Today's Veterinary Practice

NOV-DEC 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 14 NOVEMBER/DECEMBER 2018 REVIEWED PEER The approach to nutritional management of chronic kidney disease (CKD) in cats has changed significantly over the past 2 decades. In the past, cats typically were diagnosed as having late-stage kidney "failure," or what would now be classified as International Renal Interest Society (IRIS; ) later stage 3 or stage 4, when clinical signs such as anorexia, lethargy, and weight loss raised concerns on the part of the cat owner. After diagnosis, veterinarians prescribed one of a limited number of reduced- protein therapeutic renal diets that inappetent or ill patients often refused. The clinical picture tended to deteriorate quickly, resulting in poor quality of life for the patient and anxiety for the owner. Today the outlook is significantly improved for both cats and owners. Proactive preventive care, monitoring, and screening, coupled with heightened awareness of feline CKD prevalence, have enabled veterinarians to diagnose CKD earlier—frequently in IRIS stages 1 and 2, before cats have begun to demonstrate clinical signs of disease. This, in turn, has facilitated early nutritional intervention and a stepwise approach to CKD management. With diligent monitoring and individualized management, there is opportunity not only to slow the disease progression but to sustain a good quality of life for many years. This article, the second in a 2-part series on feline CKD, 1 addresses nutritional intervention, which is the cornerstone for maintaining health and quality of life for cats with CKD. Rather than resorting to the one-size-fits-all dietary approaches of the past, veterinarians today can manage patients as the unique individuals they are when making nutritional recommendations. Overall, the goals of nutritional management of CKD are as follows: 2 (1) improve or prevent consequences of CKD and uremia; (2) slow progression and/or prolong survival; (3) minimize imbalances of electrolyte, mineral, and acid-base balance; and (4) maintain adequate nutrition. NUTRITIONAL ASSESSMENT FOLLOWING CKD DIAGNOSIS After patient diagnosis and staging, veterinarians should complete a nutrition assessment. 3 Steps include the following: ■ Thorough diet history, including current diet and intake. What is the cat currently eating ( TABLE 1 ), including treats and food used to give medication? Has appetite or intake changed? Is the cat eating enough of its current diet to assure sufficient consumption of specific nutrients and calories? Feeding Cats With Chronic Kidney Disease: Customizing the Nutritional Management Plan Julie Churchill, DVM, PhD, DACVN Associate Professor, Department of Veterinary Clinical Sciences, University of Minnesota College of Veterinary Medicine NUTRITION Nichizhenova

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