Therapies for Feline Chronic Kidney Disease

Abstract

Practical relevance Successful treatment and prevention of kidney disease in pet animals requires a multidimensional approach to identify and eliminate causes or exacerbating factors, provide professional examination and care on a regular basis, and plan and implement a comprehensive treatment program when necessary. Evidence base Over the years, many therapeutic and preventive interventions have been developed or advocated for chronic kidney disease (CKD), but evidence of efficacy or effectiveness is often lacking or highly variable. Accordingly, the main objective of this systematic review was to identify and critically appraise the evidence supporting various approaches to managing feline CKD; namely, fluid therapy, calcitrioi therapy, antihypertensive therapy, ACE inhibitor therapy, erythropoietic hormone replacement therapy, potassium supplementation, antioxidant supplementation, alkalinization therapy, dietary phosphorus restriction and intestinal phosphate binders, therapeutic renal foods, assisted feeding, dialysis and renal transplantation.

Intrarenal Distributions and Changes of Angiotensin-Converting Enzyme and Angiotensin-Converting Enzyme 2 in Feline and Canine Chronic Kidney Disease

“…In human clinical studies, blockade of RAS by ACE inhibitor (ACEI) limits the progression of CKD, especially when the disease is associated with proteinuria [10, 17, 24]. This clinical strategy is the same in small animal medicine, and administration of ACEI is widely accepted for the management of proteinuric CKD in dogs and cats [18, 19]. …”

Ethical considerations in feline renal transplantation

“…This gamble is especially difficult because it relies on limited scientific information (Roudebush et al, 2009). There will also be different odds for different cats, as recipients may be affected by kidney disease or by a particular medical treatment in different ways.…”

An evidence‐based review of therapies for canine chronic kidney disease

“…Today, there appears to be a consensus of opinion that phosphate retention and hyperparathyroidism contribute to spontaneous, self‐perpetuating progression of CKD in dogs as well as other species. In models of induced kidney disease in cats and cats with spontaneous CKD, there is good evidence for use of dietary phosphorus restriction (Roudebush and others 2009). In human haemodialysis patients, the adjusted relative risk of mortality was stable in patients with serum phosphate concentrations below 6·5 mg/dl but increased significantly above this level (Block and others 1998).…”

“…The beneficial effect of ACEI in patients with renal disease seems to be mediated by factors in addition to decreasing blood pressure and urinary protein excretion and is greater in patients with proteinuria (Jafar and others 2001). Although ACEI therapy has been shown to reduce the magnitude of proteinuria in cats with spontaneous CKD, weak evidence exists to support a recommendation for or against the use of ACEI therapy for the purpose of slowing progression and prolonging survival of cats with CKD (Roudebush and others 2009).…”