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transfer of high systemic pressures to the glomerular capillaries, development of glomerular hypertension, glomerulosclerosis and exacerbation of proteinuria.(11) However, hypertension per se has not been identified
as a risk factor for survival in cats with CKD and indeed
it was proteinuria that was associated with the survival
of cats with systemic hypertension.(12) Never-the-less, management of systemic hypertension, due to the known effect on target organs is considered an important part of management of CKD when identified and there
is good evidence from both experimental and clinical cohort studies that amlodipine besylate is an effective anti-hypertensive agent.(13-15)
Other management and treatment strategies that are advocated in cats with CKD are dependent largely on the individual patient and include addressing hypokaleamia and anaemia when identified, maintaining hydration
and consideration for subcutaneous fluid therapy or oesophageal feeding tube placement when indicated. Historically there has been anecdotal support for the use of antacid products. However, recent data indicates that gastric ulceration is an infrequent finding in cats with CKD with gastric fibrosis being a more common histopathological abnormality.(16) This raises questions regarding the routine use of either H2 blockers or proton pump inhibitors. For those cats where appetite is poor then new evidence supports that both mirtazapine and anti-emetics such as maropitant may be of clinical utility. (17, 18) There is no current evidence base for the use of treatments such as anabolic steroids or Vitamin B12.
References
1. Polzin D. Evidence-based step-wise approach to managing chronic kidney disease in dogs and cats. J Vet Emerg Crit Care (San Antonio). 2013;23(2):205-15.
2. Geddes RF, Finch NC, Syme HM, Elliott J. The role of phosphorus in the pathophysiology of chronic kidney disease. Journal of Veterinary Emergency and Critical Care. 2013;23(2):122-33.
3. Elliott J, Rawlings JM, Markwell PJ, Barber PJ. Survival of cats with naturally occurring chronic renal failure: effect of dietary management. Journal of Small Animal Practice. 2000;41(6):235-42.
4. Ross SJ, Osborne CA, Kirk CA, Lowry SR, Koehler LA, Polzin DJ. Clinical evaluation of dietary modification for the treatment of spontaneous chronic kidney disease in cats. J Am Vet Med Assoc. 2006;229(6):949-57.
5. Geddes RF, Elliott J, Syme HM. 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. 2013:n/a- n/a.
6. Syme HM, Markwell PJ, Pfeiffer D, Elliott J. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria. J Vet Intern Med. 2006;20(3):528-35.
7. Jepson RE, Brodbelt D, Vallance C, Syme HM, Elliott J. Evaluation of predictors of the development of azotemia in cats. J Vet Intern Med. 2009 Jul-Aug;23(4):806-13. PubMed PMID: 19566846. Epub 2009/07/02. eng.
8. Chakrabarti S, Syme HM, Elliott J. Clinicopathological Variables Predicting Progression of Azotemia in Cats with Chronic Kidney Disease. Journal of Veterinary Internal Medicine. 2012;26(2):275-81.
9. King JN, Gunn-Moore DA, Tasker S, Gleadhill A, Strehlau G. Tolerability and efficacy of benazepril in cats with chronic kidney disease. J Vet Intern Med. 2006 Sep-Oct;20(5):1054-64. PubMed PMID: 17063696. Epub 2006/10/27. eng.
10. Sent U, Gössl R, Elliott J, Syme HM, Zimmering T. Comparison of Efficacy of Long-term Oral Treatment with Telmisartan and Benazepril in Cats
with Chronic Kidney Disease. Journal of Veterinary Internal Medicine. 2015;29(6):1479-87.
11. Chakrabarti S, Syme HM, Brown CA, Elliott J. Histomorphometry of Feline Chronic Kidney Disease and Correlation With Markers of Renal Dysfunction. Vet Pathol. 2012 Jul 5. PubMed PMID: 22773469. Epub 2012/07/10. Eng.
12. Jepson RE, Elliott J, Brodbelt D, Syme HM. Effect of Control of Systolic Blood Pressure on Survival in Cats with Systemic Hypertension. Journal of Veterinary Internal Medicine. 2007;21(3):402-9.
13. Bijsmans ES, Doig M, Jepson RE, Syme HM, Elliott J, Pelligand L. Factors Influencing the Relationship Between the Dose of Amlodipine Required for Blood Pressure Control and Change in Blood Pressure in Hypertensive Cats. J Vet Int Med. 2016;30(5):1939-676.
14. Huhtinen M, Derré G, Renoldi HJ, Rinkinen M, Adler K, Aspegrén J, et al. Randomized Placebo-Controlled Clinical Trial of a Chewable Formulation of Amlodipine for the Treatment of Hypertension in Client-Owned Cats. Journal of Veterinary Internal Medicine. 2015;29(3):786-93.
15. Mathur S, Syme HM, Brown CA, Elliott J, Moore PA, Newell MA, et al. Effects of the calcium channel antagonist amlodipine in cats with surgically induced hypertensive renal insufficiency. Am J Vet Res. 2002;63(6):833-9.
16. McLeland SM, Lunn KF, Duncan CG, Refsal KR, Quimby JM. Relationship among serum creatinine, serum gastrin, calcium-phosphorus product, and uremic gastropathy in cats with chronic kidney disease. J Vet Intern Med. 2014 May-Jun;28(3):827-37. PubMed PMID: 24628683.
17. Quimby JM, 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 Sep;197(3):651-5. PubMed PMID: 23838205.
18. Quimby JM, Brock WT, Moses K, Bolotin D, Patricelli K. Chronic use of maropitant for the management of vomiting and inappetence in cats with chronic kidney disease: a blinded placebo-controlled clinical trial. J Feline Med Surg. 2014 Oct 21. PubMed PMID: 25336450.
An Urban Experience
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