Long term treatment with meloxicam in cats

Gowan RA, Baral RM, Lingard AE, et al. A retrospective analysis of the effects of meloxicam on the longevity of aged cats with and without overt chronic kidney disease. J Feline Med Surg. 2012; 14: 876-81.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed pharmaceuticals for the treatment of pain and inflammation in humans, dogs, and horses. Meloxicam is metabolized primarily through the oxidative pathway rather than the glucuronidation pathway, an important factor in limiting toxicity in cats. The dependence of many NSAIDs on the glucuronidation pathway is part of the reason for the cat’s susceptibility to NSAID toxicity. Meloxicam is a COX-2 selective inhibitor with a COX-1/COX-2 ratio of inhibition of 2.7; thus, adverse effects of meloxicam are still of concern and primarily involve the gastrointestinal tract and kidneys due to the dependence of these organs on COX-1 for health. In the European Union, Switzerland, Australia, and New Zealand, meloxicam is licensed for long-term treatment of chronic pain in cats. In the United States, meloxicam has a black box label for avoiding its repeated use due to an increased risk of acute renal failure and death. This unacceptable risk has not been a concern in other countries, possibly due to better patient selection and the lower doses used. Regardless of licensed or extra-label use of meloxicam, previous studies have shown that it can be administered safely to aged cats with or without chronic kidney disease (CKD), at least at low therapeutic doses and provided they are clinically stable and monitored carefully.



This study builds on previous work of Gunew et al. and Gowan et al. and further examines the effect of long-term meloxicam administration on renal function in cats with and without pre-existing CKD by providing long-term survival data. A total of 82 cats were enrolled in the study of which 47 had CKD and 35 did not have evidence of overt CKD. Treatment with meloxicam did not appear to decrease longevity in cats with pre-existing CKD, as survival times (median 1608 days) were not reduced when compared with previously published data. Quality of life is a major concern for cat owners, in particular with regard to chronic painful conditions. In conclusion, these authors recommend that meloxicam should be considered as part of a therapeutic regimen in cats with chronic painful conditions, with or without overt stable CKD. [GO]

See also:
Sparkes AH, Heiene R, Lascelles BDX, et al. ISFM and AAFP consensus guidelines: Long-term use of NSAIDs in cats. J Feline Med Surg. 2010; 12: 521-38.

Gowan RA, Lingard AE, Johnston L, Stansen W, Brown SA and Malik R. Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease. J Feline Med Surg. 2011; 13: 752-61. 

Related blog articles:
Meloxicam for feline arthritis (June 2008)
Cats and arthritis (2009)

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Gowan RA, Baral RM, Lingard AE, et al. A retrospective analysis of the effects of meloxicam on the longevity of aged cats with and without overt chronic kidney disease. J Feline Med Surg. 2012; 14: 876-81.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed pharmaceuticals for the treatment of pain and inflammation in humans, dogs, and horses. Meloxicam is metabolized primarily through the oxidative pathway rather than the glucuronidation pathway, an important factor in limiting toxicity in cats. The dependence of many NSAIDs on the glucuronidation pathway is part of the reason for the cat’s susceptibility to NSAID toxicity. Meloxicam is a COX-2 selective inhibitor with a COX-1/COX-2 ratio of inhibition of 2.7; thus, adverse effects of meloxicam are still of concern and primarily involve the gastrointestinal tract and kidneys due to the dependence of these organs on COX-1 for health. In the European Union, Switzerland, Australia, and New Zealand, meloxicam is licensed for long-term treatment of chronic pain in cats. In the United States, meloxicam has a black box label for avoiding its repeated use due to an increased risk of acute renal failure and death. This unacceptable risk has not been a concern in other countries, possibly due to better patient selection and the lower doses used. Regardless of licensed or extra-label use of meloxicam, previous studies have shown that it can be administered safely to aged cats with or without chronic kidney disease (CKD), at least at low therapeutic doses and provided they are clinically stable and monitored carefully.



This study builds on previous work of Gunew et al. and Gowan et al. and further examines the effect of long-term meloxicam administration on renal function in cats with and without pre-existing CKD by providing long-term survival data. A total of 82 cats were enrolled in the study of which 47 had CKD and 35 did not have evidence of overt CKD. Treatment with meloxicam did not appear to decrease longevity in cats with pre-existing CKD, as survival times (median 1608 days) were not reduced when compared with previously published data. Quality of life is a major concern for cat owners, in particular with regard to chronic painful conditions. In conclusion, these authors recommend that meloxicam should be considered as part of a therapeutic regimen in cats with chronic painful conditions, with or without overt stable CKD. [GO]

See also:
Sparkes AH, Heiene R, Lascelles BDX, et al. ISFM and AAFP consensus guidelines: Long-term use of NSAIDs in cats. J Feline Med Surg. 2010; 12: 521-38.

Gowan RA, Lingard AE, Johnston L, Stansen W, Brown SA and Malik R. Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease. J Feline Med Surg. 2011; 13: 752-61. 

Related blog articles:
Meloxicam for feline arthritis (June 2008)
Cats and arthritis (2009)

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Treatment of anemia in cats with chronic kidney disease

Final report: Winn grant W11-035
Vapniarsky N, Lame M, McDonnel S and Murphy B. A lentiviral gene therapy strategy for the in vitro production of feline erythropoietin. PLoS ONE. 2012; 7: e45099. [free, full text] 
 
A common problem in domestic cats with chronic renal failure (CRF) is non-regenerative anemia. Currently, the administration of recombinant human erythropoietin (rHuEPO) frequently only improves anemia temporarily due to antibody development. Antibodies can develop within the first few months of rHuEPO administration. A clinically significant reaction has been reported in 20-70% of feline patients receiving rHuEPO. Adverse reactions reported with the use of rHUEPO in cats are refractory anemia, systemic hypertension, polycythemia, seizures, vomiting, iron deficiency, injection discomfort, cellulitis, cutaneous or mucocutaneous reactions, and arthralgia. Several therapeutic strategies utilizing species-specific recombinant EPO have attempted to address this issue of immunogenicity in cats.

In this study, the researchers wanted to investigate a possible gene delivery system for treatment of CRF-associated non-regenerative anemia that would have limited or no secondary immunogenicity, have stable and native transgene expression, and the ability to transduce both dividing and non-dividing cells. They looked at the ability of replication-incompetent lentiviral vectors to fulfill this list of requirements. They established an in vitro study system where feline erythropoietin cDNA was cloned from feline renal tissue and utilized in construction of a replication-defective lentiviral vector. The recombinant feline erythropoietin sequence was confirmed by subsequent sequencing. The results demonstrated the feasibility of this type of in vitro delivery system for the production of biologically active feline erythropoietin. In the future, cats with anemia due to CRF may benefit from a lentiviral gene therapy system. [VT]

See also: Chalhoub S, Langston CE and Farrelly J. The use of darbepoetin to stimulate erythropoiesis in anemia of chronic kidney disease in cats: 25 cases. J Vet Intern Med. 2012; 26: 363-9.

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Final report: Winn grant W11-035
Vapniarsky N, Lame M, McDonnel S and Murphy B. A lentiviral gene therapy strategy for the in vitro production of feline erythropoietin. PLoS ONE. 2012; 7: e45099. [free, full text] 
 
A common problem in domestic cats with chronic renal failure (CRF) is non-regenerative anemia. Currently, the administration of recombinant human erythropoietin (rHuEPO) frequently only improves anemia temporarily due to antibody development. Antibodies can develop within the first few months of rHuEPO administration. A clinically significant reaction has been reported in 20-70% of feline patients receiving rHuEPO. Adverse reactions reported with the use of rHUEPO in cats are refractory anemia, systemic hypertension, polycythemia, seizures, vomiting, iron deficiency, injection discomfort, cellulitis, cutaneous or mucocutaneous reactions, and arthralgia. Several therapeutic strategies utilizing species-specific recombinant EPO have attempted to address this issue of immunogenicity in cats.

In this study, the researchers wanted to investigate a possible gene delivery system for treatment of CRF-associated non-regenerative anemia that would have limited or no secondary immunogenicity, have stable and native transgene expression, and the ability to transduce both dividing and non-dividing cells. They looked at the ability of replication-incompetent lentiviral vectors to fulfill this list of requirements. They established an in vitro study system where feline erythropoietin cDNA was cloned from feline renal tissue and utilized in construction of a replication-defective lentiviral vector. The recombinant feline erythropoietin sequence was confirmed by subsequent sequencing. The results demonstrated the feasibility of this type of in vitro delivery system for the production of biologically active feline erythropoietin. In the future, cats with anemia due to CRF may benefit from a lentiviral gene therapy system. [VT]

See also: Chalhoub S, Langston CE and Farrelly J. The use of darbepoetin to stimulate erythropoiesis in anemia of chronic kidney disease in cats: 25 cases. J Vet Intern Med. 2012; 26: 363-9.

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Renal secondary hyperparathyroidism in cats

Finch NC, Syme HM and Elliott J. Parathyroid hormone concentration in geriatric cats with various degrees of renal function. J Am Vet Med Assoc. 2012; 241: 1326-35.
 
Chronic kidney disease (CKD) in cats is commonly associated with an increase in plasma parathyroid hormone (PTH) and is known as renal secondary hyperparathyroidism. PTH is a primary regulator of calcium and phosphorus homeostasis. PTH secretion is stimulated when parathyroid gland calcium-sensing receptors detect a low ionized calcium plasma concentration. Cats with CKD have decreased glomerular filtration rate resulting in phosphate retention. Retained phosphate complexes with ionized calcium leading to reduction in ionized calcium concentration and an increase in PTH. The prevalence of hyperparathyroidism in cats with CKD has previously been reported to be as high as 84%. PTH is regarded as a uremic toxin and elevated levels are suggested to contribute to renal damage and increase morbidity and mortality. Clinical consequences of increased PTH concentration include renal osteodystrophy, soft tissue calcification, glucose and lipid metabolic disturbances, contribution to immunosuppression and anemia, and neurologic and cardiovascular dysfunction. Therefore, recognition of the stage of CKD at which plasma PTH concentrations increase and management of renal secondary hyperparathyroidism is important in cats.
 
The authors of this paper enrolled 118 clinically normal geriatric cats (over 9 years) with various degrees of renal disease. Cats were monitored for 12 months after which time they were categorized into 1 of 3 groups. Group 1 cats were basically non-azotemic with adequate urine concentrating ability, group 2 cats were mildly azotemic (creatinine between 1.6-2 mg/dL, or creatinine > 2.0 mg/dL with USG > 1.035), and group 3 cats were azotemic (creatinine > 2.0 mg/dL with USG < 1.035). This study revealed that plasma PTH concentration could increase in non-azotemic cats that subsequently developed azotemia, compared with cats remaining non-azotemic, in the absence of concurrent hypocalcemia or hyperphosphatemia. Traditionally, the pathophysiologic mechanism for the development of renal secondary hyperparathyroidism in cats with CKD was thought to only involve disturbances in calcium and phosphate homeostasis. Therefore, this study suggests other factors are involved in the development of renal secondary hyperparathyroidism. Other factors discussed included age, decreased ionized calcium rather than total calcium concentrations, hypomagnesemia, decreased expression of calcium-sensing receptors, and increased fibroblast growth factor-23 concentration. A positive correlation was noted between increased PTH and calcitriol concentrations, but the role of calcitriol in the development of renal secondary hyperparathyroidism in cats remains unclear. [GO]

See also: Kidder AC and Chew D. Treatment options for hyperphosphatemia in feline CKD: What's out there? Journal of Feline Medicine & Surgery. 2009; 11: 913-24.

Related blog articles:
Survival of cats with kidney disease (September 2008)
Predictors of feline kidney disease (August 2009)
Improving treatment of feline kidney disease; 2012 Winn grant (May 2012)

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Winn Feline Foundation Library
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Finch NC, Syme HM and Elliott J. Parathyroid hormone concentration in geriatric cats with various degrees of renal function. J Am Vet Med Assoc. 2012; 241: 1326-35.
 
Chronic kidney disease (CKD) in cats is commonly associated with an increase in plasma parathyroid hormone (PTH) and is known as renal secondary hyperparathyroidism. PTH is a primary regulator of calcium and phosphorus homeostasis. PTH secretion is stimulated when parathyroid gland calcium-sensing receptors detect a low ionized calcium plasma concentration. Cats with CKD have decreased glomerular filtration rate resulting in phosphate retention. Retained phosphate complexes with ionized calcium leading to reduction in ionized calcium concentration and an increase in PTH. The prevalence of hyperparathyroidism in cats with CKD has previously been reported to be as high as 84%. PTH is regarded as a uremic toxin and elevated levels are suggested to contribute to renal damage and increase morbidity and mortality. Clinical consequences of increased PTH concentration include renal osteodystrophy, soft tissue calcification, glucose and lipid metabolic disturbances, contribution to immunosuppression and anemia, and neurologic and cardiovascular dysfunction. Therefore, recognition of the stage of CKD at which plasma PTH concentrations increase and management of renal secondary hyperparathyroidism is important in cats.
 
The authors of this paper enrolled 118 clinically normal geriatric cats (over 9 years) with various degrees of renal disease. Cats were monitored for 12 months after which time they were categorized into 1 of 3 groups. Group 1 cats were basically non-azotemic with adequate urine concentrating ability, group 2 cats were mildly azotemic (creatinine between 1.6-2 mg/dL, or creatinine > 2.0 mg/dL with USG > 1.035), and group 3 cats were azotemic (creatinine > 2.0 mg/dL with USG < 1.035). This study revealed that plasma PTH concentration could increase in non-azotemic cats that subsequently developed azotemia, compared with cats remaining non-azotemic, in the absence of concurrent hypocalcemia or hyperphosphatemia. Traditionally, the pathophysiologic mechanism for the development of renal secondary hyperparathyroidism in cats with CKD was thought to only involve disturbances in calcium and phosphate homeostasis. Therefore, this study suggests other factors are involved in the development of renal secondary hyperparathyroidism. Other factors discussed included age, decreased ionized calcium rather than total calcium concentrations, hypomagnesemia, decreased expression of calcium-sensing receptors, and increased fibroblast growth factor-23 concentration. A positive correlation was noted between increased PTH and calcitriol concentrations, but the role of calcitriol in the development of renal secondary hyperparathyroidism in cats remains unclear. [GO]

See also: Kidder AC and Chew D. Treatment options for hyperphosphatemia in feline CKD: What's out there? Journal of Feline Medicine & Surgery. 2009; 11: 913-24.

Related blog articles:
Survival of cats with kidney disease (September 2008)
Predictors of feline kidney disease (August 2009)
Improving treatment of feline kidney disease; 2012 Winn grant (May 2012)

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Kidney disease in cats and people

Poli A, Tozon N, Guidi G and Pistello M. Renal alterations in feline immunodeficiency virus (FIV)-infected cats: a natural model of lentivirus-induced renal disease changes. Viruses. 2012; 4: 1372-89. [Free, full text article]
 
Human immunodeficiency virus (HIV) is associated with severe kidney disease including acute and chronic renal failure, but the underlying pathogenic mechanisms are unclear. HIV and feline immunodeficiency virus (FIV) are closely related viruses so that disease in cats may be a model for disease in humans. Both human and feline patients may live for many years after infection and suffer from chronic diseases. While kidney disease has been documented in cats with FIV, no detailed description of the kidney lesions has been published.

The investigators, working at the University of Pisa in Italy, examined kidneys from 72 cats infected with FIV. They found and described pathologic changes in the kidneys of cats with FIV that are similar to those in humans with HIV. A high proportion of the cats were affected. Thus they conclude that FIV may cause kidney changes, perhaps leading to kidney disease in infected cats. [MK]

See also: Baxter KJ, Levy JK, Edinboro CH, Vaden SL and Tompkins MB. Renal disease in cats infected with feline immunodeficiency virus. J Vet Intern Med. 2012; 26: 238-43.

Related blog articles:
FIV and kidney disease in cats (February 2010)
FIV and kidney disease (October 2012)

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Poli A, Tozon N, Guidi G and Pistello M. Renal alterations in feline immunodeficiency virus (FIV)-infected cats: a natural model of lentivirus-induced renal disease changes. Viruses. 2012; 4: 1372-89. [Free, full text article]
 
Human immunodeficiency virus (HIV) is associated with severe kidney disease including acute and chronic renal failure, but the underlying pathogenic mechanisms are unclear. HIV and feline immunodeficiency virus (FIV) are closely related viruses so that disease in cats may be a model for disease in humans. Both human and feline patients may live for many years after infection and suffer from chronic diseases. While kidney disease has been documented in cats with FIV, no detailed description of the kidney lesions has been published.

The investigators, working at the University of Pisa in Italy, examined kidneys from 72 cats infected with FIV. They found and described pathologic changes in the kidneys of cats with FIV that are similar to those in humans with HIV. A high proportion of the cats were affected. Thus they conclude that FIV may cause kidney changes, perhaps leading to kidney disease in infected cats. [MK]

See also: Baxter KJ, Levy JK, Edinboro CH, Vaden SL and Tompkins MB. Renal disease in cats infected with feline immunodeficiency virus. J Vet Intern Med. 2012; 26: 238-43.

Related blog articles:
FIV and kidney disease in cats (February 2010)
FIV and kidney disease (October 2012)

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Ragdoll cats and kidney disease

Paepe D, Saunders JH, Bavegems V, et al. Screening of ragdoll cats for kidney -disease: a retrospective evaluation. J Small Anim Pract. 2012; 53: 572-7.

A very popular cat breed worldwide is the Ragdoll. Ragdoll breeders often advise clients to watch for future renal disease in their cats. Most of these questions center around potential chronic interstitial nephritis and polycystic kidney disease (PKD). There is minimal scientific evidence regarding risk of renal disease in this breed. The Veterinary Medical College at Ghent University in Belgium performed a retrospective evaluation of Ragdolls screened for renal disease over an 8-year period. The screening methods included abdominal ultrasonography, measurement of serum creatinine and urea concentrations, and genetic testing for the PKD-1 mutation. The study population was made up of 244 Ragdoll cats: 172 females and 72 males.
 
In this study, 8.6% of the screened cats showed ultrasonographic abnormalities that could be compatible with chronic kidney disease (CKD). The suspected CKD cats were significantly older and had significantly higher urea and creatinine concentrations compared to cats with normal ultrasound results. Ragdolls are one of the breeds that have been outcrossed with Persians, so Ragdoll cats could be at risk for PKD. The researchers found a PKD prevalence of less than 3% in the study cats, considerably lower than the 31-42% prevalence of PKD described in European studies of Persians and related cats. Only one PKD-positive and one suspected PKD-positive Ragdoll cat were noted in the last 7 years of the study. This could mean that PKD screening before breeding is effective at eradicating PKD in this breed. All genetically tested cats tested negative for PKD.

In conclusion, almost 10% of this healthy Ragdoll population had ultrasonographic findings compatible with CKD, and PKD occurs at a low prevalence in Ragdoll cats in Belgium and the Netherlands. [VT]

See also: Heiene R, Rumsby G, Ziener M, et al. Chronic kidney disease with three cases of oxalate-like nephrosis in Ragdoll cats. Journal of Feline Medicine & Surgery. 2009; 11: 474-80.

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Paepe D, Saunders JH, Bavegems V, et al. Screening of ragdoll cats for kidney -disease: a retrospective evaluation. J Small Anim Pract. 2012; 53: 572-7.

A very popular cat breed worldwide is the Ragdoll. Ragdoll breeders often advise clients to watch for future renal disease in their cats. Most of these questions center around potential chronic interstitial nephritis and polycystic kidney disease (PKD). There is minimal scientific evidence regarding risk of renal disease in this breed. The Veterinary Medical College at Ghent University in Belgium performed a retrospective evaluation of Ragdolls screened for renal disease over an 8-year period. The screening methods included abdominal ultrasonography, measurement of serum creatinine and urea concentrations, and genetic testing for the PKD-1 mutation. The study population was made up of 244 Ragdoll cats: 172 females and 72 males.
 
In this study, 8.6% of the screened cats showed ultrasonographic abnormalities that could be compatible with chronic kidney disease (CKD). The suspected CKD cats were significantly older and had significantly higher urea and creatinine concentrations compared to cats with normal ultrasound results. Ragdolls are one of the breeds that have been outcrossed with Persians, so Ragdoll cats could be at risk for PKD. The researchers found a PKD prevalence of less than 3% in the study cats, considerably lower than the 31-42% prevalence of PKD described in European studies of Persians and related cats. Only one PKD-positive and one suspected PKD-positive Ragdoll cat were noted in the last 7 years of the study. This could mean that PKD screening before breeding is effective at eradicating PKD in this breed. All genetically tested cats tested negative for PKD.

In conclusion, almost 10% of this healthy Ragdoll population had ultrasonographic findings compatible with CKD, and PKD occurs at a low prevalence in Ragdoll cats in Belgium and the Netherlands. [VT]

See also: Heiene R, Rumsby G, Ziener M, et al. Chronic kidney disease with three cases of oxalate-like nephrosis in Ragdoll cats. Journal of Feline Medicine & Surgery. 2009; 11: 474-80.

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FIV and kidney disease

Baxter KJ, Levy JK, Edinboro CH, Vaden SL and Tompkins MB. Renal disease in cats infected with feline immunodeficiency virus. J Vet Intern Med. 2012; 26: 238-43.
 
In people infected with human immunodeficiency virus (HIV), renal disease is the fourth most common cause of death. Feline immunodeficiency virus (FIV) causes similar clinical syndromes to HIV in humans (e.g., immune dysregulation, opportunistic infections, inflammatory diseases, and neoplasia). The seroprevalence of FIV in cats in North America is estimated to be 3.6-4.3%, with the highest prevalence found in adult male, sick, and free-roaming cats. The authors used a mixed retrospective/prospective cross-sectional study of client-owned cats (153 FIV-infected, 306 FIV-uninfected) and specific-pathogen-free (SPF) research colony cats (95 FIV-infected, 98 FIV-uninfected). The researchers hypothesized that cats infected with FIV are at increased risk of proteinuria, and that proteinuria is associated with advanced FIV infection and comorbidity factors contribute to the prevalence of renal disease. 

Comparisons were made by evaluating blood urea nitrogen, serum creatinine, urine specific gravity, and urine protein-creatinine (UPC) ratio between infected and uninfected cats. Also CD4+ and CD8+ T lymphocytes were measured and the ratio was calculated. Renal azotemia was defined as a serum creatinine > 1.9 mg/dL with urine specific gravity < 1.035. Proteinuria was defined as a UPC ratio > 0.4 with an inactive urine sediment. The results indicated that the prevalence of proteinuria was higher in client-owned FIV-infected cats than in FIV-uninfected cats. Yet, there was no significant difference in the prevalence of azotemia. The authors believe that using their classification system, being considered “diseased” was not a risk factor for proteinuria in FIV-infected cats. The primary conclusion from the study was that client-owned cats with naturally acquired FIV infection were at increased risk of proteinuria, but not renal azotemia. The cause and pathogenesis of this proteinuria is uncertain. [VT]

See also: Poli A, Abramo F, Matteucci D, et al. Renal involvement in feline immunodeficiency virus infection: p24 antigen detection, virus isolation and PCR analysis. Vet Immunol Immunopathol. 1995; 46: 13-20.

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Baxter KJ, Levy JK, Edinboro CH, Vaden SL and Tompkins MB. Renal disease in cats infected with feline immunodeficiency virus. J Vet Intern Med. 2012; 26: 238-43.
 
In people infected with human immunodeficiency virus (HIV), renal disease is the fourth most common cause of death. Feline immunodeficiency virus (FIV) causes similar clinical syndromes to HIV in humans (e.g., immune dysregulation, opportunistic infections, inflammatory diseases, and neoplasia). The seroprevalence of FIV in cats in North America is estimated to be 3.6-4.3%, with the highest prevalence found in adult male, sick, and free-roaming cats. The authors used a mixed retrospective/prospective cross-sectional study of client-owned cats (153 FIV-infected, 306 FIV-uninfected) and specific-pathogen-free (SPF) research colony cats (95 FIV-infected, 98 FIV-uninfected). The researchers hypothesized that cats infected with FIV are at increased risk of proteinuria, and that proteinuria is associated with advanced FIV infection and comorbidity factors contribute to the prevalence of renal disease. 

Comparisons were made by evaluating blood urea nitrogen, serum creatinine, urine specific gravity, and urine protein-creatinine (UPC) ratio between infected and uninfected cats. Also CD4+ and CD8+ T lymphocytes were measured and the ratio was calculated. Renal azotemia was defined as a serum creatinine > 1.9 mg/dL with urine specific gravity < 1.035. Proteinuria was defined as a UPC ratio > 0.4 with an inactive urine sediment. The results indicated that the prevalence of proteinuria was higher in client-owned FIV-infected cats than in FIV-uninfected cats. Yet, there was no significant difference in the prevalence of azotemia. The authors believe that using their classification system, being considered “diseased” was not a risk factor for proteinuria in FIV-infected cats. The primary conclusion from the study was that client-owned cats with naturally acquired FIV infection were at increased risk of proteinuria, but not renal azotemia. The cause and pathogenesis of this proteinuria is uncertain. [VT]

See also: Poli A, Abramo F, Matteucci D, et al. Renal involvement in feline immunodeficiency virus infection: p24 antigen detection, virus isolation and PCR analysis. Vet Immunol Immunopathol. 1995; 46: 13-20.

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Hyperthyroidism and kidney disease in cats

Progress report, Winn grant 09-013
Identification of a biomarker for masked renal failure in hyperthyroid cats
Investigator: Thomas Schermerhorn, Kansas State University and collaborators
 
These researchers are trying to improve diagnosis and prognosis of cats with both hyperthyroidism and kidney disease, two common ailments of aging cats. Often, hyperthyroidism masks underlying kidney disease until it is revealed during treatment. The investigators are attempting to define a method for identifying the kidney disease before treatment of hyperthyroidism. This would improve the well-being of the cat as well as its life expectancy. To do this, they are analyzing the urine of hyperthyroid cats using a cutting-edge technique to identify literally thousands of urine components to see if any correlate with post-treatment appearance of kidney disease.

It has been a challenge acquiring sufficient numbers of cases of cats with hyperthyroidism able to participate in the study. Despite this, analysis is ongoing. To date, no identifiable correlate with renal disease has been found. However, the urine composition of hyperthyroid cats has been determined at a much more detailed level, which may allow future diagnosis of this condition via a simple urine test. [MK]

See also: Riensche MR, Graves TK, Schaeffer DJ. An investigation of predictors of renal insufficiency following treatment of hyperthyroidism in cats. J Feline Med Surg 2008;10:160-166.

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Progress report, Winn grant 09-013
Identification of a biomarker for masked renal failure in hyperthyroid cats
Investigator: Thomas Schermerhorn, Kansas State University and collaborators
 
These researchers are trying to improve diagnosis and prognosis of cats with both hyperthyroidism and kidney disease, two common ailments of aging cats. Often, hyperthyroidism masks underlying kidney disease until it is revealed during treatment. The investigators are attempting to define a method for identifying the kidney disease before treatment of hyperthyroidism. This would improve the well-being of the cat as well as its life expectancy. To do this, they are analyzing the urine of hyperthyroid cats using a cutting-edge technique to identify literally thousands of urine components to see if any correlate with post-treatment appearance of kidney disease.

It has been a challenge acquiring sufficient numbers of cases of cats with hyperthyroidism able to participate in the study. Despite this, analysis is ongoing. To date, no identifiable correlate with renal disease has been found. However, the urine composition of hyperthyroid cats has been determined at a much more detailed level, which may allow future diagnosis of this condition via a simple urine test. [MK]

See also: Riensche MR, Graves TK, Schaeffer DJ. An investigation of predictors of renal insufficiency following treatment of hyperthyroidism in cats. J Feline Med Surg 2008;10:160-166.

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Improving treatment of feline kidney disease

Winn grant W12-039
Administration of pimobendan to cats with chronic kidney disease
Investigators: Mary Anna Labato, Brandi R. Gallagher, John Rush; Tufts University

Chronic kidney disease (CKD) is one of the most common reasons geriatric cats present to the veterinarian. CKD is considered irreversible and progressive, and effective treatments are limited. A common co-existing condition seen in feline CKD patients is heart disease. Two of the investigators in this study have administered pimobendan to cats with combined kidney and heart disease. The patients had developed congestive heart failure (CHF) secondary to intravenous fluid administration, a typical standard of care for kidney disease. In some of these patients, addition of pimobendan resulted in a great improvement in kidney values and clinical response. Tolerability and safety of this drug has already been established in cats with heart disease. This will be a pilot study to assess the tolerability of pimobendan in cats with CKD and search for benefits in comparison to the current standard of care. Investigating these observations in a larger study will help establish whether pimobendan could be a novel treatment for cats with CKD. 

This project is available for sponsorship. When you sponsor a project, your name will be added to the list of the project's supporters on our website and in any publications we produce about the project. You will receive exclusive pre-publication reports on the progress of your chosen project as they become available, and a final report at its conclusion.

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Winn grant W12-039
Administration of pimobendan to cats with chronic kidney disease
Investigators: Mary Anna Labato, Brandi R. Gallagher, John Rush; Tufts University

Chronic kidney disease (CKD) is one of the most common reasons geriatric cats present to the veterinarian. CKD is considered irreversible and progressive, and effective treatments are limited. A common co-existing condition seen in feline CKD patients is heart disease. Two of the investigators in this study have administered pimobendan to cats with combined kidney and heart disease. The patients had developed congestive heart failure (CHF) secondary to intravenous fluid administration, a typical standard of care for kidney disease. In some of these patients, addition of pimobendan resulted in a great improvement in kidney values and clinical response. Tolerability and safety of this drug has already been established in cats with heart disease. This will be a pilot study to assess the tolerability of pimobendan in cats with CKD and search for benefits in comparison to the current standard of care. Investigating these observations in a larger study will help establish whether pimobendan could be a novel treatment for cats with CKD. 

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Azodyl in cats with chronic kidney disease

Rishniw M and Wynn SG. Azodyl, a synbiotic, fails to alter azotemia in cats with chronic kidney disease when sprinkled onto food. Journal of feline medicine and surgery. 2011; 13: 405-9.

A probiotic-prebiotic combination therapy (known as a “synbiotic”) was investigated for its ability to aid in reducing azotemia in cats with chronic kidney disease (CKD). Specific bacteria are used in the product that are capable of metabolizing urea and creatinine into non-toxic metabolites. One synbiotic, Azodyl, contains strains of three naturally occurring bacteria (Streptococcus (enterococcus) thermophiles, Lactobacillus acidophilus, and Bifodobacterium longum) combined with a prebiotic (psyllium husk) in an enteric-coated capsule that releases the contents within the contents within the ileo-colic region. Studies in humans have suggested that synbiotic therapy can alter azotemia in patients with CKD. The manufacturer of Azodyl recommends administering the synbiotic product capsules intact where many cat owners prefer to administer such products by mixing the contents with food. This study was a double-blinded, controlled evaluation of 10 cats with naturally occurring CKD that were randomized to receive either Azodyl or psyllium husk (prebiotic only) for 2 months. The medications were sprinkled into food or given as a slurry. Blood urea nitrogen and creatinine were measured twice prior to administration of the medication, and then monthly for 2 months during the study. The study found that Azodyl when applied to food or administered as a slurry failed to reduce azotemia in cats with CKD. The moral of this story is that it is important to follow the manufacturer’s recommendations when administering medications. [VT] 


Related articles: King JN, Tasker S, Gunn-Moore DA and Strehlau G. Prognostic factors in cats with chronic kidney disease. J Vet Intern Med. 2007; 21: 906-16. 

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Rishniw M and Wynn SG. Azodyl, a synbiotic, fails to alter azotemia in cats with chronic kidney disease when sprinkled onto food. Journal of feline medicine and surgery. 2011; 13: 405-9.

A probiotic-prebiotic combination therapy (known as a “synbiotic”) was investigated for its ability to aid in reducing azotemia in cats with chronic kidney disease (CKD). Specific bacteria are used in the product that are capable of metabolizing urea and creatinine into non-toxic metabolites. One synbiotic, Azodyl, contains strains of three naturally occurring bacteria (Streptococcus (enterococcus) thermophiles, Lactobacillus acidophilus, and Bifodobacterium longum) combined with a prebiotic (psyllium husk) in an enteric-coated capsule that releases the contents within the contents within the ileo-colic region. Studies in humans have suggested that synbiotic therapy can alter azotemia in patients with CKD. The manufacturer of Azodyl recommends administering the synbiotic product capsules intact where many cat owners prefer to administer such products by mixing the contents with food. This study was a double-blinded, controlled evaluation of 10 cats with naturally occurring CKD that were randomized to receive either Azodyl or psyllium husk (prebiotic only) for 2 months. The medications were sprinkled into food or given as a slurry. Blood urea nitrogen and creatinine were measured twice prior to administration of the medication, and then monthly for 2 months during the study. The study found that Azodyl when applied to food or administered as a slurry failed to reduce azotemia in cats with CKD. The moral of this story is that it is important to follow the manufacturer’s recommendations when administering medications. [VT] 


Related articles: King JN, Tasker S, Gunn-Moore DA and Strehlau G. Prognostic factors in cats with chronic kidney disease. J Vet Intern Med. 2007; 21: 906-16. 

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Feline Hyperthyroidism and Kidney Disease

Williams T, Elliott J, Syme H: Association of iatrogenic hypothyroidism with azotemia and reduced survival time in cats treated for hyperthyroidism, J Vet Intern Med 24:1086, 2010.

Within 6 months of treatment of hyperthyroidism, 17-49% of cats develop azotemia. Treatment to restore euthyroidism in cats results in a decrease in renal glomerular filtration rate (GFR) which can lead to the development of azotemia if underlying chronic renal disease (CRD) is present. Antithyroid treatment could lead to iatrogenic hypothyroidism and hypothyroidism has been correlated with reduced GFR. The authors performed two retrospective studies. The first study was of 12 hyperthyroid cats treated with radioiodine and documented as euthyroid after treatment where changes were assessed in plasma thyroid stimulating hormone (TSH) concentration over a 6-month follow-up period. The second study was of 75 hyperthyroid cats, documented as euthyroid, that were monitored 6 months after starting treatment to identify the relationship between thyroid status and the development of azotemia. Plasma TSH concentrations were not suppressed in 7 of 8 cats with hypothyroidism 3 months after radioiodine treatment. The study concluded that cats with iatrogenic hypothyroidism were more likely to develop azotemia within 6 months after treatment for hyperthyroidism than cats defined as euthyroid. Hypothyroid cats with azotemia had shorter survival times than non-azotemic cats.  There was no difference in survival times of euthyroid cats with or without azotemia.  [VT]

Related articles:
Williams TL, Peak KJ, Brodbelt D et al: Survival and the development of azotemia after treatment of hyperthyroid cats, J Vet Intern Med 24:863, 2010.

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Williams T, Elliott J, Syme H: Association of iatrogenic hypothyroidism with azotemia and reduced survival time in cats treated for hyperthyroidism, J Vet Intern Med 24:1086, 2010.

Within 6 months of treatment of hyperthyroidism, 17-49% of cats develop azotemia. Treatment to restore euthyroidism in cats results in a decrease in renal glomerular filtration rate (GFR) which can lead to the development of azotemia if underlying chronic renal disease (CRD) is present. Antithyroid treatment could lead to iatrogenic hypothyroidism and hypothyroidism has been correlated with reduced GFR. The authors performed two retrospective studies. The first study was of 12 hyperthyroid cats treated with radioiodine and documented as euthyroid after treatment where changes were assessed in plasma thyroid stimulating hormone (TSH) concentration over a 6-month follow-up period. The second study was of 75 hyperthyroid cats, documented as euthyroid, that were monitored 6 months after starting treatment to identify the relationship between thyroid status and the development of azotemia. Plasma TSH concentrations were not suppressed in 7 of 8 cats with hypothyroidism 3 months after radioiodine treatment. The study concluded that cats with iatrogenic hypothyroidism were more likely to develop azotemia within 6 months after treatment for hyperthyroidism than cats defined as euthyroid. Hypothyroid cats with azotemia had shorter survival times than non-azotemic cats.  There was no difference in survival times of euthyroid cats with or without azotemia.  [VT]

Related articles:
Williams TL, Peak KJ, Brodbelt D et al: Survival and the development of azotemia after treatment of hyperthyroid cats, J Vet Intern Med 24:863, 2010.

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FIV and Kidney Disease in Cats

White JD, Malik R, Norris JM, Malikides N. Association between naturally occurring chronic kidney disease and feline immunodeficiency virus infection status in cats. J Am Vet Med Assoc. Feb 15 2010;236(4):424-429.

Chronic kidney disease (CKD) is well known in older cats. In most cases, the underlying cause is never identified. CKD appears more common in young male cats and feline immunodeficiency virus (FIV) is also common in these cats, raising the question of whether the two are related. To investigate a potential association between chronic kidney disease and FIV in cats in Australia, a case-control study was designed. The study included 73 cats with CKD and 69 cats with no evidence of CKD. All cats were tested for FIV antibodies and information on age, breed and gender was gathered. The cats were divided into two age groups - under 11 years old and over 11 years old. Statistical analysis was performed to investigate any relationship between CKD and FIV, and with the other variables. Among cats under 11 years old, those with CKD were significantly more likely to be infected with FIV than cats without CKD. It was not possible to determine if infection with FIV occurred before the cats developed CKD. The role of FIV in the development of CKD disease requires further research. [SL]

Related articles:
White JD, Norris JM, Baral RM, Malik R. Naturally-occurring chronic renal disease in Australian cats: a prospective study of 184 cases. Aust Vet J. Jun 2006;84(6):188-194.

Norris JM, Bell ET, Hales L, et al. Prevalence of feline immunodeficiency virus infection in domesticated and feral cats in eastern Australia. J Feline Med Surg. Aug 2007;9(4):300-308.

More on cat health: Winn Feline Foundation Library
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New for 2010: subscribe to our e-newsletter

White JD, Malik R, Norris JM, Malikides N. Association between naturally occurring chronic kidney disease and feline immunodeficiency virus infection status in cats. J Am Vet Med Assoc. Feb 15 2010;236(4):424-429.

Chronic kidney disease (CKD) is well known in older cats. In most cases, the underlying cause is never identified. CKD appears more common in young male cats and feline immunodeficiency virus (FIV) is also common in these cats, raising the question of whether the two are related. To investigate a potential association between chronic kidney disease and FIV in cats in Australia, a case-control study was designed. The study included 73 cats with CKD and 69 cats with no evidence of CKD. All cats were tested for FIV antibodies and information on age, breed and gender was gathered. The cats were divided into two age groups - under 11 years old and over 11 years old. Statistical analysis was performed to investigate any relationship between CKD and FIV, and with the other variables. Among cats under 11 years old, those with CKD were significantly more likely to be infected with FIV than cats without CKD. It was not possible to determine if infection with FIV occurred before the cats developed CKD. The role of FIV in the development of CKD disease requires further research. [SL]

Related articles:
White JD, Norris JM, Baral RM, Malik R. Naturally-occurring chronic renal disease in Australian cats: a prospective study of 184 cases. Aust Vet J. Jun 2006;84(6):188-194.

Norris JM, Bell ET, Hales L, et al. Prevalence of feline immunodeficiency virus infection in domesticated and feral cats in eastern Australia. J Feline Med Surg. Aug 2007;9(4):300-308.

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New for 2010: subscribe to our e-newsletter

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Predictors of Feline Kidney Disease

Jepson, R. E., D. Brodbelt, et al. (2009). "Evaluation of predictors of the development of azotemia in cats." J Vet Intern Med 23(4): 806-13.

Chronic kidney disease (CKD) often afflicts geriatric cats, with prevalence rates of 15% reported. The important factors for development of CKD that could be monitored in cats are not known, and were investigated by these researchers. They followed healthy geriatric cats for 12 months (exams every six months), measuring various clinical parameters and correlated these with development of kidney disease. The study evaluated 118 client-owned cats with an average age of 13 years. All were neutered. Physical exams, blood pressure measurement, and blood and urine analyses were done on all cats. Thirty percent of the cats enrolled developed evidence of kidney disease (azotemia) during the study. Of the parameters measured, only two – increased levels of creatinine (including high normal levels) in the blood and detectable protein in the urine – correlated with development of kidney disease (as evidenced by azotemia). The authors concluded that measurement of protein in the urine is an inexpensive and easy way to monitor aging cats for development of CKD. [MK]
>> PubMed Abstract

Related articles:
King JN, Tasker S, Gunn-Moore DA, Strehlau G; BENRIC (benazepril in renal
insufficiency in cats) Study Group. Prognostic factors in cats with chronic kidney disease. J Vet Intern Med. 2007 Sep-Oct;21(5):906-16.
>> PubMed Abstract

Boyd LM, Langston C, Thompson K, Zivin K, Imanishi M. Survival in cats with
naturally occurring chronic kidney disease (2000-2002). J Vet Intern Med. 2008 Sep-Oct;22(5):1111-7.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library
Join us on Facebook

Jepson, R. E., D. Brodbelt, et al. (2009). "Evaluation of predictors of the development of azotemia in cats." J Vet Intern Med 23(4): 806-13.

Chronic kidney disease (CKD) often afflicts geriatric cats, with prevalence rates of 15% reported. The important factors for development of CKD that could be monitored in cats are not known, and were investigated by these researchers. They followed healthy geriatric cats for 12 months (exams every six months), measuring various clinical parameters and correlated these with development of kidney disease. The study evaluated 118 client-owned cats with an average age of 13 years. All were neutered. Physical exams, blood pressure measurement, and blood and urine analyses were done on all cats. Thirty percent of the cats enrolled developed evidence of kidney disease (azotemia) during the study. Of the parameters measured, only two – increased levels of creatinine (including high normal levels) in the blood and detectable protein in the urine – correlated with development of kidney disease (as evidenced by azotemia). The authors concluded that measurement of protein in the urine is an inexpensive and easy way to monitor aging cats for development of CKD. [MK]
>> PubMed Abstract

Related articles:
King JN, Tasker S, Gunn-Moore DA, Strehlau G; BENRIC (benazepril in renal
insufficiency in cats) Study Group. Prognostic factors in cats with chronic kidney disease. J Vet Intern Med. 2007 Sep-Oct;21(5):906-16.
>> PubMed Abstract

Boyd LM, Langston C, Thompson K, Zivin K, Imanishi M. Survival in cats with
naturally occurring chronic kidney disease (2000-2002). J Vet Intern Med. 2008 Sep-Oct;22(5):1111-7.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library
Join us on Facebook

Read More

Evaluation of Kidney Function in Cats

Heiene, R., B. S. Reynolds, et al. (2009). "Estimation of glomerular filtration rate via 2- and 4-sample plasma clearance of iohexol and creatinine in clinically normal cats." American Journal of Veterinary Research 70(2): 176-185.

Large numbers of elderly cats develop renal disease. Survival time after diagnosis is variable. The ability to estimate glomerular filtration rate (GFR) could lead to early detection of renal disease and allow earlier institution of therapeutic measures that protect renal function. GFR is considered the overall best indicator of renal function in healthy and diseased animals and is estimated by measurement of clearance of a marker substance. This study used 51 cats to compare 2 methods for estimating GFR, evaluate the effect of ages and body size and their interaction on GFR estimates, and establish reference ranges for GFR in clinically normal cats. The two contrast markers evaluated were iohexol and creatinine. No adverse drug reactions were noted with the use of iohexol for GFR estimation. GFR values were established in all the cats in the study. A difference in estimated GFR between young and old cats was not evident in this study. The study did find a small but significant effect of body size on estimated GFR and this was more important than the effect of age. The 4-sample method was a convenient and reliable means to establish GFR in cats with values considered normal or near normal. The 2-sample method also provided acceptable approximations for GFR and worked well in non-sedated cats. However, the 4-sample method is more accurate in cats with low renal function. Since body weight should be taken into account for estimating GFR, further studies are indicated to provide more information. [VT]
>> PubMed Abstract

Related articles:
van Hoek, I., H. P. Lefebvre, et al. (2008). "Plasma clearance of exogenous creatinine, exo-iohexol, and endo-iohexol in hyperthyroid cats before and after treatment with radioiodine." J Vet Intern Med 22(4): 879-885.
>> PubMed Abstract

van Hoek, I., E. Vandermeulen, et al. (2007). "Comparison and reproducibility of plasma clearance of exogenous creatinine, exo-iohexol, endo-iohexol, and 51Cr-EDTA in young adult and aged healthy cats." J Vet Intern Med 21(5): 950-8.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library

Heiene, R., B. S. Reynolds, et al. (2009). "Estimation of glomerular filtration rate via 2- and 4-sample plasma clearance of iohexol and creatinine in clinically normal cats." American Journal of Veterinary Research 70(2): 176-185.

Large numbers of elderly cats develop renal disease. Survival time after diagnosis is variable. The ability to estimate glomerular filtration rate (GFR) could lead to early detection of renal disease and allow earlier institution of therapeutic measures that protect renal function. GFR is considered the overall best indicator of renal function in healthy and diseased animals and is estimated by measurement of clearance of a marker substance. This study used 51 cats to compare 2 methods for estimating GFR, evaluate the effect of ages and body size and their interaction on GFR estimates, and establish reference ranges for GFR in clinically normal cats. The two contrast markers evaluated were iohexol and creatinine. No adverse drug reactions were noted with the use of iohexol for GFR estimation. GFR values were established in all the cats in the study. A difference in estimated GFR between young and old cats was not evident in this study. The study did find a small but significant effect of body size on estimated GFR and this was more important than the effect of age. The 4-sample method was a convenient and reliable means to establish GFR in cats with values considered normal or near normal. The 2-sample method also provided acceptable approximations for GFR and worked well in non-sedated cats. However, the 4-sample method is more accurate in cats with low renal function. Since body weight should be taken into account for estimating GFR, further studies are indicated to provide more information. [VT]
>> PubMed Abstract

Related articles:
van Hoek, I., H. P. Lefebvre, et al. (2008). "Plasma clearance of exogenous creatinine, exo-iohexol, and endo-iohexol in hyperthyroid cats before and after treatment with radioiodine." J Vet Intern Med 22(4): 879-885.
>> PubMed Abstract

van Hoek, I., E. Vandermeulen, et al. (2007). "Comparison and reproducibility of plasma clearance of exogenous creatinine, exo-iohexol, endo-iohexol, and 51Cr-EDTA in young adult and aged healthy cats." J Vet Intern Med 21(5): 950-8.
>> PubMed Abstract

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Read More

Survival of Cats with Kidney Disease

Boyd, L. M., C. Langston, et al. (2008). "Survival in Cats with Naturally Occurring Chronic Kidney Disease (2000-2002)." Journal of Veterinary Internal Medicine 22(5): 1111-1117.

Up to 20% of cats will be affected with chronic kidney disease (CKD) during their lifetime. The prevalence of CKD increases with age, so that almost 1/3 of cats over the age of 15 years are affected. The disease has unpredictable progression and variable presentation, making it difficult to perform long-term survival studies. The International Renal Interest Society (IRIS) has developed a classification scheme for CKD in dogs and cats that is often used in long-term studies. The purpose of this study was to determine the average survival time for a large populatoin of cats from a facility that sees both first and second opinion cases, and to determine if the IRIS stage at diagnosis and after correction of pre-renal azotemia are associated with survival time. The study population consisted of 211 client-owned cats enrolled between April 2000 and January 2002. Clinical characteristics, clinicopathologic data, and survival times were extracted from the medical records. Kaplan-Meier survival curves were performed to determine survival times. Median survival for cats in IRIS stage IIb at the time of diagnosis was 1,151 days, and was longer than survival in stage III (median 778 days) or stage IV (median 103 days). The researchers conclude that IRIS stage of CKD based on serum creatinine at the time of diagnosis is strongly predictive of survival in cats with naturally occurring CKD.
>> PubMed Abstract

Related articles:
Syme, H. M., P. J. Markwell, et al. (2006). "Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria." J Vet Intern Med 20(3): 528-35.
>> PubMed Abstract

Elliott, J., J. M. Rawlings, et al. (2000). "Survival of cats with naturally occurring chronic renal failure: effect of dietary management." J Small Anim Pract 41(6): 235-42.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library

Boyd, L. M., C. Langston, et al. (2008). "Survival in Cats with Naturally Occurring Chronic Kidney Disease (2000-2002)." Journal of Veterinary Internal Medicine 22(5): 1111-1117.

Up to 20% of cats will be affected with chronic kidney disease (CKD) during their lifetime. The prevalence of CKD increases with age, so that almost 1/3 of cats over the age of 15 years are affected. The disease has unpredictable progression and variable presentation, making it difficult to perform long-term survival studies. The International Renal Interest Society (IRIS) has developed a classification scheme for CKD in dogs and cats that is often used in long-term studies. The purpose of this study was to determine the average survival time for a large populatoin of cats from a facility that sees both first and second opinion cases, and to determine if the IRIS stage at diagnosis and after correction of pre-renal azotemia are associated with survival time. The study population consisted of 211 client-owned cats enrolled between April 2000 and January 2002. Clinical characteristics, clinicopathologic data, and survival times were extracted from the medical records. Kaplan-Meier survival curves were performed to determine survival times. Median survival for cats in IRIS stage IIb at the time of diagnosis was 1,151 days, and was longer than survival in stage III (median 778 days) or stage IV (median 103 days). The researchers conclude that IRIS stage of CKD based on serum creatinine at the time of diagnosis is strongly predictive of survival in cats with naturally occurring CKD.
>> PubMed Abstract

Related articles:
Syme, H. M., P. J. Markwell, et al. (2006). "Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria." J Vet Intern Med 20(3): 528-35.
>> PubMed Abstract

Elliott, J., J. M. Rawlings, et al. (2000). "Survival of cats with naturally occurring chronic renal failure: effect of dietary management." J Small Anim Pract 41(6): 235-42.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library

Read More