Treatment Options for Hyperphosphatemia in Feline CKD: What's Out there?

Kidder, Aimee C.; Chew, Dennis J.

doi:10.1016/j.jfms.2009.09.012

Cited by 35 publications

(45 citation statements)

References 50 publications

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“…At that point, control of serum phosphorus, via restriction of dietary phosphorus and/or intestinal phosphate binders, is considered of prime importance. 60,61 Phosphorus intake or binders should be adjusted or added to maintain serum phosphorus concentrations within the low-normal range.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

Nutrition of Aging Cats

Laflamme¹,

Gunn-Moore

2014

Veterinary Clinics of North America: Small Animal Practice

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Section: Chronic Kidney Diseasementioning

confidence: 99%

Nutrition of Aging Cats

Laflamme¹,

Gunn-Moore

2014

Veterinary Clinics of North America: Small Animal Practice

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“…The pathophysiology of SRHPT is multifactorial and complex (Kidder & Chew 2009). In the early stages (I and II) of CKD, according to the International Renal Interest Society (IRIS) classification, reduced renal excretion of phosphorus results in phosphorus retention, but phosphorus serum levels are usually within the normal range because of the compensatory mechanisms responsible for enhancing phosphaturia (Slatopolsky et al 1980, Kidder & Chew 2009, Wesseling-Perry K. 2010.…”

Section: Introductionmentioning

confidence: 99%

“…In the early stages (I and II) of CKD, according to the International Renal Interest Society (IRIS) classification, reduced renal excretion of phosphorus results in phosphorus retention, but phosphorus serum levels are usually within the normal range because of the compensatory mechanisms responsible for enhancing phosphaturia (Slatopolsky et al 1980, Kidder & Chew 2009, Wesseling-Perry K. 2010. However, in the late stages (III and IV), those compensatory mechanisms could fail to prevent hyperphosphatemia, leading to inhibition of calcitriol synthesis that promotes reduction in serum ionized calcium and, in turn, stimulation in iPTH synthesis and secretion, and development of SRHPT (Krueger & Osborne 1995, Goodman et al 1996, Polzin et al 2009b).…”

Section: Introductionmentioning

confidence: 99%

“…In cats with CKD, the increase of one unit in serum phosphorus concentration has been associated with the elevation of 11.8% in the risk of death (Kidder & Chew 2009), and serum phosphate above 7 mg/ dL could decrease serum iCa fraction and, in turn, increasing iPTH synthesis (Plotnick 2007). In humans with CKD, it is recommended to maintain serum phosphorus levels between 2.5 and 5.5 mg/dL in order to minimize the risk of mortality resulting from calcification of coronary arteries and renal tissue (Mendonça et al 2002, Sesso & Ferraz 2003, Rasouli & Kiasari 2006.…”

Section: Introductionmentioning

confidence: 99%

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Serum intact parathyroid hormone levels in cats with chronic kidney disease

et al. 2013

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Pesq. Vet. Bras. 33(2):229-235, fevereiro 2013 229 RESUMO.-[Avaliação das concentrações séricas de paratormônio intacto em gatos com doença renal crônica.] A doença renal crônica (DRC) em gatos é frequentemente observada e caracteriza-se como alteração multissistêmi-ca, causada por alterações metabólicas, e o hiperparatireoidismo secundário renal (HPTSR) seria o mais comum e usualmente está associada com progressão da doença renal e mau prognóstico. Esse estudo teve como objetivo determinar a frequência do HPTSR, e discutir os possíveis Chronic kidney disease (CKD) is frequently observed in cats and it is characterized as a multisystemic illness, caused by several underlying metabolic changes, and secondary renal hyperparathyroidism (SRHPT) is relatively common; usually it is associated with the progression of renal disease and poor prognosis. This study aimed at determining the frequency of SRHPT, and discussing possible mechanisms that could contribute to the development of SRHPT in cats at different stages of CKD through the evaluation of calcium and phosphorus metabolism, as well as acid-base status. Forty owned cats with CKD were included and divided into three groups, according to the stages of the disease, classified according to the International Renal Interest Society (IRIS) as Stage II (n=12), Stage III (n=22) and Stage IV (n=6). Control group was composed of 21 clinically healthy cats. Increased serum intact parathyroid hormone (iPTH) concentrations were observed in most CKD cats in all stages, and mainly in Stage IV, which hyperphosphatemia and ionized hypocalcemia were detected and associated to the cause for the development of SRHPT. In Stages II and III, however, ionized hypercalcemia was noticed suggesting that the development of SRHPT might be associated with other factors, and metabolic acidosis could be involved to the increase of serum ionized calcium. Therefore, causes for the development of SRHPT seem to be multifactorial and they must be further investigated, mainly in the early stages of CKD in cats, as hyperphosphatemia and ionized hypocalcemia could not be the only factors involved.INDEX TERMS: Renal disease in cats, ionized calcium, hyperphosphatemia, secondary renal hyperparathyroidism, metabolic acidosis.

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“…However renal diets may not be effective alone in maintaining plasma phosphate concentrations in the recommended target ranges [6] and many renal diets have relatively low palatability in cats [2,10]. Phosphate binders, which reduce the oral absorption of dietary phosphate, are therefore useful agents in the management of hyperphosphataemia [11]. …”

Section: Introductionmentioning

confidence: 99%

Efficacy, acceptability and tolerability of the new oral phosphate binder Lenziaren® in healthy cats fed a standard diet

et al. 2014

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BackgroundThe efficacy, acceptability and tolerability of the new oral phosphate binder Lenziaren® (SBR759) were evaluated in a randomized parallel-group design study in 36 healthy cats (n = 6 per group). Five groups were fed once daily with a commercial diet containing 0.2% phosphorus (“standard diet”) into which was mixed Lenziaren® at 0.25, 0.5, 1.0 or 2.0 g/day or no treatment (control group) daily for 30 days. A sixth group was fed a commercial diet containing lower amounts (0.12%) of phosphorus (“renal diet”) and no treatment.ResultsWhen compared to the control group, Lenziaren® produced significant dose-related reductions in urine phosphate concentrations, urine phosphate excretion and fractional urinary phosphate excretion. Significant effects versus the control group were observed at the 0.5, 1.0 and 2.0 g/day dosages. Lenziaren® was well tolerated and was associated with higher food consumption and serum iron concentrations versus the control.When compared to the control group, the renal diet was associated with significantly lower urine phosphate concentrations and loss of body weight. Lenziaren® had similar effects on urine phosphate concentrations compared to the renal diet, but was not associated with loss of body weight.ConclusionsLenziaren® was effective as an oral phosphate binder in cats fed with a standard diet containing 0.2% phosphorus. The acceptability and tolerability were good. Dosages of 0.5-1.0 g/cat per day are recommended for clinical testing in cats fed with a standard diet.

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Treatment Options for Hyperphosphatemia in Feline CKD: What's Out there?

Abstract: Companion animal and feline practitioners are at the forefront in the management of CKD in cats.

Cited by 35 publications

References 50 publications

Nutrition of Aging Cats

Nutrition of Aging Cats

Serum intact parathyroid hormone levels in cats with chronic kidney disease

Efficacy, acceptability and tolerability of the new oral phosphate binder Lenziaren® in healthy cats fed a standard diet

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