Veterinary Medicine - December 2007 - (Page 789)

TABLE 1 A Summary of the IRIS Staging System of Chronic Kidney Disease* Disease Stage Stage 1 Plasma Creatinine Concentration** Dogs Cats < 1.4 mg/dl < 125 µmol/L < 1.6 mg/dl 5 mg/dl > 440 µmol/L 1.6 to 2.8 mg/dl 140 to 249 µmol/L 2.9 to 5 mg/dl 250 to 439 µmol/L > 5 mg/dl > 440 µmol/L *Adapted from www.iris-kidney.com. **Based on a fasting plasma sample measured in stable, hydrated patients on two occasions. These values apply to dogs of average size; the creatinine concentrations in extremely large or small dogs may vary. Recommend feeding a renal diet. Strong evidence (evidencebased medicine grade 1; see sidebar on page 794) supports feeding a diet formulated to address the specific nutritional needs of animals with chronic kidney disease (a renal diet) to dogs and cats with serum creatinine concentrations in excess of 2 mg/dl (chronic kidney disease stages 3 and 4 in dogs and stages 2 through 4 in cats).2-4 Dietary therapy in dogs and cats slows the progression of chronic kidney disease and prevents or delays the onset of uremia and premature death due to complications of the disease. Renal diets have been shown to maintain or improve nutrition compared with maintenance diets.2-4 Patient and owner acceptance of the diets used in these studies was excellent, perhaps in large part because of gradual diet introduction over several weeks. A common misconception is that renal diets are simply low-protein diets. Renal diets encompass a variety of modifications, including limited quantities of phosphorus and salt, enhanced levels of omega-3 polyunsaturated fatty acids, fiber and vitamin D, and a neutral pH effect. Indeed, the principal beneficial effects of these diets may not accrue from their low- #1 protein content. Thus, simply replacing a renal diet with a standard manufactured diet that is lower in protein content is insufficient. Since inappropriate diets can exacerbate clinical signs of uremia and promote progression of chronic kidney disease, cats and dogs with chronic kidney disease should be fed a renal diet. Re-evaluate dogs and cats receiving diet therapy every three to four months. Ensure adequate nutrition. Owners often consider food consumption to be a premier indicator of their pets’ quality of life, and they are often happy when their pets show any interest in food. However, it is inappropriate to accept a pet’s consumption of some food as a goal of therapy. Malnutrition is a major cause of morbidity and mortality in dogs and cats with chronic kidney disease stages 3 and 4.5 Ideally, patients should consume sufficient calories from an appropriate diet to maintain a body condition score of 4 or 5/9.4 Increased efforts are indicated to ensure sufficient calorie intake for patients with body condition scores of 3/9 or lower or when patients fail to consume adequate calories to maintain a stable, appropriate body weight. #2 In addition to inattention to adequate nutrition, some factors that may contribute to malnutrition in dogs and cats with chronic kidney disease include consumption of inappropriate diets and metabolic factors related to uremia (especially uremic gastrointestinal signs and metabolic acidosis). Failure to adequately address uremic gastritis, uremic stomatitis, and dental health can promote anorexia. Metabolic acidosis can promote protein catabolism and malnutrition.1 Force-feeding new diets, exposing patients to new diets while hospitalized, or administering medications or other unpleasant events during and around feeding times should all be avoided. A renal diet should be introduced to patients gradually. Consider placing a feeding tube when patients fail to spontaneously consume adequate food. Feeding through a gastrostomy or esophagostomy tube is a simple and effective way to provide an adequate intake of calories and water. In addition, feeding tubes simplify drug administration. Although there is only weak evidence (grade 4) to support the effectiveness of feeding tubes in achieving nutritional goals in dogs and cats with chronic kidney disease, there is no proven effective alternative. VETERINARY MEDICINE December 2007 789 http://www.iris-kidney.com

Table of Contents Feed for the Digital Edition of Veterinary Medicine - December 2007

Veterinary Medicine - December 2007 Contents Letters Editors' Guest Thanking Our Valued Reviewers The Veterinary Medicine Interview: Dr. Joseph Harari Clinical Exposures Idea Exchange Answers to Three Commonly Asked Questions About Lyme Disease Practical Ideas for Managing Common Internal Medicine Problems A Tip for Interpreting Leptospira Species Titers Investigating Proteinuric Kidney Disease Counseling New Puppy Owners: Normal Play vs. Aggressive Tendencies 11 Guidelines for Conservatively Treating Chronic Kidney Disease CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller Merial Insert

Veterinary Medicine - December 2007

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