TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

 

FELINE RESEARCH AND PARTICIPATION OPPORTUNITIES

 

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CKD Studies Requiring Attendance


CKD Studies Not Requiring Attendance


Donating to CKD Research


Finding Other Research Studies


Closed CKD Studies


 

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WHAT IS CKD?


What Happens in CKD?


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The Importance of Phosphorus Control


All About Hypertension


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All About Constipation


Potassium Imbalances


Metabolic Acidosis


Kidney Stones


 

SUPPORT


Coping with CKD


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SYMPTOMS


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


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2007 Food Recall USA


 

FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


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How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


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Home > Feline Research and Participation Opportunities

 


Overview


  • There used to be very little research into feline CKD but fortunately that is changing.

  • It is sometimes possible to participate in research studies, both to help your cat and to help other CKD cats who should benefit from the research findings.

  • With some studies, you will need to attend the research facility, normally one of the main US vet schools. However, distance participation is possible with some of the studies.


CKD Studies Where Attendance is Necessary



Stem Cell Transplant: Animal Medical Center, NYC


 

Autogenous stem cell delivery for chronic kidney disease. Phase II: Efficacy

 

The Animal Medical Center is researching stem cell treatment in CKD cats. The cat needs to be not over 16 years old and must have no history of stones or any other illness, although controlled hypertension is acceptable.

 

The stem cells will be obtained from the cat's own fat, and will be transplanted into the cat's renal artery via the femoral artery under general anaesthetic.

 

Leah Soergel

Phone 212-329-8835

leah.soergel@amcny.org

 


Aluminium Concentrations: Ohio State University


 

Aluminum concentrations in cats with kidney disease

 

Since phosphorus levels often rise in CKD cats, treatments called phosphorus binders are often necessary, and one commonly used phosphorus binder is aluminium hydroxide. There is some concern about the possible risk of aluminium toxicity in cats using aluminium hydroxide based binders, but it is not known what is a normal aluminium level in cats. This study aims to ascertain normal blood aluminium levels in healthy cats and CKD cats, and check the effect of aluminium hydroxide binders on blood aluminium levels.

 

Participants must be healthy based on tests within the last week or alternatively have been diagnosed with CKD within the last week.

 

Phone (614) 247-8706

CVM-ClinicalTrials@osu.edu

 


Meloxicam: Kansas State University


 

Evaluation of the effectiveness of low-dose meloxicam (Metacam) in slowing the progression of renal dysfunction in cats with chronic kidney disease

 

Meloxicam is a non-steroidal anti-inflammatory (NSAID) which is commonly used post-surgery and which is sometimes used on an ongoing basis for problems such as arthritis. Two studies in Australia indicated that CKD cats given low doses of meloxicam appeared to be more stable, with improved quality of life and they lived longer than CKD cats who were not given low dose meloxicam. Ths double-blinded randomised study will investigate further. Unfortunately the nature of the study does not permit us to be told exactly what is meant by "low dose."

 

Cats with stable CKD with creatinine above 2 mg/dl and below 4 mg/dl are eligible to participate. Cats with proteinuria or hypertension are still eligible. Cats in the study may only eat the therapeutic kidney diet provided by the study, which will last six months. Participants will receive free testing at 1, 3 and 6 months and will be supplied with the therapeutic kidney diet.

 

Phone (785) 532-5555 or (785) 532-3046

clinicaltrials@vet.k-state.edu

 


Hyperammonaemia: Tufts University


 

Evaluation of hyperammonema in cats with renal azotemia

 

Azotaemia means there is increased nitrogenous waste in the bloodstream, i.e. BUN/urea and creatinine levels are elevated. Hyperammonaemia means elevated levels of ammonia. This study will examine the hypothesis that blood ammonia levels will be elevated in cats with renal azotaemia. If the ammonia levels are high, therapy will be used to reduce them. Vitamin B12 levels will also be checked and supplemented if they are low.

 

Cats with confirmed CKD with creatinine over 1.6 mg/dl are eligible. Cats with other diseases which may increase ammonia levels (e.g. portosystemic shunt) or a previously documented vitamin B12 deficiency are not eligible to participate. Cats taking medications which reduce ammonia levels such as lactulose or antibiotics may not participate.

 

clinicaltrials@tufts.edu

 


Ureteral Obstructions and Stent Placement: UC Davis


 

Evaluation of post-operative outcome in cats undergoing ureteral stent placement to relieve ureteral obstruction

 

This study is to assess the complications that may arise during and after the placement of a ureteral stent to relieve blockages. Bloodwork and urine output will be monitored, with visits required two weeks and three months after stent placement. Some of the blood tests and ultrasound tests will be paid for by the study.

 

Dr. Culp

Phone (530) 752-1393

wculp@ucdavis.edu

 


SDMA and Creatinine Levels in Cats with Blockages: Animal Medical Center, NYC


 

Assessment of symmetric dimethylarginine SDMA and creatinine concentrations in cats with post-renal obstructions before and after decompression of the obstruction

 

This study investigates the usefulness of SDMA, a new measure of kidney function, in cats with animals with post-renal azotemia (increased kidney values caused by obstructions of the ureters or urethra).

 

Dr. Kendall Wilson

212-329-8871

kendall.wilson@amcny.org

 


Studies Where Attendance is Not Necessary



Mirtazapine: Colorado State University


 

Assessment of transdermal mirtazapine as an appetite stimulant in cats with chronic kidney disease

 

Mirtazapine is commonly used as an appetite stimulant in CKD cats (see Persuading Your Cat to Eat). Colorado State University has been running trials into mirtazapine for CKD cats for some years. The current study is researching the effectiveness of mirtazapine when given transdermally (applied to the outside of the ear).

 

Cats with stable CKD with creatinine 2-5 mg/dl are eligible to participate. Cats with other illnesses such as hyperthyroidism or complications such as pyelonephritis are not eligible. The study requires three visits and medicating your cat for six weeks. Your vet can liaise with Colorado State University to arrange everything.

 

Dr Michael Lappin

Phone 970-297-0313

michael.lappin@colostate.edu

 


Kidney Samples from Cats with Kidney Stones: University of Minnesota


 

Cats with kidney stones and/or chronic kidney disease

 

Kidneys removed from cats with kidney stones (either as part of the treatment plan or from deceased cats) can be sent to the Minnesota Urolith Center to assist with research into kidney stones.

 

The study is open until 1 January 2018.

 

Dr. Lulich

Phone 612-625-4221

lulic001@umn.edu

support@urolithcenter.org

 


Telomere Senescence Study: Colorado State University


 

Telomeres are specialised protective structures located at the ends of chromosomes. The DNA component of telomeres gradually shortens with age and eventually becomes too short to allow protective structures to form and signal the cell to stop dividing. This process is called cell senescence.

 

In a study sponsored by the Morris Animal Foundation, researchers at Colorado State University are investigating the role of cell senescence in the development of feline CKD. Using a series of tests, they will compare measurements of cell senescence in deceased CKD cats and deceased cats who did not have CKD. They hope this may help lead to further treatment options for CKD.

 

In order to do this, the researchers need to obtain kidney samples from deceased cats. They are particularly interested in the kidneys of cats with kidney stones. Although this is a difficult thing to contemplate, some people might like to consider donating their cat's body to Colorado State University, to allow them to take a few small samples after death. In return, they are offering free cremation. The ashes of the deceased cat would be returned to their caregiver within about a week.

 

The kidney samples would also help with studies into whether nausea and lack of appetite in cats with CKD are caused by a specific condition, and to better understand the stages of kidney disease.

 

Please note: Dr Quimby has left Colorado State University (see below), and it is not yet clear whether this study will continue. Dr Lappin may know more in due course.

 

Dr Michael Lappin

Phone 970-297-0313

michael.lappin@colostate.edu

 

 


Donations to Feline CKD Research


 

Dr Jessica Quimby at Ohio State University


Dr Jessica Quimby, previously at Colorado State University and now moving to Ohio State University, is the leading researcher into CKD in cats. There is a fund to which you may donate if you wish to fund her work (this will be moving to Ohio State University but has not arrived yet):

 

Buttons Duh Cat and Teo Legacy Endowment


Buttons Duh Cat and Teo Legacy Endowment is a fund set up to fund CKD research, which will be undertaken at Ohio State University College of Veterinary Medicine by Dr Quimby. I will correct the link once the fund is up and running at its new home.

 

Foundation for Feline Renal Research


The Foundation for Feline Renal Research is currently funding a genetic study at the Royal Veterinary College in the UK. Unravelling the genetic basis of blood pressure and kidney function in the cat is a 2016 update on the study.

 


Finding Other Research Studies


 

Above I list the current trials I am aware of that may be of use to CKD cats. You can check for other trials at the following:

 

American Veterinary Medical Association

maintains a database of trials across the USA and Canada.

 

Colorado State University Veterinary Teaching Hospital

CKD research studies at Colorado State.

 

Colorado State University Veterinary Teaching Hospital

Studies at Colorado State.

 

University of Pennsylvania School of Veterinary Medicine

Studies at Penn.

 

Tufts University Cummings School of Veterinary Medicine

Studies at Tufts.

 

University of Wisconsin-Madison School of Veterinary Medicine

Studies at Wisconsin-Madison.

 

University of Minnesota College of Veterinary Medicine

Studies at Minnesota..

 

Kansas State University Veterinary Health Center

Studies at Kansas State.

 

University of California at Davis School of Veterinary Medicine

Studies at Davis.

 

Animal Medical Center

Studies at Animal Medical Center, NYC.

 


Chronic Kidney Disease Feline Research - Closed Studies


 


Stem Cell Transplants: Colorado State University


A 2004 study demonstrated that adult stem cells may assist with repairing damaged kidneys in mice. Adult stem cells were taken from the muscle tissue of healthy mice and cultured. Following implantation into mice with damaged kidneys, the cells formed new blood vessels and appeared to improve kidney function.

 

A number of CKD cats have now received stem cell treatments at Colorado State University College of Veterinary Medicine and the Animal Medical Center, NYC. Please see Treatments for more information on stem cell transplants in cats and the findings of published studies. Colorado State University are not currently recruiting for stem cell research, but see above for more information on the criteria for taking part in the ongoing AMC research.

 


Pimobendan


 

Administration of pimobendan to cats with chronic kidney disease

 

Pimobendan (Vetmedin) is a heart medication commonly used in dogs. It belongs to a family of drugs known as imodilators, and is usually used in conjunction with other heart medications. It appears to be particularly effective in cases of congestive heart failure.

 

Like many medications, pimobendan is not licensed for use in cats but has been widely used off label. Use of pimobendan in 170 cats (2006-2010) (2011) MacGregor JM, Rush JE, Laste NJ, Malakoff RL, Cunningham SM, Aronow N, Hall DJ, Williams J, Price LL Journal of Veterinary Cardiology 13(4) pp251-60 found that pimobendan seemed to be effective in cats with advanced heart disease and congestive heart disease when used in conjunction with other heart medications. Effect of pimobendan on the clinical outcome and survival of cats with non-taurine responsive dilated cardiomyopathy (2012) Hambrook LE & Bennett PF Journal of Feline Medicine & Surgery 14(4) pp233-9 found that cats with this type of heart disease who received pimobendan lived for four times as long as cats not given pimobendan. Effect of oral administration of pimobendan on cats with heart failure (2012) Gordon SG, Saunders AB, Roland RM, Winter RL, Drourr L, Achen SE, Hariu CD, Fries RC, Boggess MM & Miller MW Journal of the American Veterinary Medical Association 241(1) pp89-94 found that pimobendan worked well for certain types of heart failure but that others developed hypotension (low blood pressure). It concluded "Additional studies are needed to establish dosages for pimobendan and its effects before it can be recommended for treatment of cats with CHF."

 

In 2010, a member of Tanya's CKD Support Group whose cat had both CKD and heart problems was prescribed pimobendan by a vet school. Her cat did very well on it.

 

The Winn Feline Foundation reported in 2012 on a new study to investigate the use of pimobendan to help cats with CKD at Tufts University. The researchers had already found it helpful in previous studies for cats who developed congestive heart failure following intravenous fluids. They found that pimobendan not only helped with the heart problems, but the cats' kidney values also improved. The study, Administration of pimobendan to cats with chronic kidney disease, was still recruiting in 2015 but has now closed. The findings will presumably be published in due course.

 

Veterinary Partner has some information about pimobendan use generally.

 


Anaemia Study: University of Pennsylvania


CKD cats are prone to developing anaemia because the kidneys produce a hormone (erythropoietin) which stimulates the bone marrow to make red blood cells, but damaged kidneys find it hard to do this, so anaemia results. There are treatments available but they have potential downsides, so there is interest in finding safer alternatives.

 

University of Pennsylvania School of Veterinary Medicine ran a study in 2016 into a new treatment for CKD cats with anaemia, with qualifying criteria being that the cat should be in at least Stage 3 CKD, have a haematocrit level (HCV or PCV) below 29% and not have previously been given any form of ESA. I thought the treatment might be a prolyl hydroxylase inhibitor (HIF-PH inhibitor) but that is normally an oral treatment, whereas in this study, the cats were given one intramuscular injection of the treatment, so I don't know for sure. I expect the results of the trial will be published in due course.

 


Oxidative Stress Study: University of Wisconsin-Madison


Feline kidney disease may need earlier treatment/

 

In humans, it is known that the degree of oxidative stress reflects the stage of CKD. Initial research at the University of Wisconsin-Madison School of Veterinary Medicine aimed to measure a biomarker of oxidative stress in the kidney called urinary F2-Isoprostanes (F2-IsoP) to see whether the same correlation exists in cats.

 

The results were unexpected: F2-IsoP levels for cats in IRIS stages 2-4 were much lower than levels in healthy cats, which is the opposite of what happens in humans. However, it was also found that F2-IsoP levels were noticeably increased in IRIS stage 1 cats compared to healthy cats.

 

In 2014 further research was being conducted, because the initial findings may indicate that antioxidant treatment is necessary earlier in CKD than was previously thought.

 

 

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This page last updated: 14 March 2017

Links on this page last checked: 26 February 2017

 

   

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

 

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