Your Pet has been diagnosed with Kidney Disease, now what?
In previous blogs we discussed the diagnosis of renal disease, now we will discuss therapies for these pets. Some of this information was collected from the Cornell Feline Health Center Website, although it applies to both cats and dogs.We will focus on chronic kidney disease (CKD) as we tend to see that more frequently. There is no specific cure for CKD, treatment can improve and prolong the lives of pets with this disease. Treatment is aimed at minimizing the buildup of toxic waste products in the bloodstream (BUN, Creat and Phosphorus), maintaining good hydration, correcting electrolyte disturbances, supporting good nutrition, controlling blood pressure, monitoring anemia, reducing the amount of protein lost in the urine and slowing the progression of the disease.
Diet is a scientifically proven aspect of CKD treatment. Therapeutic diets that are restricted in protein, phosphorus and sodium content and high in water-soluble vitamins, fibre, and antioxidant concentrations may prolong life and improve quality of life in pets with CKD. One of the concerns is that often these pets are already feeling poorly and have some degree of anorexia and although most of the companies that make this type of diet strive for palatability it is often difficult to get these pets to eat. It is important to make a gradual transition to a therapeutic diet and to consider food temperature, texture, and flavour. I often tell owners that I want their pet to eat, although therapeutic diets are beneficial, and nutrition is more important.
Blood pressure and urinary protein loss are usually controlled with an oral medication called an angiotensin-converting enzyme inhibitor (semintra, fortekor). Anemia in pets with CKD may be treated by replacement therapy with erythropoietin, a hormone that the kidneys usually produce, which stimulates red blood cell production, we do not do this very frequently.
Although a number of other therapies, including phosphate binders, potassium supplementation, nutritional supplements and administration of fluids either intravenously in the hospital or subcutaneously (can be done in cats at home), have the potential to help with CKD, although these approaches have not been fully validated. At Westwood Hills, we find that potassium supplements and fluids help pets feel much better. Hemodialysis, the removal of toxic waste products from the bloodstream by specially designed equipment that is done in people is not done routinely in animals and it needs more controlled studies to find out if it is effective. Kidney transplantation has only been done experimentally at a few select research hospitals.
Pets respond variably to treatment for CKD, so the prognosis for CKD in affected animals is difficult to predict. Some studies suggest that pets that lose more protein in their urine have less favourable prognoses. Pets that are still eating well and have no problems with a switch to therapeutic diets and taking medications tend to have better outcomes with respect to quality and length of life.
Written by Jane Corkum, DVM