11 guidelines for conservatively treating chronic kidney disease - Veterinary Medicine
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11 guidelines for conservatively treating chronic kidney disease
You can prolong and improve the quality of life in dogs and cats suffering from this reduction in kidney function by monitoring and treating key parameters and signs.


VETERINARY MEDICINE



TABLE 4: Therapeutic Measures for Dogs and Cats with Chronic Kidney Disease
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-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.


The evidence-based medicine hierarchy
#2 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. Mal nutrition 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.

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.

CORRECT DEFICITS AND EXCESSES IN FLUIDS, ACID-BASE BALANCE, AND ELECTROLYTES

#3 Maintain serum phosphorus concentrations below target levels. Excessive phosphorus intake and inappropriately high serum phosphorus concentrations appear to promote progressive kidney injury.4,6 Intervention is indicated in dogs and cats with chronic kidney disease stages 2 through 4 when the phosphorus concentrations rise above stage-specific therapeutic target concentrations. The targets proposed for serum phosphorus concentrations reflect a consensus of expert opinion (evidence grade 4).

Ideally, the serum phosphorus concentration should be below 4.5 mg/dl in stage 2 chronic kidney disease, below 5 mg/dl in stage 3, and below 6 mg/dl in stage 4. When the serum phosphorus concentration exceeds these target concentrations, initiate dietary phosphorus restriction by feeding a renal diet. In most dogs and cats with chronic kidney disease stages 2 and 3, dietary phosphorus restriction alone will maintain the concentration below the target concentration. However, in some patients with stage 3 chronic kidney disease and in most patients with stage 4 disease, adding an intestinal phosphate-binding agent will be necessary. If calcium-based phosphate binding agents are used, it is particularly important to monitor serum calcium concentrations. In patients with elevated serum calcium concentration or reduced serum albumin concentrations, it is desirable to measure ionized calcium concentrations.


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Source: VETERINARY MEDICINE,
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