Kidney, diabetes Flashcards
kidney disease nutritional goals
- Slow the progression of disease
- Maintain appropriate body weight & body condition
- Reduce incidents of uremic crises
- Support immune function
- Increase quality of life
what is IRIS staging, and what are the ‘stages?’
guidelines to help better diagnose, understand, and treat renal disease in cats and dogs
- Staging based off blood creatinine and SDMA
- Sub-staging by Proteinuria
- Sub-staging by Blood Pressure
when do we use IRIS staging
- Important to stage AFTER fluid therapy and stabilization!
how many iris results do we need
at least 2
KNFs for renal diet: water
need lots
KNFs for renal diet: phosphorus
- Accumulation due to imbalance between intake and excretion
(P retention) - Increased PTH
- Secondary renal hyperparathyroidism
- more P corresponds to more renal lesions
- Intestinal Phosphorus Binders
KNFs for renal diet: protein
- Restriction?
- Approach:
- Early Stage: goal - altering disease course
- Late Stage: goal - controlling clinical signs/uremic symptoms
- Early stages (I/II)
- Proteinuria (elevated UPC)
- Minimize proteinuria
- High protein intake led to increased UPC in laboratory induced disease
- Moderate protein may limit diet-related hyperfiltration
- Late stages (III/IV)
- Azotemia and uremia
- Accumulation of protein metabolites
- Excess protein: azotemia and morbidity
- Protein malnutrition
- Provide high quality protein
- Minimal protein requirements?
Best approach:
1. Treat each patient as an individual
2. Monitor BW, BCS, MCS, albumin, total protein, UPC, BUN, creatinine etc.
3. Adjust based on patient response
kidney disease KNF: energy
Fat
* Energy density
- EPA+DHA
- ↓ Glomerular hypertension (↓ TXA2, ↓ PGE2) - Anti-inflammatory (↓ LTB4, ↓ PGE2)
- ↓ Systemic hypertension
- EPA+DHA
- Precautions: high doses (n-6:n-3 ±1:1)
- Immunosuppression
- Oxidative stress
- ↓ platelet function
- ↓ wound healing
kidney disease KNF: sodium
- Sodium retention leads to hypertension
- Hypertenstion contributes to progression of disease
- Risk of target organ damage (e.g. kidneys, eyes, brain, heart)
kidney disease KNF: potassium
- 2—30% of cats with CKD have hypokalemia
- Reduced dietary intake: anorexia, vomiting
- Excessive renal loss
- Hyperkalemia in dogs
- ACE inhibitors?
- Not possible to control with renal diet?→Homemade diet
buffering capacity / pH for urine in kidney disease
- Buffering capacity
- Urine pH of 6.5 to 7 recommended
TIPS FOR INTRODUCING RENAL DIETS
- Better success when cat/dog is feeling “healthy”
- Slow gradual transition
- Weigh on gram scale
- Try different flavours/textures
- Homemade diets?
NUTRITIONAL GOALS FOR DIABETES
- Improve blood glucose
- Maintain ideal BCS/MCS
- Eliminate clinical signs
- Minimize complications
How?
* Medical treatment: insulin
* Diet
* Treat causes of insulin resistance (obesity!)
difference in diabetes type in dogs vs cats
- Dog: Type 1 (B-cell destruction – absolute insulin deficiency)
- Cat: Type 2 (insulin resistance)
feeding frequency for diabetes
- CONSISTENCY! in type, amount, timing
- Multiple small meals
- Regular intervals
- Timed with insulin
KNF diabetes: water
- Fresh and clean water should be available at all times
KNF diabetes: protein
- Varies in diabetic diets
- Important to provide all essential amino acids
- Prevent loss of lean muscle
- Cats: 28-55% DM
> High protein, low carb approach (‘Catkins’ diet) - Dogs: 15-35% DM
KNF diabetes: fat
- Hyperlipidemia
- Excess fat can contribute extra calories
- Important for overweight and obese diabetics
- Dogs and Cats: <25% DM
> Moderate fat (12-15% DM)
> Low fat (<10% DM) if obese
KNF diabetes: carbs
- Simple vs complex carbs
simple absorb fast and give postprandial hyperglycemia, glucosuria, should be avoided
>found in semi-moist/canned foods with sauce
- NOT nutritionally essential for cats and other mammals
>cats have different digestion, Glucose absorption, Hepatic glucose metabolism
- Do carbohydrates cause obesity and/or diabetes in cats?
unclear?
- Macronutrient content→NO major cause of obesity & diabetes
- More attention to:
- Normalising public’s view of a normal body condition for cats
- Feeding behaviour & amount fed
- Lifestyle and activity level
KEY NUTRITIONAL FACTORS: DIABETES carbohydrate macro % for dogs and cats
- Dogs: <55% DM
- Cats:
- Option 1: <40% DM (high fibre/carb approach)
- Option 2: <20% DM (high protein, low carb approach)
KEY NUTRITIONAL FACTORS: DIABETES: fibre
- Dogs: 7 to 18% DM
- Cats: 7 to 18% DM (high fibre/high carb option)
KEY NUTRITIONAL FACTORS: DIABETES: energy
Depends on BCS
* BCS 5/9: weight maintenance
* BCS 6 to 9/9: weight loss
* BCS 1 to 3(4)/9: weight gain
Controlled vs uncontrolled
* Energy requirement can be much higher in uncontrolled diabetics
* Weight maintenance until controlled
