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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ESSENTIALS todaysveterinarypractice.com NOVEMBER/DECEMBER 2018 15 ■ Complete physical exam, including body weight and body (BCS) and muscle condition scores (MCS). Is the patient's BCS ideal, underweight, or overweight? Has the cat lost weight or remained weight-stable since its last exam? Does the MCS assessment reveal mild, age-related sarcopenia or has muscle loss accelerated? ■ Hydration status. Is the cat dehydrated? Have changes in urine output been noted? ■ Comorbidities. Does the patient have a concurrent condition, such as hyperthyroidism, hypertension, obesity, or impaired gastrointestinal function? Assessing the nutritional status, the stage of disease, and the patient's overall state of health can help guide the veterinarian's nutritional recommendation to meet the needs of the individual cat. When conducting a nutritional assessment, it is important to gain a comprehensive understanding of everything the cat is eating daily, while also analyzing the nutritional profile of the diet. A STEP-WISE APPROACH TO NUTRITIONAL MANAGEMENT The advent of new strategies to diagnose CKD earlier also makes it possible to intervene earlier with nutrition. However, clinical research is less clear regarding when or what nutritional therapy should be implemented in early stages of CKD. Few nutrients aside from phosphorus have been studied in isolation or at early stages of disease. Clinical trials have resulted in recommendations based instead on overall "diet effect," especially in IRIS stages 3 and 4. The following are prioritized nutritional goals for cats diagnosed with early CKD: ■ Promote and increase water intake, transitioning to all or part canned food if necessary. ■ Make diet changes gradually to increase acceptance. ■ Meet individual calorie needs to maintain healthy, stable weight. ■ Select a product that provides high-quality protein to meet the cat's needs (approximately 5 g/kg body weight) 4 yet avoid excessive levels. ■ Reduce dietary phosphorus. ■ Ensure that more than 90% of calories consumed are from a therapeutic diet formulated to meet the cat's needs and that foods used for treats or medication administration don't exceed 10% of caloric intake, provide excess nutrients, or create nutrient imbalances. TABLE 1 Assessing the Diet of the CKD Cat When conducting a nutritional assessment, it is important to gain a comprehensive understanding of everything the cat is eating daily, while also analyzing the nutritional profile of the diet. PATIENT: Lily, 12-year-old spayed female domestic short-haired cat with a BCS of 5/9, stable body weight of 4 kg, and IRIS stage 2 FOOD NAME FORM AMOUNT PER FEEDING MEALS OR TIMES FED PER DAY DURATION FED KCAL/DAY PROTEIN/ PHOSORUS LEVEL Purina True Nature Adult 45% Protein Formula Natural Trout & Rice* Dry 1/4 cup 450 kcal/cup 2 2 y 225 kcal/d 29 g protein/d Protein 12.89 g/100 kcal Phosphorus 367 mg/100 kcal Purina Pro Plan Adult Tuna Entrée in sauce* Wet 1/2 can 68 kcal/can 1 3 y 34 kcal/d 5.6 g protein/d Protein 16.7 g protein/100 kcal Phosphorus 293 mg/100 kcal TREATS AND SUPPLEMENTS (INCLUDE FOODS USED TO ADMINISTER MEDICATIONS) Purina Pro Plan Focus Hairball Remedy Chews* Dry 3 pieces (3 kcal/each) 1 3 years 9 kcal total Unknown Total Intake 268 kcal/d Protein 34.6 g/d High phosphorus intake Assessment 268 kcal meets Lily's daily calorie needs and exceeds her daily protein and phosphorus requirements *Nutrient values from Proplan Veterinary Diet 2018 Product Guide.

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