THERAPEUTIC NUTRITION
THERAPEUTIC NUTRITION
Useful information about the needs of cats and dogs with nutritionally sensitive health conditions.
Renal & Urinary Disorders
The Importance of Nutrition in Feline Chronic Kidney Disease
Jessica Quimby
DVM, PhD, DACVIM (SAIM)
The Ohio State University
Columbus, Ohio, USA
Q. Why should veterinary health care professionals recommend therapeutic renal diets for cats with chronic kidney disease?
A. Several studies have documented the therapeutic value of feeding a renal diet in the management of feline chronic kidney disease (CKD), including amelioration of CKD mineral bone disorder, decreased incidence of uremic crisis and increased survival.1,2 Feeding a renal diet also decreases fibroblast growth factor 23 (FGF-23) concentrations, a biomarker that is positively correlated with disease stage.2 However, the failure of the patient to eat the diet negates the benefit of dietary management, and therefore a key therapeutic target for these patients is the maintenance of appetite and food intake.
Q. How can nutrition be included in medical plans for CKD in cats?
A. Serial evaluations of nutritional status are a key part of CKD patient management, and a proactive nutritional plan should be created for every patient. A nutritional assessment should include body weight, body condition score, muscle condition score, adequacy of caloric intake (including open-ended questions about how the pet is eating), and a complete dietary history (including pet food, treats, supplements and items used to give medications). A nutritional plan is important in feline CKD because low body weight and decreased body condition are associated with a poorer prognosis.2 Additionally, appetite is perceived by caregivers as a significant aspect of quality of life.3
Q. What strategies can be implemented to increase food intake in cats with CKD?
A. To increase compliance with renal diet intake, complications of decreased kidney function (hydration, hypokalemia, anemia, etc.) that have the potential to affect appetite should be addressed. Medical management for inappetence and nausea should be instituted. Lastly, a slow dietary transition over several weeks is recommended. It may be helpful to initially offer the renal diet in a separate bowl(s) as an alternative option instead of mixing together with previous diet. If cats cannot be enticed to eat an appropriate amount of renal diet with medical management, then placement of a feeding tube may facilitate meeting nutritional goals.
Related Tools and Content:
CHRONIC KIDNEY DISEASE IN CATS: Nutritional Management
Nutritional interventions tailored to the individual cat with CKD can play a key role in slowing disease progression, reducing signs of uremia, addressing homeostatic changes resulting from CKD, and improving quality of life as well as life span.
Comprehensive Management of Feline CKD: A Panel Discussion
Learn more about nutritional intervention for feline CKD and how to partner with pet owners to improve adherence to your diagnostic and nutritional recommendations in this discussion, moderated by feline internal medicine specialist Dr. Andy Sparkes, featuring internal medicine specialist Dr. Jessica Quimby and Board Certified Veterinary Nutritionist® Dr. Lindsey Bullen.
Strategies to Improve Renal Diet Acceptance in Cats
Cats with chronic kidney disease often experience nausea, which can affect their appetite and food intake. Pet owners can try different approaches to help increase a cat’s acceptance of a diet and daily calorie intake.
Using Open-Ended Questions to Elicit Accurate Nutrition Information
Getting accurate information is the first step toward creating a solid nutrition plan.
Chronic Kidney Disease (CKD) in Cats
In this brief video, Martha G. Cline DVM, DACVIM (Nutrition), shares quick tips on how to manage CKD in feline patients.
Strategies for Enhancing Feline Hydration
Increased water intake can benefit all cats, but especially those with renal and urinary tract conditions. Discover what strategies can be used to encourage greater water intake and how to tell if they are successful.
To Share with Pet Owner:
Challenges in Feeding Dogs and Cats with Chronic Kidney Disease
A poor appetite and weight loss are common in chronic kidney disease (CKD) making nutritional intervention crucial to successful case management.
References
Geddes, R. F., Elliott, J., & Syme, H. M. (2013). The effect of feeding a renal diet on plasma fibroblast growth factor 23 concentrations in cats with stable azotemic chronic kidney disease. Journal of Veterinary Internal Medicine, 27(6), 1354-1361. doi: 10.1111/jvim.12187
Parker, V. J. (2021). Nutritional management for dogs and cats with chronic kidney disease. Veterinary Clinics of North America: Small Animal Practice, 51(3), 685-710. doi: 10.1016/j.cvsm.2021.01.007
Lorbach, S., Quimby, J., Nijveldt, E., Paschall, R., & Reid, J. (2022). Evaluation of health-related quality of life in cats with chronic kidney disease. Journal of Veterinary Internal Medicine, 36(6), 2369-2370. doi: 10.1111/jvim.16541