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Cat kidney disease: Symptoms, causes, and treatments every owner should know · The Hissing Feline

• 0:01
  SPEAKER_02: This is the Hissing Feline Podcast, a weekly program that is about everything cats.
• 0:08
  SPEAKER_02: The Hissing Feline features experts and other cat aficionados who share their knowledge and perspectives about dealing with felines.
• 0:17
  SPEAKER_02: From strays and ferals to adoption, health, and cat psychology.
• 0:23
  SPEAKER_02: We hope the topics give you helpful and interesting insight into the world of cats.
• 0:28
  SPEAKER_02: Now, here is the host of the hissing feline, Clark Greer.
• 0:34
  SPEAKER_01: Chronic kidney disease is one of the most common health issues cat owners face, especially in older cats.
• 0:41
  SPEAKER_01: What symptoms might cat parents observe that point to kidney disease?
• 0:45
  SPEAKER_01: How is the disease diagnosed?
• 0:47
  SPEAKER_01: And what treatment methods are available?
• 0:50
  SPEAKER_01: It's my pleasure today to welcome Dr.
• 0:52
  SPEAKER_01: Jessica Quimby to the podcast to discuss various aspects of feline chronic kidney disease.
• 0:58
  SPEAKER_01: She is professor and vice chair of research in the College of Veterinary Medicine at the Ohio State University.
• 1:05
  SPEAKER_01: Dr.
• 1:06
  SPEAKER_01: Quimby is a board-certified internal medicine specialist.
• 1:10
  SPEAKER_01: Doctor, thank you very much for joining me on the show today to talk about a very serious feline issue.
• 1:16
  SPEAKER_03: Thanks, Clarica.
• 1:17
  SPEAKER_03: It's a pleasure to be here and always a good thing to discuss feline chronic kidney disease.
• 1:22
  SPEAKER_01: We had a cat that lived to be almost 21, and she she had uh chronic kidney disease and we knew it was progressive.
• 1:30
  SPEAKER_01: It's it's very serious.
• 1:32
  SPEAKER_01: What exactly is CKD?
• 1:35
  SPEAKER_03: Yeah, so when we we use the terminology CKD, we think of a chronic disease affecting the kidney.
• 1:41
  SPEAKER_03: And the the official definition is that means it's been going on for longer than three months.
• 1:46
  SPEAKER_03: But it can actually happen uh several different ways.
• 1:49
  SPEAKER_03: You can, in essence, have different parts of the kidney that are broken.
• 1:54
  SPEAKER_03: Um what we call the tubules or the glomerulus, either the filtering part of the kidney or the part of the kidney that's really the workload that that takes up a lot of the substances and excretes a lot of the substances.
• 2:06
  SPEAKER_03: And so when that happens, essentially the kidney becomes diseased.
• 2:10
  SPEAKER_03: We say approximately 75% of the kidney is no longer functioning by the time you actually see uh something on the lab work, and the the concentrating ability or the concentration of your cat's urine might actually decrease as well as part of that disease process.
• 2:27
  SPEAKER_03: But the problem is when that happens, all the important things that the kidney does they start going awry.
• 2:34
  SPEAKER_03: So we have these complications of kidney disease that occur as a result.
• 2:38
  SPEAKER_01: And it gets to be very serious.
• 2:40
  SPEAKER_01: Cats really go through a lot because of that.
• 2:42
  SPEAKER_03: They do.
• 2:43
  SPEAKER_03: There's a broad spectrum of disease, to be fair.
• 2:46
  SPEAKER_03: Sometimes you first catch it when it's quite early, but there's basically four stages of chronic kidney disease that are based on the serum creatinine or the main kidney value in the blood that we measure.
• 2:57
  SPEAKER_03: And you can you progress eventually through those four stages of disease.
• 3:02
  SPEAKER_03: So in the first two stages, you probably you may not notice anything very specific, subtle signs of weight loss or drinking more or urinating more.
• 3:11
  SPEAKER_03: But as they get to stages, uh the later stages, then more complications start to occur.
• 3:17
  SPEAKER_03: High blood pressure, electrolyte abnormalities, anemia, dehydration, constipation, and of course, unfortunately, appetite problems.
• 3:26
  SPEAKER_03: The kiddies really struggle with their appetites.
• 3:28
  SPEAKER_03: So there's so many things, unfortunately for them, that can go wrong throughout the disease process.
• 3:34
  SPEAKER_01: Let's back up just a bit and talk about risk factors and things that contribute to feline kidney disease.
• 3:42
  SPEAKER_03: That's a great question.
• 3:43
  SPEAKER_03: I I think it might be the million-dollar question is what actually causes kidney disease in cats and and why is it so common?
• 3:50
  SPEAKER_03: And honestly, we still don't really have an answer to that.
• 3:53
  SPEAKER_03: But one thing that we do know in cats is that it is often age-related.
• 3:57
  SPEAKER_03: Like you, your cat, I mean, wow, 20 years of age.
• 4:01
  SPEAKER_03: But if you get to your teens as a cat and you actually don't have some degree of kidney disease, that's honestly surprising to me.
• 4:09
  SPEAKER_03: So the the the longer those kidneys have been uh, you know, experiencing the world at large, the more likely they are to have some kidney disease.
• 4:18
  SPEAKER_03: So there can be an aging change component to it, but honestly, it's probably all of the little insults that might happen to the kidney throughout the cat's life that ultimately culminate in that disease process.
• 4:32
  SPEAKER_03: And that's the most common type of kidney disease we have.
• 4:35
  SPEAKER_03: But for young kiddies, there can be some instigators, such as stone disease, or currently we're studying the association between plasma cell potodermatitis or pillow foot, and that disease in the feet uh can actually have um can actually result in damage to the kidney.
• 4:55
  SPEAKER_03: So that would be a predisposing factor for the young cat.
• 4:58
  SPEAKER_01: Yeah, so age is is is not the only thing.
• 5:01
  SPEAKER_01: There are other things that can contribute that in a cat's life.
• 5:05
  SPEAKER_03: Correct.
• 5:06
  SPEAKER_03: Yep.
• 5:06
  SPEAKER_03: So age is one thing, um, but then for instance, um uh you know, anesthesia events or um other diseases, uh medications, any little thing that might accidentally harm the kidney at some point in time.
• 5:21
  SPEAKER_03: And often we never even know that this damage occurs.
• 5:24
  SPEAKER_03: It's just a little something that's happened.
• 5:26
  SPEAKER_03: But those things build up over time.
• 5:28
  SPEAKER_03: So by the time you get to be 10 or 15 or uh 20 years of age, the you know, the we've we've lived a good life and and all of those things are adding up in that aged kidney.
• 5:40
  SPEAKER_01: What are some symptoms that cat owners could observe if they're you know really concerned about their cat possibly having uh CKD?
• 5:51
  SPEAKER_03: That's a great question.
• 5:52
  SPEAKER_03: And in general, I think that cat caregivers should be really aware of um what's going on in the litter box.
• 5:59
  SPEAKER_03: So how much urine and feces is being produced and how often, because with kidney disease, we see more urination, so larger litter clumps is one way to look for that.
• 6:09
  SPEAKER_03: Honestly, that's probably an easier thing to notice than if the cat is drinking more, especially if you happen to not be home during the day.
• 6:17
  SPEAKER_03: Um, we can see constipation with kidney disease as well, but the the big thing is weight loss and changes in appetite.
• 6:23
  SPEAKER_03: And and some of these are non-specific for kidney disease, they could mean any illness, but if you see those subtle signs, that's when you need to make sure that your cat is evaluated by a veterinarian to discover why it is we're having changes in appetite.
• 6:37
  SPEAKER_03: Why are we having that weight loss or the muscle mass wasting that's happening?
• 6:41
  SPEAKER_01: Yeah, so that's why it's important to see a veterinarian early.
• 6:44
  SPEAKER_01: Uh, on this show, uh, I talked to a couple of guests who have discussed pain in cats and stress, and just paying attention to your cat and its expression and what its mannerisms are is really a good way to indicate that maybe there's something going on and it might be CKD.
• 7:04
  SPEAKER_03: Mm-hmm.
• 7:05
  SPEAKER_03: Yep.
• 7:05
  SPEAKER_03: And and so cats are the masters of subtlety, right?
• 7:08
  SPEAKER_03: They they they don't want to let us know when something is going on.
• 7:12
  SPEAKER_03: And the other thing that I would comment is that early detection is so important.
• 7:16
  SPEAKER_03: So in fact, it's really important for your cat to see the vet regularly, even if you don't think that something is going on, because there are subtle changes that happen even before you might notice something at home.
• 7:28
  SPEAKER_03: So if you if you regularly have blood work and a urinalysis, we can track these things over time and we can actually see little changes in the lab work that indicate to us that the kidney disease might be coming, and we might want to pay closer attention.
• 7:43
  SPEAKER_01: Are there certain uh types of effects of the disease that would be really specific to this that might not be the results of other types of ailments in the cat?
• 7:54
  SPEAKER_03: Aaron Powell I think that um from the standpoint of what the caregiver might notice, it it's actually not necessarily specific.
• 8:02
  SPEAKER_03: So weight loss or increased urination uh could happen with several disease processes, including diabetes.
• 8:10
  SPEAKER_03: And and changes in appetite can actually happen with several disease processes too.
• 8:14
  SPEAKER_03: So that's that's why it's important just to realize that those uh those changes are inherently concerning, and we want to make sure that cat gets evaluated then to see if it is chronic kidney disease.
• 8:25
  SPEAKER_03: I I think there's probably not something specific from the caregiver standpoint, but when we start to look at the lab work, we obviously would have those changes in kidney values.
• 8:34
  SPEAKER_03: Those start to go up over time, the urine concentration starts to decrease, but that can also happen with diabetes or even hyperthyroidism as well.
• 8:43
  SPEAKER_03: So it's really the kidney values in conjunction with the other changes that let us know that we're starting to have problems with the kidneys.
• 8:51
  SPEAKER_01: Yeah.
• 8:51
  SPEAKER_01: So is that going to be different in a uh urinalysis than let's say what you find if you find a UTI in a cat?
• 9:00
  SPEAKER_03: So a urinary tract infection could occur without having kidney disease, but in an elderly cat, if they are having a urinary tract infection, I would absolutely want to know what's happening with their kidneys because you're right, those things are correlated.
• 9:15
  SPEAKER_03: Especially when an an elderly cat has a decreased concentration to their urine, they're actually more prone to getting infections.
• 9:22
  SPEAKER_03: And that is one of the complications that we do see with kidney disease.
• 9:25
  SPEAKER_03: So any sign of any urinary troubles, abnormalities in the litter box or house soiling, those would also be important warning signs to have that checked out and not only to do a urinalysis, but also look at lab work to make sure we know what the kidney value is doing in that moment.
• 9:42
  SPEAKER_01: Let's talk a bit about diagnosis and screening.
• 9:45
  SPEAKER_01: What are the steps that you as a veterinarian would go through to check to see what's going on with the cat's kidneys?
• 9:53
  SPEAKER_03: So there are a couple very core diagnostics that we like to do.
• 9:58
  SPEAKER_03: So I will say most commonly people talk about the lab work, and I and I did say that creatinine, that kidney value, is so very important.
• 10:05
  SPEAKER_03: We want to measure that.
• 10:06
  SPEAKER_03: On the lab work, we also look to see if they're anemic and if they have um electrolyte abnormalities like low potassium or high phosphorus.
• 10:15
  SPEAKER_03: But the urinalysis is very key.
• 10:18
  SPEAKER_03: It's very important to be able to get that urine sample as well, and to see what the concentration of the urine is, and also, like you said, to check for infection.
• 10:27
  SPEAKER_03: And then lastly, blood pressure is hugely important.
• 10:30
  SPEAKER_03: This is something that probably doesn't come up enough.
• 10:32
  SPEAKER_03: Um, multiple diseases in the older cats, so primarily kidney disease, but also hyperthyroidism, can cause high blood pressure or be associated with high blood pressure.
• 10:42
  SPEAKER_03: So taking that blood pressure in that kitty is really important because it is pretty common to have high blood pressure.
• 10:48
  SPEAKER_03: And it can actually cause blindness, it can cause problems with the eyes, it can cause neurologic signs.
• 10:54
  SPEAKER_03: We really want to catch that uh early so we don't we don't have those issues.
• 10:59
  SPEAKER_03: So it's very, it's very important to have blood pressure measured as well as we're um investigating kidney disease and and doing those diagnostics.
• 11:07
  SPEAKER_03: Yeah, it's not a bad thing.
• 11:09
  SPEAKER_01: Yeah, it's not a bad thing to be overly cautious.
• 11:12
  SPEAKER_01: I don't really know.
• 11:14
  SPEAKER_03: Yeah, agreed.
• 11:15
  SPEAKER_03: So um and then ultimately, if we can, we also do like to image the kidneys in some way, either just from an x-ray or potentially having an ultrasound of the kidneys.
• 11:24
  SPEAKER_03: That's gonna tell us more about the health of the kidney, um, if there are any stones or masses or signs of possible infection in the kidney.
• 11:33
  SPEAKER_01: There are some positives of early diagnosis.
• 11:35
  SPEAKER_01: You mentioned some of those.
• 11:37
  SPEAKER_01: Uh what are you looking for for an early diagnosis?
• 11:41
  SPEAKER_01: And then uh what types of things can you do as a veterinarian for that?
• 11:46
  SPEAKER_03: I think honestly, the best way to put that is that knowledge is power.
• 11:50
  SPEAKER_03: Just just knowing that the process is happening means that you're more tuned in to what's going on with your cat and that you can be more careful and monitor more carefully to realize this process, you know, any little abnormality will, you know, we're more alert that we maybe should be concerned.
• 12:07
  SPEAKER_03: But the big things therapeutically that we can do at this point in time is decide whether a therapeutic renal diet or kidney diet is the best thing for that cat.
• 12:16
  SPEAKER_03: Um, there's multiple studies that have shown benefits of changing the diet and how that could help the cat, making sure their weight and their appetite is addressed.
• 12:26
  SPEAKER_03: We actually see those changes pretty early sometimes in kidney disease.
• 12:31
  SPEAKER_03: And then also thinking about this is a new concept, thinking about uremic toxins that build up in the bloodstream as a result of kidney disease.
• 12:39
  SPEAKER_03: We do have a supplement, an adsorbent that's now been shown that even early in kidney disease, you're starting to get a buildup of those toxins.
• 12:47
  SPEAKER_03: So that that supplement porous one, that is something that would be prescribed pretty early in the in the process as well.
• 12:54
  SPEAKER_03: Hydration, really key, making sure that hydration is adequately addressed and constipation is another big one.
• 13:00
  SPEAKER_01: That again can be observed through making sure the cat is drinking well enough.
• 13:06
  SPEAKER_01: And if not, then maybe there's some type of issue in the uh in the system that is that is affecting the cat.
• 13:14
  SPEAKER_01: And also paying attention to the litter box, it's really easy just to clean it without thinking what is the size of the litter, you know, the clump in the litter and and what's happening with those types of things.
• 13:25
  SPEAKER_03: Yep.
• 13:25
  SPEAKER_03: And I think that's where sometimes folks can get fooled because that that inherent damage in the kidney, you can no longer concentrate your urine.
• 13:34
  SPEAKER_03: So you see your cat drinking and you think that that then implies that they would be hydrated, but actually the water goes through the body and the kidney can't hold on to it anymore.
• 13:44
  SPEAKER_03: It just it just goes straight out into the urine.
• 13:47
  SPEAKER_03: So that's how you get those large urine clumps.
• 13:49
  SPEAKER_03: And the cat is drinking, drinking, trying to keep up.
• 13:52
  SPEAKER_03: So sometimes even when you see them drinking so much, they can actually still be dehydrated because they're losing all that water through that kidney that can no longer concentrate the urine.
• 14:02
  SPEAKER_01: You're listening to the Hissing Feline podcast.
• 14:04
  SPEAKER_01: I'm your host, Clark Greer.
• 14:06
  SPEAKER_01: My guest today is Dr.
• 14:07
  SPEAKER_01: Jessica Quimby, professor and vice chair of research in the College of Veterinary Medicine at the Ohio State University.
• 14:14
  SPEAKER_01: Coming up after break, Dr.
• 14:16
  SPEAKER_01: Quimby will talk about treatment methods for feline chronic kidney disease, monitoring cats with CKD, and prognosis of the disease.
• 14:25
  SPEAKER_01: Please stay with us.
• 14:31
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• 15:13
  SPEAKER_01: Welcome back to this episode of the Hissing Feline.
• 15:16
  SPEAKER_01: I'm Clark Greer, your host.
• 15:19
  SPEAKER_01: Joining me today is Dr.
• 15:20
  SPEAKER_01: Jessica Quimby, professor and vice chair of research in the College of Veterinary Medicine at the Ohio State University.
• 15:28
  SPEAKER_01: We're talking about feline chronic kidney disease or CKD.
• 15:34
  SPEAKER_01: In the first segment, we focused on diagnosis and effects of kidney disease.
• 15:38
  SPEAKER_01: Let's talk a little bit further about treatment methods.
• 15:41
  SPEAKER_01: What are veterinarians uh doing today to help with this disease?
• 15:47
  SPEAKER_03: That's a big question, actually.
• 15:48
  SPEAKER_03: So uh um there is a lot that we can do to help our cats with chronic kidney disease.
• 15:53
  SPEAKER_03: And I think the big piece to understand is that so many things can go wrong, unfortunately for them when they have this disease.
• 16:01
  SPEAKER_03: So our job as veterinarians is to identify those changes that happen with kidney disease and then to treat those different, those different abnormalities.
• 16:10
  SPEAKER_03: So, for example, appetite, huge problem.
• 16:13
  SPEAKER_03: There we actually call appetite dysregulation.
• 16:17
  SPEAKER_03: So when you have kidney disease, you have buildup of toxins in the bloodstream, and those actually go centrally to the brain and they decrease your appetite.
• 16:26
  SPEAKER_03: So we can give appetite stimulants to re-regulate that process and to help that cat eat better and maintain its weight and be able to give it the more favorable diet.
• 16:36
  SPEAKER_03: We want to do a renal therapeutic diet.
• 16:39
  SPEAKER_03: But there are many other aspects of disease as well.
• 16:41
  SPEAKER_03: So anemia for low potassium, dehydration, constipation, all of these we have to kind of dig in and investigate.
• 16:50
  SPEAKER_03: Does this cat have that?
• 16:52
  SPEAKER_03: Is there a possibility they have a UTI?
• 16:54
  SPEAKER_03: Do they have high blood pressure?
• 16:56
  SPEAKER_03: So that that the diagnostics that we do is really to say, what does this cat have going on with its kidney disease and what can we fix to make them feel better?
• 17:06
  SPEAKER_03: And importantly, our research has shown that some of the important aspects that can really affect how your cat feels are things like anemia and that poor appetite and constipation.
• 17:19
  SPEAKER_03: Uh so by by finding those and addressing them, we can make the cat feel better and have better quality of life in general.
• 17:26
  SPEAKER_03: So unfortunately for us, we don't have a cure for kidney disease at this point in time.
• 17:30
  SPEAKER_03: We're left picking up the pieces, identifying all those complications and treating them as they come along.
• 17:36
  SPEAKER_01: Does it help to uh give the cat wet food?
• 17:40
  SPEAKER_01: Does that help to put some uh uh liquid into their diet?
• 17:43
  SPEAKER_03: Yeah, that that's a great question.
• 17:44
  SPEAKER_03: So that's something that people have classically said, um, but it really honestly depends on the cat in terms of what their preference is.
• 17:53
  SPEAKER_03: So because we struggle with appetite so much, you're right, feeding more wet food does provide better hydration, but you actually have to feed quite a bit of wet food in order to move that mark.
• 18:04
  SPEAKER_03: And many cats, some cats don't like wet food, and wet foods is much less calorically dense.
• 18:10
  SPEAKER_03: So they might actually struggle to eat enough wet food to get all the calories that they need to maintain their weight.
• 18:17
  SPEAKER_03: And that's often where we also need to have a little bit of a component of really calorically dense kibble as well to try to meet their caloric goals for the day.
• 18:26
  SPEAKER_03: So we we address hydration a number of different ways.
• 18:29
  SPEAKER_03: Um we use products uh like hydration supplements like HydroCare or there's one called cat years, in addition to the wet or dry kibble that they have to supplement hydration.
• 18:41
  SPEAKER_03: We may do sub Q fluids, et cetera.
• 18:43
  SPEAKER_03: It just depends on the individual cat.
• 18:45
  SPEAKER_01: Do new technologies help with diagnosis and treatment of uh feline uh kidney disease?
• 18:53
  SPEAKER_03: That's a great question.
• 18:54
  SPEAKER_03: Probably one of the most pertinent spots that that come into play is is monitoring technology, if that's what you mean.
• 19:00
  SPEAKER_03: So we we actually have um a lot of um we have smart litter box monitors, for example, and monitors that m uh look at water intake and food intake and get you more information from the home environment.
• 19:15
  SPEAKER_03: So we actually have done a study looking at litter box monitors because truthfully, it's hard to know what's going on in the litter box, especially if you're not there.
• 19:23
  SPEAKER_03: And even when you're scooping it regularly, it's challenging to say, well, when did this happen and is there a concern?
• 19:29
  SPEAKER_03: So we used litter box monitoring technology to in fact show us that cats with kidney disease defecate less frequently than normal cats do.
• 19:37
  SPEAKER_03: And that's potentially a concern because it's just leading them towards having an uh overt problem with constipation.
• 19:45
  SPEAKER_03: So recognizing that that is a clinical concern for them.
• 19:48
  SPEAKER_03: And then caregivers can use litter box monitoring technology to see what defecation frequency is, to monitor for uh urinary tract infections.
• 19:57
  SPEAKER_03: And a lot of these devices also keep track of weight over time and will alert you if your cat was losing weight.
• 20:03
  SPEAKER_03: And similarly, that that home information that's so valuable for us because otherwise, as a veterinarian, when I see the cat in the clinic, it's only that one snapshot of time.
• 20:13
  SPEAKER_03: And it's it's hard to say what's happening at home for the kitty.
• 20:16
  SPEAKER_03: And sometimes the caregiver isn't really aware of that either because uh, you know, they they may be retired, they may be at home, but often people are leaving the home and and for and they're gone for the a long part of the day.
• 20:28
  SPEAKER_03: So they they're not able to provide us with a complete history.
• 20:32
  SPEAKER_03: Um, so that's where that new technology and that monitoring equipment can actually be really helpful for cats with kidney disease.
• 20:39
  SPEAKER_01: Those are some of the things that people can do at home is to have those uh technologies.
• 20:44
  SPEAKER_01: Are there anything else that owners can do to either recognize it or or to help treat it?
• 20:51
  SPEAKER_01: Let's say it's it's uh been diagnosed in the cat.
• 20:54
  SPEAKER_01: Are there some things that they can do to help?
• 20:56
  SPEAKER_03: The most common thing that I tell our caregivers is to be very aware of what their cat is eating, how much.
• 21:03
  SPEAKER_03: I really want them to have an idea of exactly how many calories per day their cat eats.
• 21:08
  SPEAKER_03: We we provide them with a caloric goal for that specific cat.
• 21:12
  SPEAKER_03: You know, fluffy should be eating 200 kcals per day and having an understanding of what the caloric density of the food is that they're feeding.
• 21:20
  SPEAKER_03: And we we talk about that calorie goal.
• 21:22
  SPEAKER_03: And if we're not meeting that calorie goal, then we need to help appetite.
• 21:26
  SPEAKER_03: We might utilize a medication to do so.
• 21:29
  SPEAKER_03: That's a really, really that's a that's a long-term struggle for this disease.
• 21:34
  SPEAKER_03: And the other big part is hydration, understanding again that hydration aspect.
• 21:38
  SPEAKER_03: We teach folks how to do a skin tent and be able to monitor hydration in the home environment, keeping track of the weight in the home environment.
• 21:45
  SPEAKER_03: So there are there are lots of things that you as a cat caregiver can do to really better understand how your cat is doing at home and provide us, the veterinarian, with really important information to be able to make good um recommendations and and treatment.
• 22:00
  SPEAKER_03: Decisions for them.
• 22:01
  SPEAKER_01: Let's talk about the prognosis of CKD between finding it early and later in a cat.
• 22:08
  SPEAKER_03: Prognosis is a is a big question.
• 22:10
  SPEAKER_03: And I will say that it is actually really hard for us to be able to prognosticate for any individual cat.
• 22:17
  SPEAKER_03: Unfortunately, we still don't really completely understand what causes some cats to progress faster than others.
• 22:26
  SPEAKER_03: That's still a big matter of debate.
• 22:28
  SPEAKER_03: What is very important is all of these complications that I mentioned.
• 22:33
  SPEAKER_03: Those complications, they really, they're hard for the cat.
• 22:36
  SPEAKER_03: And so if the cat has kidney disease and they have less complications, it's quite logically that they're going to do better.
• 22:42
  SPEAKER_03: But scientifically speaking, we still don't have a really good understanding of why one cat might have, I guess, fairly straightforward kidney disease and other cats might have a lot more complex kidney disease.
• 22:52
  SPEAKER_03: Also, they're older cats, so they have comorbidities, other disease processes that are going to, you know, be happening at the same time as their kidney disease.
• 23:01
  SPEAKER_03: I will say that there are at least two older studies that talk about prognosis.
• 23:05
  SPEAKER_03: And if if they're probably available online as cat caregivers, you might have seen them.
• 23:10
  SPEAKER_03: They are no longer reality.
• 23:14
  SPEAKER_03: Those studies are so old, I would not look at those numbers because they don't look good, quite frankly.
• 23:21
  SPEAKER_03: That is no longer my clinical reality.
• 23:23
  SPEAKER_03: We have a whole host of new medications, new therapies that we never had when those articles from 15 or 20 years ago were written.
• 23:32
  SPEAKER_03: So we we actually need a new version of those studies.
• 23:36
  SPEAKER_03: And although it's true that cats who are diagnosed with kidney disease later in stage three or stage four have a shorter survival time, I still have cats who are diagnosed with stage three or four that actually live for several years with their, you know, their complications managed and a good quality of life.
• 23:54
  SPEAKER_03: It it just really depends on the individual cat and also what the caregiver can do and what the cat will allow, because not all kitties are going to do very well.
• 24:05
  SPEAKER_03: Uh they they they might be stressed by medications.
• 24:08
  SPEAKER_03: And so we have to make individual decisions about what's best for their care.
• 24:14
  SPEAKER_03: And that's very much important in the concept of caring for these cats long term.
• 24:20
  SPEAKER_03: This cat may have these complications, but what's the best way for that cat for us to treat those complications?
• 24:26
  SPEAKER_03: So those are discussions that we have with our caregivers as well to say what's going to work best for your kitty?
• 24:33
  SPEAKER_03: A pill or a liquid, or how do we give it, or which medications do we prioritize so that we have the best outcome for everybody?
• 24:40
  SPEAKER_01: We ended up giving a pill to our old cat for about a year or so uh because she had thyroid problems also is like there was you have one thing wrong in a cat and you have ten things wrong in a cat.
• 24:53
  SPEAKER_01: And we tried we tried different methods of hiding a pill and she just knew it was there.
• 24:58
  SPEAKER_01: I ended up doing the pill popper, and I'm not sure she liked that very well.
• 25:02
  SPEAKER_01: So yeah, cats react differently.
• 25:04
  SPEAKER_01: But another Yeah, another thing you mentioned is uh old studies and things that change a lot because things just change with new uh with new research, is if uh if any of my listeners are interested in looking at things and they find an article or something, they do really need to make sure that it's very current research.
• 25:23
  SPEAKER_03: Yeah, that's very true.
• 25:25
  SPEAKER_03: I I would say I'm I'm proud to be involved.
• 25:28
  SPEAKER_03: This is my major field of study, right?
• 25:30
  SPEAKER_03: It's it's what I do is is creating that research and trying to help our cats with kidney disease.
• 25:36
  SPEAKER_03: But we're actually really lucky right now in feline medicine because we have so much interest in feline kidney disease, and we have a lot of new treatments that have come our way and new treatments that are on the horizon too.
• 25:49
  SPEAKER_03: So it's a it's really a wonderful time to be involved, uh, you know, so much hope for the future, and so many things have been uh already offered to us.
• 25:59
  SPEAKER_03: You know, the the the treatments for appetite, the treatment for anemia, these are things that we never had 20 years ago, even 10 years ago.
• 26:07
  SPEAKER_03: And that's why those old uh you know, prognosis studies they don't apply anymore because at that time those cats weren't lucky enough to have the drugs that we now have today.
• 26:17
  SPEAKER_03: And that that really makes a difference for our patients.
• 26:19
  SPEAKER_03: So that's that's important.
• 26:21
  SPEAKER_01: How about end stage CKD?
• 26:24
  SPEAKER_01: What can people expect uh if they're cat owners?
• 26:28
  SPEAKER_03: End stage kidney disease.
• 26:29
  SPEAKER_03: I think it's important to distinguish whether we mean is this the first diagnosis or if we have been slowly progressing there over time.
• 26:40
  SPEAKER_03: If it's the very first time and someone's telling you that your cat has end stage kidney disease, we actually first need to make sure that we're not missing something, that you're not missing a treatable complication that could have resulted in that cat's numbers being quite high, because that's a very different picture than a cat that you've been treating for years and now we have progressed to end stage kidney disease, and there aren't any complications that we can address to make that that clinical picture better.
• 27:09
  SPEAKER_03: I think it's it's really hard because it is tends to be a slow decline.
• 27:15
  SPEAKER_03: And we have to really think about quality of life and good days and bad days and how many of them there are.
• 27:22
  SPEAKER_03: So those are the conversations that we have to say, what what is quality of life for this particular cat?
• 27:28
  SPEAKER_03: How do we decide how many good days she's having and how many bad days?
• 27:33
  SPEAKER_03: And it's hard to make the decision.
• 27:36
  SPEAKER_03: It's so hard to make the decision to say goodbye.
• 27:38
  SPEAKER_03: But as we as we move towards end stage disease, there'll be a time when the bad days outnumber the good days.
• 27:45
  SPEAKER_03: And that's a really important concept to hold because kidney disease can be a little bit of a roller coaster, unfortunately.
• 27:52
  SPEAKER_03: Is in the in the middle of the disease process, you'll have good days and bad days, and you'll have good periods of time and then rough periods of time when they're going through a little bit of a bad patch or a new complication comes up.
• 28:03
  SPEAKER_03: So emotionally, unfortunately, it can be really up and down like that.
• 28:07
  SPEAKER_03: But as we move more towards end stage disease, we get to the point where we actually can't, there's nothing else we can do to help.
• 28:15
  SPEAKER_03: And then we're really concentrating on that quality of life piece and and making sure that um you know we we make that compassionate decision if we're if we're not maintaining any quality of life.
• 28:26
  SPEAKER_01: Right.
• 28:26
  SPEAKER_01: And palliative care uh for the cat as it gets older and then having to make that decision, which is which is very very difficult.
• 28:34
  SPEAKER_03: It is, it is, it's always a very hard decision, yes.
• 28:38
  SPEAKER_01: Are there websites that uh listeners could go to if they want to find out more about uh feline coronary kidney disease?
• 28:48
  SPEAKER_03: There's actually not too many official resources.
• 28:51
  SPEAKER_03: So one of the historical caregiver run one has been Tanya's website.
• 28:56
  SPEAKER_03: A lot of people have gone there, but from like a university standpoint or uh a research expert standpoint, we actually don't have that many resources.
• 29:04
  SPEAKER_03: But um there is just very soon going to be coming out.
• 29:09
  SPEAKER_03: This would be the best thing that I would recommend.
• 29:11
  SPEAKER_03: The ICAT Care Society.
• 29:14
  SPEAKER_03: We have just we're just launching a new guidelines for the management of feline CKD, and that should be coming out.
• 29:21
  SPEAKER_03: It will be open access and it's really comprehensive, and there's going to be information for the caregiver in there as well.
• 29:28
  SPEAKER_03: So that I would expect is going to be out in the next month or two here in the early fall.
• 29:34
  SPEAKER_03: That is the resource that I would actually recommend.
• 29:37
  SPEAKER_03: Because there's there's not necessarily any individual website, but this is a document that's been put together by several experts in CKD, including myself, that covers a lot of the things that we've talked about here today, things to think about, things to monitor, all the complications that happen, etc.
• 29:54
  SPEAKER_03: And it's a it's a lovely document.
• 29:56
  SPEAKER_01: I know that will be helpful for cat owners to uh get some more information uh about this if they suspect their cat is uh having that.
• 30:05
  SPEAKER_01: Of course, they need to visit their vet in those instances to get a diagnosis and really find out what's going on if they're having problems with their cat.
• 30:14
  SPEAKER_01: Dr.
• 30:14
  SPEAKER_01: Jessica Quimby has been my guest today on the podcast.
• 30:18
  SPEAKER_01: She is professor and vice chair of research in the College of Veterinary Medicine at the Ohio State University.
• 30:25
  SPEAKER_01: And we've been talking about chronic kidney disease.
• 30:29
  SPEAKER_01: Dr.
• 30:29
  SPEAKER_01: Quimby, thank you very much for joining me on today's episode.
• 30:32
  SPEAKER_01: You're welcome, Clark.
• 30:33
  SPEAKER_01: It's been a pleasure.
• 30:34
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• 30:40
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• 30:45
  SPEAKER_01: Next week on the Hissing Feline podcast, please join me as I visit with author Kat McCarthy about her book, The Wild Side of the Wall, A Cat's Perspective of the World.
• 30:56
  SPEAKER_01: Have a great day and remember to keep curring.
• 31:02
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• 31:14
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• 31:21
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• 31:28
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• 31:42
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