Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
- Bookmark your favorite articles in My Library for future reading.
- Save future meetings and courses in My Calendar and My e-Learning.
- Ask authors questions and read what others have to say.
Dietary Management of Chronic Renal Failure in Cats
Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
- Bookmark your favorite articles in My Library for future reading.
- Save future meetings and courses in My Calendar and My e-Learning.
- Ask authors questions and read what others have to say.
Read
Even as new therapeutic options such as haemodialysis and renal transplantation become available, diet continues to be a cornerstone in the treatment of feline chronic renal failure (CRF).
Over the past decades, protein and phosphorus restricted diets were shown to be beneficial in slowing the rate of clinical deterioration in feline CRF (Harte et al., 1994). Reducing nonessential protein intake will decrease production and accumulation of nitrogenous waste products, ameliorating clinical signs of uraemia (Polzin et al., 1996). Yet, until to day, the impact of protein intake on the progression of renal insufficiency has been vigorously debated. Finco et al. (1998) concluded that high protein diets were not associated with increased severity of renal lesions and decreased glomerular filtration rate in cats with induced CRF. However, Adams et al. (1994) showed high protein diets to increase glomerular filtration rate in cats with partial nephrectomy. Phosphorus retention occurs early in patients with CRF, due to the critical balance between dietary phosphorus intake and renal function, and is linked to the development of secondary renal hyperparathyroidism. Whether phosphorus retention and increased parathyroid hormone (PTH) synthesis and secretion are detrimental to health and wellbeing of cats with CRF has also been a topic of debate. Ross et al. (1982) evidenced reduced renal mineralization and fibrosis in cats with induced CRF when fed a low phosphorus diet. Also Elliott et al. (2000) observed reduced all cause mortality in cats with naturally occurring CRF due to lowering phosphorus intake. Unfortunately, as renal failure becomes more advanced, dietary phosphorus restriction alone often fails to prevent hyperphosphatemia and administration of intestinal phosphorus binders should be considered (Polzin et al., 1996) Oral administration of very low doses of calcitriol is also reported to normalize serum PTH levels and to slow the progression of naturally occurring CRF in cats (Nagode & Chew, 1992), yet controlled conditions are needed.
Sodium restriction is generally accepted in patients with CRF, since reduced functional renal mass hampers sodium homeostasis and sodium retention might promote hypertension, causing further damage of remaining nephrons and progressive renal failure. However, several observations have cast doubt on dietary sodium restriction. At first, in cats with normal renal function, excessive dietary sodium intake does not lead to hypertension (Buranakarl et al., 2004; Luckschander et al., 2004). Secondly, in cats with experimentally diminished renal function and hypertension, reduction of sodium intake induces activation of the rennin-angiotensin-aldosterone system, increasing renal losses of potassium, resulting in hypokalemia, without any effect of arterial blood pressure (Buranakarl et al., 2004). However, the clinical use of sodium restricted diets for the dietary treatment of naturally occurring CRF does not go with aggravating hypokalemia (Elliott et al., 2000).
Hypokalemia is seen in 20-30% of feline patients with CRF (DiBartola et al., 1987; Elliott et al., 1998), as a result of decreased dietary intake due to anorexia and vomiting and increased urinary losses due to polyuria. Since the potassium requirement increases with increasing protein intake, renal diets should be moderate in protein and contain sufficient potassium. [...]
Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
- Bookmark your favorite articles in My Library for future reading.
- Save future meetings and courses in My Calendar and My e-Learning.
- Ask authors questions and read what others have to say.
Comments (0)
Ask the author
0 comments