Clinical and nutritional follow-up of cats with chronic kidney disease fed with a renal prescription diet

Background: The use of prescription diets for cats with chronic kidney disease (CKD) is one of the main management approach of this disease in cats, and is considered a renoprotective strategy that may promote increased survival and/or improve quality of life, according to the stage of CKD. Besides that, nutritional assessment is important to monitor the maintenance of quality of life of the patients and their response to disease, especially those with chronic conditions. The aim of this study was to follow the clinical and nutritional status of cats with chronic kidney disease (CKD) IRIS stages II, III and IV fed with a renal prescription diet, followed for 12 months. Materials, Methods & Results: Patients were fed exclusively with a dry renal prescription diet and medications for the management of CKD were prescribed when needed. Exclusion criteria were cats that already received a renal prescription diet or medications for the treatment of CKD. Cats were evaluated every 2 months, considering body weight (BW), body condition score (BCS), muscle mass score (MMS), clinical and laboratory parameters. In all assessments, a complete blood count and biochemistry were performed by conventional methods with the patient fasted for 12 h. In addition, urinalysis, urine protein:creatinine ratio (UPC) and urine culture were performed from a urine sample collected by cystocentesis. The quantitative variables were tested for their stability on consecutive assessments using the non-parametric Friedman test, and did not present significant variation during follow-up, except for systolic blood pressure (SBP). Eight cats with a diagnosis of CKD were included in the study and 6 of them remained in the same CKD stage during follow-up. On cat died due to an unrelated CKD cause. Regarding nutritional assessment, 5 of 7 cats maintained BW during the 12 months. Of these, 4 also maintained MMS and BCS. Three of 7 cats presented a decrease in MMS, 2 of which presented also a decreased BW and one maintained BW. Discussion: IRIS staging results combined with Friedman’s analysis demonstrated that the diet and the clinical management were effective in the non-progression of CKD in this study. As renal injury is not expected to be reversed in CKD, the maintenance of cats in the same IRIS stages and the minimum variation of the parameters is considered a positive result in this study. Hypertensive cats started on antihypertensive therapy during the study, achieving adequate control of SBP in most cases, what can justify the variation of this clinical parameter over the 12 months. Hyperphosphatemia was a frequent alteration, included stage II cats, and presented a positive response to nutritional and medical therapy. Despite CKD staging progression was not observed in most cats using serum creatinine as a single parameter, some cats presented BW and MMS reduction, which may have influenced this result. Weight loss and muscle wasting may have occurred by several reasons, including periods of hyporexia, presence of concomitant diseases, aging process or reduced protein content on renal prescription diets. This study enhances the importance of the association of clinical and nutritional management in the maintenance of cats with CKD. We suggest that other studies are done during longer periods of time and with a larger sample to support the results found. We also suggest new studies to evaluate the protein requirements for cats with CKD

Clinical and Nutritional Follow-up of Cats with Chronic Kidney Disease Fed with a Renal Prescription Diet

Background: The use of prescription diets for cats with chronic kidney disease (CKD) is one of the main management approach of this disease in cats, and is considered a renoprotective strategy that may promote increased survival and/or improve quality of life, according to the stage of CKD. Besides that, nutritional assessment is important to monitor the maintenance of quality of life of the patients and their response to disease, especially those with chronic conditions. The aim of this study was to follow the clinical and nutritional status of cats with chronic kidney disease (CKD) IRIS stages II, III and IV fed with a renal prescription diet, followed for 12 months. Materials, Methods & Results: Patients were fed exclusively with a dry renal prescription diet and medications for the management of CKD were prescribed when needed. Exclusion criteria were cats that already received a renal prescription diet or medications for the treatment of CKD. Cats were evaluated every 2 months, considering body weight (BW), body condition score (BCS), muscle mass score (MMS), clinical and laboratory parameters. In all assessments, a complete blood count and biochemistry were performed by conventional methods with the patient fasted for 12 h. In addition, urinalysis, urinary protein:creatinine ratio (UPC) and urine culture were performed from a urine sample collected by cystocentesis. The quantitative variables were tested for their stability on consecutive assessments using the non-parametric Friedman test, and did not present significant variation during follow-up, except for systolic blood pressure (SBP). Eight cats with a diagnosis of CKD were included in the study and 6 of them remained in the same CKD stage during follow-up. On cat died due to an unrelated CKD cause. Regarding nutritional assessment, 5 of 7 cats maintained BW during the 12 months. Of these, 4 also maintained MMS and BCS. Three of 7 cats presented a decrease in MMS, 2 of which presented also a decreased BW and one maintained BW.Discussion: IRIS staging results combined with Friedman’s analysis demonstrated that the diet and the clinical management were effective in the non-progression of CKD in this study. As renal injury is not expected to be reversed in CKD, the maintenance of cats in the same IRIS stages and the minimum variation of the parameters is considered a positive result in this study. Hypertensive cats started on antihypertensive therapy during the study, achieving adequate control of SBP in most cases, what can justify the variation of this clinical parameter over the 12 months. Hyperphosphatemia was a frequent alteration, included stage II cats, and presented a positive response to nutritional and medical therapy. Despite CKD staging progression was not observed in most cats using serum creatinine as a single parameter, some cats presented BW and MMS reduction, which may have influenced this result. Weight loss and muscle wasting may have occurred by several reasons, including periods of hyporexia, presence of concomitant diseases, aging process or reduced protein content on renal prescription diets. This study enhances the importance of the association of clinical and nutritional management in the maintenance of cats with CKD. We suggest that other studies are done during longer periods of time and with a larger sample to support the results found. We also suggest new studies to evaluate the protein requirements for cats with CKD

Avaliação de dietas com diferentes fontes protéicas para cães adultos

Foram comparados os coeficientes de digestibilidade aparente (CDA) de quatro alimentos secos extrusados para cães, cada um formulado com um dos ingredientes protéicos em estudo: farelo de soja (FS); farelo de glúten de milho (GM); farinha de carne e ossos (FCO); e farinha de vísceras de frango (FV). O experimento foi realizado em delineamento inteiramente casualizado, com quatro tratamentos (ingredientes protéicos) e seis repetições, totalizando 24 animais. As médias dos tratamentos foram comparadas pelo teste Tukey. O CDA da PB (média ± erro-padrão da média) foi maior na ração à base de GM (88,13±0,40%), seguida pelas dietas com FS (86,31±0,34%), FCO (85,88±0,16%) e FV (84,84±0,15%). O CDA da MS foi maior para a ração com FV (83,69±0,09%), intermediário para GM (82,41±0,23%) e FCO (82,76±0,11%) e menor para FS (81,10±0,16%). As rações à base de proteína animal apresentaram os maiores CDA dos extrativos não-nitrogenados. O teor de MS das fezes dos cães foi elevado na ração com FCO, intermediário naquela com FV e GM e baixo naquela à base de FS. As quatro fontes protéicas estudadas apresentaram bons CDA e, portanto, podem ser utilizadas em rações para cães adultos.The coefficient of apparent digestibility (CAD) of four dry extruded dog foods was compared, each one formulated with a different protein source: soybean meal (SM), corn gluten meal (GM), meat and bone meal (MBM) and poultry meal (PM). A completely randomized design was used, with four treatments (protein source) and six repetitions per treatment, in a total of 24 animals. Tukey test was used to compare treatments means. The diet based on GM showed the highest CAD of crude protein (88.13±0.40%), followed by SM (86.31±0.34%), MBM (85.88±0.16%), and PM (83.69±0.09%), with the lowest results. The CAD of dry matter was highest for PM (83.69±0.09%), intermediary for GM (82.41±0.23%) and MBM (82.76±0.11%), and lowest for SM (81.10±0.16%) The rations based on animal protein presented the highest CAD of nitrogen-free extract. The dogs fecal dry matter was higher for MBM, intermediary for PM and GM, and lower for SM. All the four protein sources analyzed have shown good CAD, and can be used in dog diets

Clinical and Nutritional Follow-up of Cats with Chronic Kidney Disease Fed with a Renal Prescription Diet

Background: The use of prescription diets for cats with chronic kidney disease (CKD) is one of the main management approach of this disease in cats, and is considered a renoprotective strategy that may promote increased survival and/or improve quality of life, according to the stage of CKD. Besides that, nutritional assessment is important to monitor the maintenance of quality of life of the patients and their response to disease, especially those with chronic conditions. The aim of this study was to follow the clinical and nutritional status of cats with chronic kidney disease (CKD) IRIS stages II, III and IV fed with a renal prescription diet, followed for 12 months. Materials, Methods & Results: Patients were fed exclusively with a dry renal prescription diet and medications for the management of CKD were prescribed when needed. Exclusion criteria were cats that already received a renal prescription diet or medications for the treatment of CKD. Cats were evaluated every 2 months, considering body weight (BW), body condition score (BCS), muscle mass score (MMS), clinical and laboratory parameters. In all assessments, a complete blood count and biochemistry were performed by conventional methods with the patient fasted for 12 h. In addition, urinalysis, urinary protein:creatinine ratio (UPC) and urine culture were performed from a urine sample collected by cystocentesis. The quantitative variables were tested for their stability on consecutive assessments using the non-parametric Friedman test, and did not present significant variation during follow-up, except for systolic blood pressure (SBP). Eight cats with a diagnosis of CKD were included in the study and 6 of them remained in the same CKD stage during follow-up. On cat died due to an unrelated CKD cause. Regarding nutritional assessment, 5 of 7 cats maintained BW during the 12 months. Of these, 4 also maintained MMS and BCS. Three of 7 cats presented a decrease in MMS, 2 of which presented also a decreased BW and one maintained BW.Discussion: IRIS staging results combined with Friedman’s analysis demonstrated that the diet and the clinical management were effective in the non-progression of CKD in this study. As renal injury is not expected to be reversed in CKD, the maintenance of cats in the same IRIS stages and the minimum variation of the parameters is considered a positive result in this study. Hypertensive cats started on antihypertensive therapy during the study, achieving adequate control of SBP in most cases, what can justify the variation of this clinical parameter over the 12 months. Hyperphosphatemia was a frequent alteration, included stage II cats, and presented a positive response to nutritional and medical therapy. Despite CKD staging progression was not observed in most cats using serum creatinine as a single parameter, some cats presented BW and MMS reduction, which may have influenced this result. Weight loss and muscle wasting may have occurred by several reasons, including periods of hyporexia, presence of concomitant diseases, aging process or reduced protein content on renal prescription diets. This study enhances the importance of the association of clinical and nutritional management in the maintenance of cats with CKD. We suggest that other studies are done during longer periods of time and with a larger sample to support the results found. We also suggest new studies to evaluate the protein requirements for cats with CKD

Serum Metabolites Characterization Produced by Cats CKD Affected, at the 1 and 2 Stages, before and after Renal Diet

Utilizing metabolomics, a tool for measuring and characterizing low-molecular-weight substances (LMWs), to identify eventual changes in response to dietary intervention is novel in cats with chronic kidney disease (CKD), a condition characterized by retention of uremic solutes. This study aims to assess the serum metabolomic profile of cats in early stages of CKD and to compare the serum metabolomic of CKD cats after 60 days of a renal diet to evaluate the effect of dietary intervention on these metabolites. Twenty-five domestic cats were included in the study. Fifteen cats with CKD stages 1 (n = 6) and 2 (n = 9) according to the International Renal Interest Society (IRIS) were included in the renal groups, and a control group consisting of 10 cats was included. All animals were enrolled on a maintenance diet for 30 days before the experimental period. The metabolomics analysis was performed by gas chromatography-mass spectrometry (GC-MS). Partial least squares discriminant analysis (PLS-DA) was performed on Metaboanalyst 4.0 software. Forty-three metabolites were identified. Citric acid and monostearin were altered in the CKD2 group when compared to CKD1 and the control group at T0. A total of seven serum metabolites differed after 60 days of the renal diet: glycine, fructose, glutamic acid, arachidonic acid, stearic acid, creatinine, and urea. Changes were seen in the serum metabolomic profile after 60 days of the renal diet, and some of the metabolites that changed in response to the diet have beneficial effects on health. Overall, metabolomics markers have the potential to identify early stages of CKD, providing insights into the possible pathophysiologic processes that contribute to the development and progression of CKD

Galactoligosaccharide and a prebiotic blend improve colonic health and immunity of adult dogs.

This study aimed to evaluate the effects of two prebiotics in different concentrations on nutrient digestibility, fermentative products and immunological variables in adult dogs. Twenty-four adult dogs were randomly divided into six blocks according to their metabolic body weights (BW0.75); within these groups, dogs were randomized to four treatments: control without prebiotics (CO); inclusion of 0.5% prebiotic blend Yes-Golf (B1); inclusion of 1.0% galactooligosaccharide (GOS); and inclusion of 1.0% prebiotic blend Yes-Golf (B2). The experiment lasted 30 days, with 20 days adaptation and 10 days stool and blood collection. Results were analyzed for normality and means were separated by ANOVA and adjusted by the Tukey test at the significance level of 5.0%. Prebiotic supplementation had no effect on apparent digestibility coefficients (ADC), total stool production and fecal scores (p > 0.05). Prebiotics evaluated also did not alter fecal pH, nor the concentrations of ammonia, lactic acid, short chain fatty acids (SCFA) and most fecal branched chain fatty acids (BCFA) (p > 0.05). The addition of GOS decreased the concentration of iso-valeric acid (p = 0.0423). Regarding immunological variables, concentrations of fecal IgA were not influenced by the treatments. Treatments GOS and B2 increased the total number of polymorphonuclear cells, as well as the oxidative burst in relation to treatments B1 and CO (p < 0.0001). Treatment B2 improved the rate of S. aureus phagocytosis in relation to CO (p = 0.0111), and both the GOS and B2 treatments had a better index for E. coli phagocytosis than the CO treatment (p = 0.0067). In conclusion, there was indication that both prebiotics GOS and B2 at 1.0% inclusion improved the immunity of healthy dogs

Evaluation of Serum and Urine Amino Acids in Dogs with Chronic Kidney Disease and Healthy Dogs Fed a Renal Diet

This observational study aimed to evaluate serum and urinary amino acid (AA) concentrations in healthy dogs and dogs with chronic kidney disease (CKD) fed a commercial therapeutic renal diet with reduced protein and phosphorus levels. Ten dogs with CKD stages 3 or 4 composed the study group and received the renal diet for 180 days (RG T180). A control group (CG T30) composed of seven healthy dogs was fed a renal diet for 30 days. When comparing serum AA between RG T180 and CG T30, histidine, isoleucine, leucine, lysine, phenylalanine, tryptophan, cysteine, citrulline, ornithine, taurine, branched-chain amino acids (BCAA), and total essential amino acids (EAA) were higher in RG T180. Meanwhile, arginine, asparagine, aspartate, glutamine, serine, and tyrosine were higher in CG T30. Serum phenylalanine, tryptophan, and hydroxyproline were higher in RG T0 (dogs with CKD before consuming a renal diet) when compared to RG T180. In addition, the serum ratios of arginine/citrulline, tyrosine/phenylalanine, and serine/glycine were higher in CG T30 than in RG T180. Concerning urinary AA concentrations in CKD dogs, isoleucine, phenylalanine, tryptophan, aspartate, cysteine, and BCAA were higher in RG T180. In urine, the total EAA/total non-essential AA ratio in RG T180 was higher than in CG T30 as well as tyrosine/phenylalanine ratio higher in CG T30. In conclusion, the combination of renal diet and conservative treatment over 6 months in dogs with CKD stages 3 or 4 affected the AAs metabolism when compared to healthy adult dogs

<i>Saccharomyces cerevisiae</i> Dehydrated Culture Modulates Fecal Microbiota and Improves Innate Immunity of Adult Dogs

Saccharomyces cerevisiae yeast culture can be dehydrated, and it has a potential prebiotic effect. This study evaluated the effects of supplementing increasing levels of dehydrated yeast culture (DYC) of Saccharomyces cerevisiae (Original XPC™, Diamond V, Cedar Rapids, IA, USA) on fecal microbiota, nutrient digestibility, and fermentative and immunological parameters of healthy adult dogs. Eighteen adult male and female dogs with a mean body weight of 15.8 ± 7.37 kg were randomly assigned to three experimental treatments: CD (control diet), DYC 0.3 (control diet with 0.3% DYC) and DYC 0.6 (control diet with 0.6% DYC). After 21 days of acclimation, fecal samples were collected for analysis of nutrient digestibility, microbiota and fecal fermentation products. On the last day, the blood samples were collected for the analysis of immunological parameters. The microbiome profile was assessed by the Illumina sequencing method, which allowed identifying the population of each bacterial phylum and genus. The statistical analyses were performed using the SAS software and the Tukey test for multiple comparison (p p = 0.0048 and p p = 0.0008). Regardless of the inclusion level, the yeast addition promoted reduction of the genera Allobaculum and Fusobacterium (p = 0.0265 and p = 0.0006, respectively) and increased (p = 0.0059) that of the genus Clostridium. At the highest prebiotic inclusion level (DYC 0.6), an increase (p = 0.0052) in the genus Collinsella and decrease (p = 0.0003) in Prevotella were observed. Besides that, the inclusion of the additive improved the apparent digestibility of the crude fiber and decreased the digestibility of crude protein, nitrogen-free extract and metabolizable energy (p p = 0.05). In addition, the inclusion of yeast resulted in an increased phagocytosis index in both treatments (p = 0.01). The addition of 0.3 and 0.6% DYC to the diet of dogs wase able to modulate the proportions of some phyla and genera in healthy dogs, in addition to yielding changes in nutrient digestibility, fermentative products and immunity in healthy adult dogs, indicating that this additive can modulate fecal microbiota and be included in dog nutrition

Gene expression of the immunoinflammatory and immunological status of obese dogs before and after weight loss.

Obesity is characterized by a low degree of chronic inflammation state that, along with metabolic modifications, promotes important changes in the animal's organism. Adipose tissue actively participates in inflammation and immunity, and several defense cells of the organism may, therefore, be involved in the diversity found between obese and ideal weight individuals. Studies regarding this subject have shown immune cell changes in humans and rats, however, the literature is scarce in relation to dogs. Thus, the present study aimed to evaluate the gene expression profile of immunoinflammatory response and the lymphoproliferation of obese dogs before and after weight loss. Eight female dogs, neutered, of different breeds, aged between 1 and 8 years (4.74±3.19), obese, with body condition score (BCS) of 9 out of a 9-point scale and body composition determined by the deuterium isotope dilution method were included. The obese dogs were enrolled in a weight loss program and after losing 20% of their initial weight became a second experimental group. A third experimental group consisted of eight female dogs, neutered, aged between 1 and 8 years (3.11±0.78) and with ideal BCS (5 out of a 9-point scale). Gene expression of immunoinflammatory cytokines (resistin, leptin, adiponectin, TNF-α, IL-6, IL-8, and IL-10) was assessed by qRT-PCR and immunity was assessed by lymphoproliferative response using the flow cytometry technique. The data that presented normal distribution was evaluated by analysis of variance by the PROC MIXED of the SAS and when differences were detected, these were compared by the Tukey test. Regarding the gene expression data, the procedure PROC GLIMMIX was adopted and the methodology of generalized linear model was used, in which the Gama distribution proved to be adequate. Values of p<0.05 were considered significant. The mean weight loss period of the animals included in the study was 194.25 ± 28.31 days and the mean weekly weight loss rate was 1.02 ± 0.82%. The average fat mass, both in percentage (P<0.001) and in kilograms (P = 0.012), was higher in the obese group (40.88%; 8.91kg), returning to normal and without difference between the control group (19.16%; 3.01kg) and after weight loss (22.10%; 4.11kg). The weight loss program resulted in an increase in percentage of lean body mass (P = 0.001), 55.50% in obese animals vs 77.90% in obese dogs after weight loss, the latter with no difference when compared to the control group (80.84%). The obese group presented increased gene expression of resistin and IL-8 in relation to the weight loss group (P = 0.002). In adiponectin, the obese group presented increased mRNA gene expression when compared to the weight loss group (P = 0.003). The evaluation of lymphocyte proliferation showed differences between the group of obese animals before and after weight loss (P = 0.004). Weight loss resulted in an increase in the lymphoproliferation rate (18.48%) compared to obese dogs at the beginning of the study (10.71%). These results indicate that weight loss modulates the immunoinflammatory response of obese dogs and may present important benefits to health and longevity of dogs