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What are cat owners feeding and giving as medications to cats with CKD?

Markovich JE, Freeman LM, Labato MA, Heinze CR. Survey of dietary and medication practices of owners of cats with chronic kidney disease. J Feline Med Surg. 2015 Dec; 17 (12):979-983.

Chronic kidney disease (CKD) is a common disease condition in cats, particularly geriatric cats. Dietary management has been considered through clinical studies as an important factor in managing the progression of the disease.  Information related to the prevalence of cat owners who are feeding veterinary diets formulated specifically for CKD is absent in veterinary literature.

This study looked at the dietary and medication patterns of cat with chronic kidney disease. The authors utilized a web-based survey as a prospective, cross-sectional descriptive study. Participating in the survey were owners of 1089 cats with CKD.  Beyond looking at the type of diets fed to the cats, the researchers looked at the type and frequency of dietary supplements and medications administered to the cats. Because the number of pills taken (i.e., pill burden) affects the quality of life and compliance in people, the same concern can be an important issue in cats.

Looking at the results of the study, the mean age of the cats was 13.7 years.  Forty percent of the cats were reported to have a concurrent disease. Hyperthyroidism (11%) was the most commonly reported concurrent disease, followed by heart disease (8%), inflammatory bowel disease (6%), diabetes mellitus (4%), neoplasia (3%), and hypertension (3%). A veterinarian’s recommendation was the most common reason reported for diet selection, followed by internet resources, pet stores, friends, and then breeders. A majority of owners (51%) fed a veterinary therapeutic diet formulated for CKD as some part of their cat’s diet.

Appetite is an important consideration in the quality of life of pets, especially cats, and the prolonged loss of their cat’s appetite can factor into the decision of an owner in regards to euthanasia. Loss of appetite, decreased caloric intake, and changes in food preferences were reported in 43% of the owners of cats with CKD in this study; 52% reported their cat had a poor appetite and needed coaxing to eat 5-7 days a week. The authors stated that such continued changes in appetite likely contribute to owners offering foods to their cat that are often not ideal for the management of CKD or are not nutritionally balanced, in their attempt to get their cat to eat. The authors suggest that earlier use of feeding tubes in some patients may allow for better nutritional and medical management in cats with CKD.

When it comes to supplements, the most common supplements given were B vitamins, followed by fatty acids, joint supplements, a symbiotic (prebiotic plus probiotic), and then multivitamins. Subcutaneous fluids were given to 47% of the cats and 51% received oral medications (most often given directly to the cat’s mouth over being crushed in the food). The most common oral medications included famotidine, phosphorus binding medications, and angiotensin-converting enzyme inhibitors. Of the phosphorus binders, aluminum hydroxide binders were administered almost twice as often as calcium-based phosphorus binders, yet most cats (78%) were not receiving phosphorus-binding medications which are often a required treatment as kidney disease progresses.

In conclusion, a key point from the survey is the importance of obtaining a complete diet history at every visit for cats with CKD to determine if additional foods are being provided to the cats that ensure the most optimal diet. Also, obtaining information at each visit on what supplements are being given is important due to the fact that some supplements can interact with different medications plus they may also affect the patient’s appetite leading to a loss or decrease in food intake. (VLT)

See also:
Korman RM, White JD. Feline CKD: Current therapies – what is achievable? J Feline Med Surg. 2013 Sept; 15 Suppl 1:29-44.