Manejo dietético na doença renal crônica felina

Abstract

Chronic kidney disease (CKD) is the most common metabolic disease in domestic cats. It occurs when the kidneys become unable to maintain their excretory, regulatory and endocrine functions in animals. The clinical picture of a feline with CKD is nonspecific and the most commonly observed clinical signs include anorexia, lethargy, polyuria and polydipsia. Clinical and historical findings suggestive of CKD, as well as increased serum creatinine concentration, inappropriately low specific urinary density, persistent increase in symmetric dimethylarginine (SDMA), and evidence of sonographic changes. Staging is performed after CKD diagnosis, based on blood creatinine or SDMA concentration, and substaging is based on whether or not hypertension and proteinuria occur. Treatment consists of supportive and symptomatic therapy designed to correct abnormalities in hydroelectrolytic, acid-base, endocrine and nutritional balance. Diet modification are considered standard therapy for the treatment of CKD. Renal diets (RDs) are specifically formulated for the purpose of clinical management of cats with CKD, modified based on the impact of declining renal function and supplemented with nutrients that improve disease complications. Protein restriction is recommended as they reduce nitrogenous waste and glomerular proteinuria; lowering serum phosphorus concentration is also associated with better long-term survival, decreasing the incidence of secondary hyperparathyroidism; Reducing sodium intake may be beneficial in CKD patients due to sodium retention and the potential for systemic arterial hypertension. Hypokalemia is common in cats with CKD, and diets formulated for CKD may provide potassium supplementation; supplementation with polyunsaturated omega-3 fatty acids (EPA) exerts renoprotective effects, may reduce glomerular hypertension and proteinuria, and limit the production of proinflammatory mediators. Thus, renal diets play an important role in decreasing clinical signs of uremia and, in the face of a progressive disease, slowing the progression of the disease, which increases the expectation and quality of life of patients. Thus, the objective of this study was to review the nutritional management of cats with chronic kidney disease (CKD), and to discuss the main nutrients present in renal diets.