Clinical progression of cats with early-stage chronic kidney disease fed diets with varying protein and phosphorus contents and calcium to phosphorus ratios.
FGF23
IRIS 1-2
feline CKD
hypercalcemia
phosphate
Journal
Journal of veterinary internal medicine
ISSN: 1939-1676
Titre abrégé: J Vet Intern Med
Pays: United States
ID NLM: 8708660
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
revised:
06
08
2021
received:
04
01
2021
accepted:
30
08
2021
pubmed:
22
9
2021
medline:
24
12
2021
entrez:
21
9
2021
Statut:
ppublish
Résumé
Dietary protein and phosphorus (P) restriction is the mainstay for nutritional management of chronic kidney disease (CKD). However, adequate restriction levels for cats with early CKD remain unclear. To investigate responses in cats with early CKD to varying dietary protein, P, and calcium (Ca) : P ratio. Nineteen research colony cats with International Renal Interest Society stages 1-2 CKD. In an opportunistic longitudinal case study, cats were fed a low protein (59 g/Mcal), low P (0.84 g/Mcal) dry diet (LP-LP; Ca : P = 1.9) for 18 months and later transitioned onto a moderate protein (76-98 g/Mcal), moderate P (1.4-1.6 g/Mcal) dry-wet diet regimen (MP-MP; Ca : P = 1.4-1.6) for 22 months. Fold-changes in serum creatinine, total Ca (tCa) and P (primary outcomes) and fibroblast growth factor 23 (FGF23) were assessed by linear-mixed models. While feeding LP-LP, mean serum creatinine decreased (0.87-fold, 95% confidence interval [CI] 0.81, 0.93, P < .001) to within reference range after 6 months, while increases in total Ca (tCa; 1.16-fold, 95% CI 1.11, 1.22, P < .001) and FGF23 (2.72-fold, 95% CI 1.72, 4.31, P < .001), but not in P (1.03-fold, 95% CI 0.945, 1.124, P = .94), were observed after 17 months. On MP-MP, mean creatinine, tCa and P remained within reference ranges and did not significantly change (P = .11, P = .98, and P = 1, respectively), while FGF23 significantly decreased (0.58-fold, 95% CI 0.36, 0.95, P = .02) after 22 months. Cats with early CKD developed hypercalcemia after long-term feeding of a highly P-restricted diet. Increasing dietary P and reducing Ca : P ratio maintained renal markers, while improving Ca-P balance. Cats with early CKD could benefit from moderately protein- and P-restricted diets.
Sections du résumé
BACKGROUND
BACKGROUND
Dietary protein and phosphorus (P) restriction is the mainstay for nutritional management of chronic kidney disease (CKD). However, adequate restriction levels for cats with early CKD remain unclear.
OBJECTIVES
OBJECTIVE
To investigate responses in cats with early CKD to varying dietary protein, P, and calcium (Ca) : P ratio.
ANIMALS
METHODS
Nineteen research colony cats with International Renal Interest Society stages 1-2 CKD.
METHODS
METHODS
In an opportunistic longitudinal case study, cats were fed a low protein (59 g/Mcal), low P (0.84 g/Mcal) dry diet (LP-LP; Ca : P = 1.9) for 18 months and later transitioned onto a moderate protein (76-98 g/Mcal), moderate P (1.4-1.6 g/Mcal) dry-wet diet regimen (MP-MP; Ca : P = 1.4-1.6) for 22 months. Fold-changes in serum creatinine, total Ca (tCa) and P (primary outcomes) and fibroblast growth factor 23 (FGF23) were assessed by linear-mixed models.
RESULTS
RESULTS
While feeding LP-LP, mean serum creatinine decreased (0.87-fold, 95% confidence interval [CI] 0.81, 0.93, P < .001) to within reference range after 6 months, while increases in total Ca (tCa; 1.16-fold, 95% CI 1.11, 1.22, P < .001) and FGF23 (2.72-fold, 95% CI 1.72, 4.31, P < .001), but not in P (1.03-fold, 95% CI 0.945, 1.124, P = .94), were observed after 17 months. On MP-MP, mean creatinine, tCa and P remained within reference ranges and did not significantly change (P = .11, P = .98, and P = 1, respectively), while FGF23 significantly decreased (0.58-fold, 95% CI 0.36, 0.95, P = .02) after 22 months.
CONCLUSIONS AND CLINICAL IMPORTANCE
CONCLUSIONS
Cats with early CKD developed hypercalcemia after long-term feeding of a highly P-restricted diet. Increasing dietary P and reducing Ca : P ratio maintained renal markers, while improving Ca-P balance. Cats with early CKD could benefit from moderately protein- and P-restricted diets.
Identifiants
pubmed: 34545958
doi: 10.1111/jvim.16263
pmc: PMC8692190
doi:
Substances chimiques
Phosphorus
27YLU75U4W
Fibroblast Growth Factors
62031-54-3
Fibroblast Growth Factor-23
7Q7P4S7RRE
Calcium
SY7Q814VUP
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2797-2811Subventions
Organisme : Mars Petcare
Informations de copyright
© 2021 Mars Inc. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Références
J Feline Med Surg. 2014 Jun;16(6):465-72
pubmed: 24217707
Am J Clin Nutr. 2015 Aug;102(2):444-53
pubmed: 26040641
J Vet Intern Med. 2021 Mar;35(2):997-1007
pubmed: 33527601
J Vet Intern Med. 2019 Nov;33(6):2644-2656
pubmed: 31557361
J Nutr. 2006 Jul;136(7 Suppl):2031S-2033S
pubmed: 16772488
J Small Anim Pract. 2012 Oct;53(10):561-71
pubmed: 22860883
J Small Anim Pract. 1999 Feb;40(2):62-70
pubmed: 10088085
Clin J Am Soc Nephrol. 2010 Jan;5 Suppl 1:S23-30
pubmed: 20089499
Br J Nutr. 2019 Feb 14;121(3):249-269
pubmed: 30572965
J Small Anim Pract. 1998 Mar;39(3):108-16
pubmed: 9551377
J Am Vet Med Assoc. 2001 Nov 1;219(9):1228-37
pubmed: 11697365
Vet Rec. 2005 Aug 13;157(7):185-7
pubmed: 16100367
Ther Apher Dial. 2018 Jun;22(3):236-241
pubmed: 29707916
PLoS One. 2017 Apr 6;12(4):e0174854
pubmed: 28384169
J Vet Intern Med. 2013 Mar-Apr;27(2):227-33
pubmed: 23363336
J Vet Intern Med. 2013 Nov-Dec;27(6):1354-61
pubmed: 24010686
J Vet Intern Med. 2009 Jul-Aug;23(4):806-13
pubmed: 19566846
J Clin Invest. 2007 Dec;117(12):4003-8
pubmed: 17992255
J Vet Intern Med. 2017 Mar;31(2):465-475
pubmed: 28190275
J Vet Intern Med. 2019 Mar;33(2):363-382
pubmed: 30806496
Am J Physiol Endocrinol Metab. 2012 Apr 15;302(8):E903-13
pubmed: 22275752
Br J Nutr. 2019 Feb;121(3):270-284
pubmed: 30420000
J Endocrinol. 1978 Sep;78(3):379-87
pubmed: 712296
J Nutr. 1994 Dec;124(12 Suppl):2660S-2662S
pubmed: 7996262
J Clin Invest. 1983 Jun;71(6):1624-32
pubmed: 6345587
J Vet Intern Med. 2015 Nov-Dec;29(6):1494-501
pubmed: 26403212
Am J Vet Res. 2011 Dec;72(12):1652-9
pubmed: 22126694
Br J Nutr. 2021 Dec 14;126(11):1626-1641
pubmed: 33550999
J Small Anim Pract. 2000 Jun;41(6):235-42
pubmed: 10879400
J Vet Intern Med. 2016 Mar-Apr;30(2):602-10
pubmed: 26948860
J Vet Intern Med. 2000 Nov-Dec;14(6):619-26
pubmed: 11110384
J Vet Intern Med. 2016 Sep;30(5):1690-1702
pubmed: 27527663
J Vet Med Sci. 2008 Aug;70(8):865-7
pubmed: 18772568
Am J Physiol Endocrinol Metab. 2013 Feb 1;304(3):E310-20
pubmed: 23233539
Annu Rev Med. 2010;61:91-104
pubmed: 20059333
Nephrol Dial Transplant. 2015 Jul;30(7):1156-62
pubmed: 25805215
J Vet Intern Med. 2013 Mar-Apr;27(2):234-41
pubmed: 23398216
Vet J. 2015 Jan;203(1):18-26
pubmed: 25475166
J Nutr. 2002 Jun;132(6 Suppl 2):1637S-41S
pubmed: 12042478
Front Vet Sci. 2019 Aug 22;6:276
pubmed: 31508432
J Nutr Biochem. 2017 Aug;46:21-29
pubmed: 28437713
J Vet Intern Med. 2021 Nov;35(6):2797-2811
pubmed: 34545958
J Am Vet Med Assoc. 2006 Sep 15;229(6):949-57
pubmed: 16978113