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 18 NOVEMBER/DECEMBER 2018 ADVANCED CKD: WHEN FEEDING NEEDS AN ASSIST Assuring hydration and food intake is one of the most important components of nutritional management of cats with CKD. The goal when recommending a specific food and dose is to maintain stable, healthy body weight. Monitoring kidney function, hydration, body weight, BCS, and MCS is key to catching any decline quickly. If cats are unable to maintain weight on their own, intervention is essential. Appetite Stimulants If the cat's intake has waned, the first approach is to minimize nausea and/or increase the palatability of the diet. If substituting food flavors, textures, or serving temperatures does not improve intake, an antiemetic or appetite stimulant can be considered. Mirtazapine has been proven to significantly increase appetite, reduce vomiting, and promote weight gain in cats with CKD 11 and can be administered orally or as a transdermal ointment. Assisted Feeding If an appetite stimulant does not yield the desired results of intake equal to the daily caloric requirement, then nutritional support by a long- term feeding tube should be considered. Either an esophagostomy tube or gastrostomy tube feeding is a very effective and a convenient way to provide food, water and liquid medications to cats with CKD. 12 This can also eliminate the need for administering subcutaneous fluids, which contain sodium. CONCLUSION Nutritional management of cats with CKD can positively affect the course of disease as well as quality of life for patients. With early diagnosis, veterinarians have the opportunity to intervene nutritionally throughout the disease process, basing their recommendations on the individual and changing needs of the whole cat, not just its kidneys. By recommending a diet that meets the individual patient's needs and supports stable body weight while minimizing the risks of disease progression, the veterinarian can make a significant difference in the lives of the patient and owner. REFERENCES 1. Parker VJ. Chronic kidney disease screening and confirmation testing in cats. Todays Vet Pract. 2018;Sep/Oct:9-12. 2. Polzin DJ, Churchill JA. Renal diets are indicated for cats with International Society Chronic Kidney Disease stage 2 to 4. The pro view. Vet Clin Small Anim Pract 2016;46(6):1049-1065. 3. Freeman L, Becvarova I, Cave N, et al. WSAVA nutritional assessment guidelines. J Small Anim Pract 2011;5 2(7):385-396. 4. Laflamme DP, Hannah SS. Discrepancy between use of lean body mass or Nitrogen balance to determine protein requirements for adult cats. J Fel Med Surg 2013;15:691-697. 5. Laflamme DP. L ean body mass as affected by aging and protein intake in geriatric cats. Proceedings of the 17 th European Society of Veterinary and Comparative Nutrition Congress; Ghent, Belgium; September 19-21, 2013. Page 50. 6. Kuwahara Y, Ohba Y, Kitoh K, et al. Association of laboratory data and death within one month in cats with chronic renal failure. J Small Anim Pract 2006;47(8):446-450. 7. Chakrabarti S, Syme HM, Elliott J. Clinicopathological variables predicting progression of azotemia in cats with chronic kidney disease. J Vet Intern Med 2012;26(2):275-281. 8. Brown SA, Brown CA, Crowell WA, et al. Dietary fatty acid composition affects renal function. Proceedings of the Purina Forum on Small Animal Nutrition 1996. Abstract P. 35. 9. Yu S, Paetau-Robinson I. Dietary supplements of vitamins E and C and beta-carotene reduce oxidative stress in cats with renal insufficiency. Vet Res Commun 2006;30(4):403-413. 10. Freeman L, Lachaud MP, Matthews S, et al. Evaluation of weight loss over time in cats with chronic kidney disease. J Vet Intern Med 2016;30(5):1661. 11. Quimby J, Lunn KF. Mirtazapine as an appetite stimulant and anti-emetic in cats with chronic kidney disease: a masked placebo- controlled crossover clinical trial. Vet J 2013;197(3):651-655. 12. Sparkes AM, Caney S, Chalhoub S, et al. ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease. J Feline Med Surg 2016;18:219-239. Julie Churchill Upon receiving a BS and DVM from Michigan State University, Dr. Churchill completed a small animal internship in medicine and surgery at the University of Georgia, followed by combined residencies and a PhD program in small animal internal medicine and clinical nutrition at University of Minnesota. Her graduate work was capped with the development of a small animal clinical nutrition service at the UMN Veterinary Medical Center. Five years later, she developed a model to make it financially self-sustaining. She is passionate about all aspects of small animal clinical nutrition, including maintaining wellness and preventive care, obesity prevention and treatment, the nutrition needs of geriatric patients, nutritional management of kidney diseases, and critical care nutrition. She served on the task force to develop the AAHA guidelines for weight management. She serves as president-elect of the Pet Nutrition Alliance (PNA) and on the educational tools committee of PNA working to develop a "go-to" website for credible nutritional information for veterinary practice teams and consumers. Dr. Churchill also serves on the Board of the Association for Pet Obesity Prevention.

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