Veterinary Medicine - December 2007 - (Page 799)

combined with ACE inhibitor therapy to achieve the therapeutic goal. The initial dose for an ACE inhibitor is 0.25 to 0.5 mg/kg with monitoring of the serum creatinine concentration response (the dose may be cautiously increased to 3 mg/kg). The dose range for amlodipine is 0.1 to 0.6 mg/kg as needed to achieve the therapeutic goal. Reassess patients receiving antihypertensive therapy every week or two until the treatment target (systolic blood pressure < 150 mm Hg) has been achieved. Thereafter, monitor blood pressure every three to four months. Provide calcitriol in dogs. Calcitriol is indicated in dogs with chronic kidney disease stages 3 and 4 to slow the progression of the disease and extend survival (evidence grade 1).18 However, do not begin calcitriol therapy until the patient’s serum phosphorus concentration is 6 mg/dl or less. Unfortunately, evidence for or against calcitriol therapy in cats with chronic kidney disease is weak. Calcitriol may be administered initially at a dose of 2.5 ng/kg/day. Monitor ionized calcium and parathyroid hormone (PTH) concentrations weekly until a treatment endpoint is reached. The dose of calcitriol may be adjusted to achieve a treatment endpoint of normalizing PTH concentrations without inducing hypercalcemia. Increase calcitriol doses about 0.75 to 1 ng/kg as needed to a maximum dose of 5 ng/kg. If hypercalcemia develops before PTH concentrations decline to normal, the dosage of calcitriol must be reduced to prevent adverse effects of hypercalcemia. An alternate approach is to attempt to provide two or three days total dose of calcitriol every second or third day. This dosage may mitigate the hypercalcemia and increase the effect on PTH concentrations. Patients receiving calcitriol should have their serum calcium, ionized calcium, and phosphorus concentrations monitored at least every two to three months. O Editors’ note: Dr. Polzin has received research sponsorship and speaking honoraria from Hill’s Pet Nutrition, Royal Canin, and Nestlé Purina; receives support for IRIS from Novartis; and has consulted for and received honoraria from Bayer, Pfizer, and Vétoquinol. REFERENCES 1. Polzin DJ, Osborne CA, Ross S. Chronic kidney disease. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 6th ed. St. Louis, Mo: Elsevier Saunders, 2005;1756-1785. 2. Jacob F, Polzin DJ, Osborne CA, et al. Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs. J Am Vet Med Assoc 2002;220(8):1163-1170. 3. Ross SJ, Osborne CA, Kirk CA, et al. Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats. J Am Vet Med Assoc 2006;229(6):949-957. 4. Elliott J, Rawlings JM, Markwell PJ, et al. Survival of cats with naturally occurring chronic renal failure: effect of dietary management. J Small Anim Pract 2000;41(6):235-242. 5. Allen TA, Polzin DJ, Adams LG. Renal disease. In: Hand MS, Thatcher CD, Remillard RL, et al. Small animal clinical nutrition. 4th ed. Topeka, Kan: Mark Morris Institute, 2000;563-604. 6. Brown SA, Crowell WA, Barsanti JA, et al. Beneficial effects of dietary mineral restriction in dogs with marked reduction of functional renal mass. J Am Soc Nephrol 1991;1(10):1169-1179. 7. Buranakarl C, Mathur S, Brown SA. Effects of dietary sodium chloride intake on renal function and blood pressure in cats with normal and reduced renal function. Am J Vet Res 2004;65(5):620-627. 8.Theisen SK, DiBartola SP, Radin MJ, et al. Muscle potassium content and potassium gluconate supplementation in normokalemic cats with naturally occurring chronic renal failure. J Vet Intern Med1997;11(4):212-217. 9. Kirk CA, Jewell DE, Lowry SR. Effects of sodium chloride on selected parameters in cats. Vet Ther 2006;7(4):333-346. 10. Weir MR, Fink JC. Salt intake and progression of chronic kidney disease: an overlooked modifiable exposure? A commentary. Am J Kidney Dis 2005;45(1):176-188. 11. Lees GE, Brown SA, Elliott J, et al. Assessment and management of proteinuria in dogs and cats: 2004 ACVIM Forum Consensus Statement (small animal). J Vet Intern Med 2005;19(3):377-385. 12. Jacob F, Polzin DJ, Osborne CA, et al. Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure. J Am Vet Med Assoc 2005;226(3):393-400. 13. Syme HM, Markwell PJ, Pfeiffer D, et al. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria. J Vet Intern Med 2006;20(3):528-535. 14. Grauer GF, Greco DS, Getzy DM, et al. Effects of enalapril versus placebo as a treatment for canine idiopathic glomerulonephritis. J Vet Intern Med 2000;14(5):526-533. 15. King JN, Gunn-Moore DA, Tasker S, et al. Tolerability and efficacy of benazepril in cats with chronic kidney disease. J Vet Intern Med 2006;20(5):1054-1064. 16. Brown S, Atkins C, Bagley R, et al. Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 2007;21(3):542-558. 17. Jepson RE, Elliott J, Brodbelt D, et al. Effect of control of systolic blood pressure on survival in cats with systemic hypertension. J Vet Intern Med 2007;21:402-409. 18. Polzin D, Ross S, Osborne C, et al. Clinical benefit of calcitriol in canine chronic kidney disease. J Vet Intern Med 2005;19:433(A). #11 EXTRA See for a cat owner fact sheet on autosomal dominant polycystic kidney disease. VETERINARY MEDICINE December 2007 799 http://www.vetstreamfelis.com/ACI/December/VMD1/EnglishFactsheet035.asp http://virbacvet.com http://virbacvet.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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