphosphatemia may reflect more progressive kidney disease. Alternatively, they may be markers for mechanisms of progression such as tubular protein overload, hypoxia, and nephrocalcinosis.

“…The failure to detect and appropriately treat renal anemia leads to lethargy and other signs of systemic illness readily recognized by the pet owner. Anemia associated with CKD is multifactorial; contributing factors include anemia of chronic disease, shortened red blood cell life span, relative erythropoietin deficiency, and gastrointestinal blood loss . In this study, early signs of anemia especially when accompanied by gastric upset were treated with famotidine.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Chinese Rhubarb, Rheum officinale, with and without Benazepril on the Progression of Naturally Occurring Chronic Kidney Disease in Cats

Hanzlicek

Roof

Sanderson

et al. 2014

BackgroundRenal fibrosis is common in progressive kidney disease. Transforming growth factors β (TGF‐β) are important mediators of all types of fibrosis, including renal fibrosis. Chinese rhubarb has been shown to have antifibrotic properties in part because of inhibition of TGF‐β and has slowed the progression of kidney disease in rodent models.HypothesisThat administration of a Chinese rhubarb supplement will slow the progression of chronic kidney disease (CKD) in cats and the concurrent administration of Chinese rhubarb and benazepril will be more effective than either alone.AnimalsTwenty‐nine client‐owned cats with naturally occurring IRIS Stage 2 or early Stage 3 CKD and without comorbidity such as cancer, urinary tract obstruction, urinary tract infection, poorly controlled hyperthyroidism, or systemic hypertension were enrolled in the study.MethodsA randomized, positive‐controlled, prospective study was performed. Cats received Chinese rhubarb, benazepril, or both in addition to standard treatment for CKD. Repeated measures ANOVA was used to assess changes in serum creatinine concentration, body weight, hematocrit, urine protein: urine creatinine ratio (UPC), and systemic arterial blood pressure over time between and within treatment groups over an average of 22 months.ResultsNo significant differences were detected in serum creatinine concentration, body weight, hematocrit, UPC, and systemic arterial pressure over time between or within treatment groups.Conclusions and Clinical ImportanceThis study failed to detect a significant difference in the progression of CKD in cats treated with Chinese rhubarb, benazepril, or both. Further study in specific subsets of cats with CKD is warranted.