The Management of Phosphataemia in Renal Dogs or Cats

Transcription

1 The Management of Phosphataemia in Renal Dogs or Cats improves both the quality of life and the life expectancy of animals. THE CARDIOLOGY - NEPHROLOGY DIMENSION PAIN INFLAMMATION ANTI-INFECTIVE

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3 PHOSPHATAEMIA MANAGEMENT ROUNDTABLE 6 - USA A group of world class experts met in 6 for building up guidelines for the management of phosphataemia in dogs and cats with CKD. They recommended the following: 1 Target the following plasma phosphate values according to the IRIS stages for cats and dogs: Stage II.5 to 4.5 mg/dl [.81 to 1.45 mmol/l] Stage III.5 to 5 mg/dl [.81 to 1.61 mmol/l] Stage IV.5 to 6 mg/dl [.81 to 1.94 mmol/l] The lower the plasma phosphate could be controlled, the better 3 Mix to the diet powdered or granular preparations in preference to liquids and gels which might affect its palatability. MODERATOR: Jonathan Elliott, Royal Veterinary College, the United Kingdom - PARTICIPANTS: Scott A. Brown, University of Georgia, the United States - Larry D. Cowgill, University of California-Davis, the United States - Astrid van Dongen, University of Utrecht, the Netherlands - Maria Josefa Fernandez del Palacio, University of Murcia, Spain - Bernhard Gerber, University of Zurich, Switzerland - Gregory F. Grauer, Kansas State University, the United States - Hervé Lefebvre, National Veterinary School Toulouse, France - David Polzin, University of Minnesota, the United States. improves both the quality of life and life expectancy of animals. 3

4 Rationale for controlling Phosphataemia in Chronic Kidney Disease Plasma phosphate plays a central role in the progression of Chronic Kidney Disease. It leads to secondary hyperparathyroidism that regulates downs phosphataemia in the first stages of the disease. Damage to renal tissues GFR decreases Whole body phosphate retention occurs Decreased calcitriol secretion Reduced plasma ionised calcium PTH synthesis and secretion increases According to Jonathan Elliott and Scott Brown 1 Hyperphosphataemia and hyperparathyroidism have detrimental effects through soft tissue mineralisation, mainly: On the kidneys tubules On the organism vasculature and on the heart Beneficial effects of Phosphate Restriction Number of days SURVIVAL INCREASED x.8 1 Outside ranges Within ranges Median survival times of cats outside or inside the phosphate reference ranges recommended by the Hyperphosphatemia Roundtable. 4 1 Pocket Guide to Renal Disease in the Dog and Cat. 4. Nova Professional Media Ltd., Oxon. Elliott J: The role of phosphate in chronic kidney disease (CKD) progression, Part. UK vet Vol, 13, No. 3, 37-47, 8.

5 3 options for the control of Phosphataemia 3 options Phosphate binder Renal food + phosphate binders Renal food Where renal food has drawbacks and Phosphate Binders can help? Palatability Efficacy in later stages Additional price Excess of protein reduction What qualities to expect from a good phosphate binder? Very effective for controlling plasma phosphate and PTH (try reach the lower value of the phosphataemia range) Readily acceptable in powder or granules Safe (no calcaemia increase) Reasonably priced. On the long term 5

6 meets all the expectations is effective With, the digestibility of phosphates in cats is reduced by more than 5% 3,5 (Over a 1-week administration period) 1% 8% 1% 8% 9% P digestibility 6% 4% 45% P digestibility 6% 4% % % % Control Renalzin % Control With, the phosphataemia in cats with CKD (stage II) is reduced by 35% 3,5 (Over a -month administration period) mmol/l % mmol/l Prior to treatment Not significant -5% Renalzin Prior to treatment is safe No increase in calcaemia was measured. 6 3 University of Vienna 4: E. Wagner and coll. Effects of dietary chitosan and calcium carbonate on Ca and P metabolism in cats. BMTW 7/8 (4). 5 Renalzin commercial communication

7 for an excellent phosphate binder tested on a one-year trial Long Term Efficacy of on Experimentally Induced IRIS Stage II Chronic Kidney Disease in Cats 4 14 Serum P & Ca (mg/dl) and Serum PTH (pmol/dl) Calcium Glomerular Filtration Rate Parathyroid Hormon Phosphate In cats with Chronic Kidney Disease (CKD), has: Significantly reduced phosphataemia to as low as 3% Significantly and dramatically reduced PTH concentration (- 61%), Renal function measured by serum creatinine and glomerular filtration rate was stabilised No increase in serum calcium Start Start + 3 months Start + 6 months Start + 9 months Start + 1 months p <.5 vs month GFR (ml/min/kg), for optimum intake is made of a palatable powder easy to mix with food. The dose (1g/5kg b.w. bid) can be increased for maximising efficacy (in the later stages of the disease) 4 University of Georgia 8: Brown S.A and coll. Effects of an Intestinal Phosphorus Binder on Serum Phosphorus and Parathyroid Hormone Concentration in Cats with Reduced Renal Function.. Intern J.Appl Res Vet Med. Vol 6, No 3, 8. 7