Risk factors associated with the development of chronic kidney disease in cats evaluated at primary care veterinary hospitals

• Localización: JAVMA: Journal of the American Veterinary Medical Association, ISSN-e 0003-1488, Vol. 244, Nº. 3, 2014, págs. 320-327
• Idioma: inglés
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• Resumen

  • Objective�To identify risk factors associated with diagnosis of chronic kidney disease (CKD) in cats.

    Design�Retrospective case-control study.

    Animals�1,230 cats with a clinical diagnosis of CKD, serum creatinine concentration > 1.6 mg/dL, and urine specific gravity < 1.035 and 1,230 age-matched control cats.

    Procedures�Data on putative risk factors for CKD were extracted for multivariate logistic regression analysis from the medical records of cats brought to 755 primary care veterinary hospitals. For a subset of cats evaluated 6 to 12 months prior to the date of CKD diagnosis or control group inclusion, the percentage change in body weight between those dates as well as clinical signs at the earlier date were analyzed for associations with CKD development.

    Results�Risk factors for CKD in cats included thin body condition, prior periodontal disease or cystitis, anesthesia or documented dehydration in the preceding year, being a neutered male (vs spayed female), and living anywhere in the United States other than the northeast. The probability of CKD decreased with increasing body weight in nondehydrated cats, domestic shorthair breed, and prior diagnosis of diabetes mellitus and increased when vomiting, polyuria or polydipsia, appetite or energy loss, or halitosis was present at the time of diagnosis or control group inclusion but not when those signs were reported 6 to 12 months earlier. Median weight loss during the preceding 6 to 12 months was 10.8% and 2.1% in cats with and without CKD, respectively.

    Conclusions and Clinical Relevance�The probability of CKD diagnosis in cats was influenced by several variables; recent weight loss, particularly in combination with the other factors, warrants assessment of cats for CKD.

    Chronic kidney disease is among the most common medical conditions in geriatric pet cats, with a reported prevalence in the general feline population of 1% to 3% and in geriatric feline populations at referral centers as high as 35%.1 Diagnosis of the disease is reliant on the use of serum creatinine concentration (as a surrogate for assessment of glomerular filtration rate) in conjunction with USG.2 However, when interpreted on the basis of typical reference intervals, serum creatinine concentration alone is a relatively poor biomarker for the presence of early kidney disease.1 Currently, the standard of care for cats with CKD is aimed at ameliorating clinical signs, maintaining adequate nutrition, and slowing the progression of disease, given that the etiopathogenesis of CKD is rarely identified. When the diagnosis is not made until late in the disease process, the opportunity to slow the rate of disease progression during the earlier stages is lost.3,4 Improved survival time has been documented when the diagnosis is made at earlier, less advanced stages versus later stages of disease5; however, it remains unclear whether this apparent increase in survival time can be explained solely by the earlier diagnosis.

    In clinical practice, annual to biannual laboratory screening tests are recommended for detection of subclinical CKD in aging cats so that early intervention can ensue.6 Various veterinary studies7,8 have been conducted to identify risk factors that may predict the future development of clinically detectable CKD. A prospective cohort study7 revealed that certain factors such as increasing age and abnormalities in systolic arterial blood pressure, plasma creatinine concentration, USG, and urine protein-to-creatinine concentration ratio could predict the development of azotemia; however, following multivariate analysis, only plasma creatinine concentration and proteinuria (as determined by the urine protein-to-creatinine concentration ratio) remained significantly associated. Another study8 of the potential association between FIV infection and CKD in cats revealed no association between the 2 diseases but did find a significant association between FIV infection and the presence of proteinuria. The purpose of the study reported here was to identify factors associated with a diagnosis of CKD in cats. We hypothesized that certain clinical characteristics, including magnitude of recent change in body weight, would differ between cats that developed CKD and those that remained nonazotemic and without a diagnosis of CKD.