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Managing Concurrent Kidney And Heart Disease

Attempting to manage concurrent heart and kidney disease can be difficult without proper diagnosis and information.

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The first step in controlling a patient’s kidney or heart condition is a reliance on the owner’s detection of a clinical problem. Cardiology and kidney specialists suggest preparing clients whose pet has a high risk of disease before symptoms begin–even running blood work or genetic testing if it applies.

Information that veterinarians provide to clients will help the owners recognize disease symptoms and increase compliance with veterinary directions when managing the disease. Two-thirds of dogs and more than half of cats suffering from cardiac disease have concurrent diseases.

Because a large number of kidney and heart disease patients are of an advanced age, it’s not uncommon for a patient being treated for one disease to develop the other, a situation that takes a vigilant veterinarian and dedicated owner to manage.

“Once we have a diagnosis and the client understands the disease and necessity to follow up, the biggest obstacle is the owner’s financial commitment,” says Megan King, VMD, Dipl. ACVIM (cardiology) of the Center for Animal Referral and Emergency Services in Langhorne, Pa. “For much of heart disease there may not be a substantial cost, but as the pet deals with more advanced disease and congestive heart failure, the cost can become more significant, especially when considering kidney disease as well.”

Because of financial hurdles, veterinarians may be restricted in treating some of their heart and kidney disease patients. This factor makes prevention a big factor in proactively serving patients’ needs. Initiating a blood workup at a certain age or for specific breeds can be a lifesaver that catches disease at a more medically and financially manageable stage.

“Disease can be captured early with annual lab work,” says Larry Cowgill, DVM, Ph.D., Dipl. ACVIM, a professor of small animal medicine at the University of California, Davis, School of Veterinary Medicine. “After age 5, particularly with cats, monitoring kidney disease must increase, as the incidence of disease continues to increase with age. Currently, laboratory perimeters aren’t as accurate as we’d like, so the International Renal Interest Society (IRIS) is working to develop a staging system for veterinarians. Also, the International Renal Veterinary Pathology Initiative (IRVPI) developed a national registry for glomerulonephritis, caused by an inflammation of the internal kidney structures called glomeruli, so veterinarians can share new information.”

Diagnosing Kidney Disease

Veterinarians know the symptoms of kidney disease all too well: increased thirst and urination, vomiting, anorexia, lethargy and with 40 percent or higher of older cats diagnosed with kidney disease, it’s the first suspect. Dogs have about a 7 percent prevalence rate, and disease is often not detected in them until its advancement allows for little more than palliative care.

If environmental components can be eliminated as the cause of a presenting animal’s symptoms, the underlying cause of disease must be detected before maintenance instructions are given.

“Some supplements are under investigation for their ability to be helpful in disease maintenance,” says David Polzin, DVM, a nephrology and urology associate at the University of Minnesota.

“Omega-3, antioxidants and calcitrol have shown some value for diet maintenance, which would be recommended for animals in second-, third- and fourth-stage disease. The best maintenance remains veterinary prescribed diets and not those found in grocery stores.”

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For dogs especially, promoting the prevention of kidney disease from environmental factors may help decrease the patients’ likelihood of getting the disease, Dr. Cowgill says.

“Depending on your geographic location, Lyme disease and leptospirosis may play a role in the incidence of kidney disease,” Cowgill says. “Non-geriatric cats have a higher incidence of kidney disease because of chronic and acute ureteral obstruction from kidney stones. These skewed perceptions don’t allow the profession to be on the same page with cause of disease, prevalence and treatment. A national registry would improve maintenance and treatment options.”

The mission of IRIS is to help veterinary practitioners better diagnose, understand and treat renal disease in cats and dogs.

One of the organization’s main objectives is to establish an internationally recognized set of guidelines on the diagnosis and assessment of progression of renal disease in small animals. IRIS’ board has developed a treatment recommendation for chronic kidney disease. These guidelines are reviewed annually and can be found at Iris-Kidney.com.

UC Davis, until its recent postponement of the procedure, performed about 24 feline kidney transplants annually, taking the treatment of kidney disease to the highest level after animals reach the final stages of disease. Veterinarians know they can combine drugs and diet to manage the disease, and if these clients make their way to a specialist, they tend to be willing to go the extra mile to financially and emotionally provide for the pet, but what happens to the animal once a second diagnosis is made?

Diagnosing Heart Disease

“Education is extremely important,” Dr. King says. “If you communicate with your clients and give them the information they need to prepare them to do what is needed for the pet, they are likely to be more compliant, but as the diagnosis worsens or disease progresses, the veterinarian needs to do more to prepare the client: give step-by-step directions for administering a special diet, exercise regulations and expectations from the pet.”

Dogs tend to be easier to diagnose because of their lessened ability to mask discomfort and reliance on the owner for elimination and closer human interaction.

“In most situations, a detailed physical examination, auscultation, thoracic radiographs, ECG and complete bloodwork will help get a baseline for the patient’s cardiac disease,” King says. “Cats continue to challenge veterinarians as they can have a relatively normal auscultation or radiographs and still have underlying heart disease. Cats can require an echocardiogram to determine cardiac disease.”

Cardiovascular disease is the best predictor of death in patients with end-stage renal disease, accounting for almost half of deaths. Patients with varying degrees of chronic kidney disease also have a markedly increased risk of morbidity and mortality from cardiovascular disease, including coronary heart disease.

“There are different drug therapies for treating animals with heart disease depending on the underlying disease type and severity,” King says. “But the mainstay of therapy once an animal goes into congestive heart failure is with diuretics and angiotensin converting enzyme inhibitors. There are additional medications for arrhythmias, hypertension or other problems. A new medication called Pimobendan, manufactured by Boehringer Ingelheim, has really helped a lot of cardiac patients. This medication has a phosphodiesterase benzimidazole-pyridazione inodilator with a potent positive intropic and vasodilatory effect.”

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Chronic renal dysfunction alone is a risk factor on its own for the development of coronary artery disease and heart disease. Chronic kidney disease is also associated with an adverse effect on prognosis from cardiovascular disease. This includes increased likelihood of death after an acute coronary syndrome.

Genetic Testing

Genetic testing allows veterinarians to proactively test for the certain types of heart disease in the specific breeds it targets, such as mitral valve disease in Cavalier King Charles Spaniels, which is the cause of death in 75 percent of the breed; polycystic kidney disease in Persian cats; and hypertrophic cardiomyopathy in rag dolls and Maine coons.

Genetic testing offers an opportunity to drastically reduce the incidence of disease by eliminating those showing markers for disease from the breeding pool, and treating them in stage 1 to provide them with the best outcome.

Veterinarians can prevent significant onset of kidney disease through blood tests; they know older cats are at the highest risk and catching the disease in early stages will allow for better maintenance. Spaniels under the age of 5 should not be bred and those 5 and older that have been diagnosed with the disease shouldn’t be bred in an effort to eradicate the disease prevalence in the breed.

“The reasons for disease frequency are numerous,” Polzin says. “But the reason disease detection is delayed is simple. Owners don’t approve blood work in cats and breeders don’t follow testing protocols.”

Veterinarians’ role in preventing disease onset is a proactive approach to disease maintenance, King says.

“Veterinarians should recommend genetic testing in Maine coons and ragdolls,” King says. “Over time using these genetic tests helps guide breeders’ decisions in order to reduce the prevalence of the disease in these breeds. These tests still have limitations.

“The heart disease has a variable penetrance so not all cats with the mutation will actually get the disease. We also know there are many forms of the disease, so despite being negative for the mutation, cats can still develop underlying cardiac disease.

“Despite amazing advancements, we are just at the tip of the iceberg and these purebred cats are only a small portion of the overall cat population affected by heart disease.”

Additional Testing

Mary Nabity, DVM, Dipl. ACVP, a clinical assistant professor and Ph.D. candidate at Texas A&M University, is working on Morris Animal Foundation-funded research that can develop an early detection test for chronic kidney disease.

Dr. Nabity is evaluating the urine proteins in mixed-breed dogs in search of novel biomarkers of early tubular damage and renal disease progression using two proteomics techniques – 2-dimensional gel electrophoresis and surface-enhanced laser desorption/ionization (SELDI).

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“We want to develop a user friendly test that can be used in-house or sent to a lab for analysis,” Nabity says. “Through a better testing method, we can expand life expectancy of animals with kidney disease. Now 65 to 75 percent of an animal’s kidney function can be wiped out before the disease is even detected.”

Leslie Lyons, Ph.D., a geneticist with UC Davis, says the ultimate maintenance for animals with concurrent kidney and heart disease will be gene therapy.

“Some gene therapy is already in use in the profession,” Dr. Lyons says. “However, we are a ways away from using it clinically to treat kidney or heart disease. Once something is finalized, it will be the gold standard of treatment.”


Therapeutic Diets for Kidney/Heart Disease Patients

Two-thirds of dogs and more than half of cats with cardiac disease have concurrent diseases that might influence their diet selection, said Lisa M. Freeman, DVM, Ph.D., Dipl. ACVN, a nutritionist at Cummings School of Veterinary Medicine at Tufts University in North Grafton, Mass.

“Some dogs with chronic heart failure might also have chronic renal failure and this might necessitate protein restriction,” Dr. Freeman says. “However, patients with cardiac disease alone should not be protein-restricted. Cats with hypertrophic cardiomyopathy might also have concurrent struvite urolithiasis. These cats need a diet that is sodium-restricted but also has nutritional modification to reduce the risk of struvite urolith formation.”

Specialists say the recommended diet for animals with cardiac disease alone is not universal but in general, the nutrients of concern in cardiac patients are calories, sodium, chloride, protein, potassium and magnesium. But deciding on a diet isn’t clear-cut. Clinical signs, laboratory parameters and food preferences all affect diet selection.

Animals diagnosed with kidney disease that have now also been diagnosed with heart disease may have been switched by the veterinarian from a non-monitored diet to a therapeutic diet that manages their kidney disease.

On a case-by-case basis, these newly diagnosed animals should be evaluated for their specific benefits for altering their diet again to avoid food aversions. Low-protein diets are an essential tool in managing disease progression in kidney disease patients to generate fewer nitrogenous wastes, but decreased protein may have a derogatory effect on animals also suffering from heart disease as low protein may contribute to muscle loss or cardiac cachexia.

“As chronic heart failure becomes more severe, more significant sodium restriction may allow lower dosages of diuretics to be used to control clinical signs,” King says. “Once the patient is stabilized with medication, a gradual change to a new diet can be made.”

The goal is to extend the quality of life of patients with kidney and heart disease without propelling disease, causing anorexia or assigning a diet that isn’t palatable. In some cases, dietary supplements may be recommended in addition to medication and diet control.

– JT


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16 thoughts on “Managing Concurrent Kidney And Heart Disease

  1. My 16 yrs old cat has CKD, he’s on the royal canin renal beef pouch. But a couple days ago, we’ve learnt that he also has a heart problem on top.So I am wondering if I should just continue to give the same diet? What else can I feed when he drops his appetite? Any supplement I could add to his diet like fish oil? Would that helps to strengthen the heart condition overall? I would mix half of each Rx diet if there was veterinary cardiac diet for cats..but sadly there isn’t like for the dogs..
    Please kindly give me some advices.
    Thanks a lot

  2. My 12 year old Sheltie mix was diagnosed with congestive heart failure a year ago. She is on medications, and recently diagnosed with kidney disease. I make her dog food, and reduced the protein by about half. She has stopped coughing completely, and has decreased thirst and urination. I’m wondering if the problem was kidney disease in the first place?

    1. What kind of food did you make for your dog. I have a 16 yr old toy poodle has a heart problem. Takes a heart pill, now she has kidney disease.

      1. I have
        A 141/2 year old yorkie who was diagnosed with pancreatitis and was treated for it only to find him falling over a week later, when I brought him back to vet did a complete blood work up he was severely dehydrated, needless to say all kidney and liver levels were off the charts! He was hospitalized and given around the clock IV with high doses of antibiotics, I took him home and administere 100ml subcutaneous fluids in morning and 200ml at night, along with denamarin pill (for liver) I make his food eye of round with white rice and green beans and a special dry kidney prescription food,( he likes to crunch) more blood work all levels normal accept for of course kidney and liver,he’s living on 25% kidney, recently started with a cough back to dr has enlarged heart do to maybe high levels of subcutaneous fluids to flush out toxin. Just stared him on pimobenadine for his enlarged heart and cut back 100 ml of fluids a day, drs seem confident and so do I! Watch out for a cough, and good luck💕

      2. My little chihuahua whom is almost 20! has heart issues and now renal failure, unfortunately some of the heart meds do cause kidney issues. like vetmedin, lasiks and other heart meds. I hate that you try to take care of one serious conditions and add on another one due to the meds. She is currently at the vet and has been there for 2 days getting labs done and fluids administered. Im not sure what the next step is but i know that I’m going to try my best to let her live as comfortably as she can. I hope and pray she gets better and hope your dog does too. If you figured out a meal plan and its been working please let me know any information you can give me, i would really appreciate it.

        1. Mabelle, I am sorry to hear about your chihuahua. My yorkie is only 8 and is dealing with heart and kidney problems. Did the cardiologist tell you that the meds were the cause of the kidney issues? Several days ago my yorkie had his second echocardiogram. Based on the echocardiogram the cardiologist determined that the meds were not the cause of the kidney issues. He made that diagnosis by evaluating the left side of the heart. I am going to see a liver specialist next. I was told to decrease the benazepril hydrochloride to 2.5mg twice daily because it can affect the liver.

          1. Correction: I was told to decrease the benazepril hydrochloride to 2.5mg ………….it can affect the kidney.

    2. Hi Teresa,

      How do you make the food for your dog and is your dog on other medicine. I saw a image of my dogs heart it is really large almost the size of his whole body and round

  3. Our 14 year old Lahasa Apso has congenital heart disease and kidney problem. We feed food from our vet but are stuck about what treats we can give, could anyone recommend anything?

  4. I have a 13 year old cavoodle who had a heart murmur. Now just been put on heart medication and x2 weeks later showing signs of kidney disease. Could the heart medication be putting stress on the kidneys? Drinking and urinating heaps more since on the medication. Vet says just feed her normal diet which has been kangaroo meat and vegetables and specialist dry food. mainly because she has previously had digestion problems.

    1. There are lots of dog owner stories on the internet of heart meds causing or worsening the kidneys. The kidneys are already weakened because the heart is not functioning properly and their purpose is to filter out bodily toxins. Pharmaceuticals are toxins. So, there is now an increased load on the already weakened kidneys. The best course of treatment as proven with my own 10-year old Pomeranian is a balanced raw food diet and the appropriate herbal supplements. Five Leaf Botanicals Canine Heart Health package healed my Pom’s grade 3 heart murmur to a grade 1-2 in 3 months. I have also used their RenaCleanse and HeparaCleanse products to detox his liver and kidneys especially after he got so sick on Vetmedin and Lasix for the two weeks he was on those drugs. http://caninehearthealth.com/

      Do your own research and use veterinary technology like X-rays, blood test, echocardiogram, etc. to know what is going on inside your pet’s body.

      My little guy just got a great checkup from his regular vet who still maintains there is no cure for CHF and that pharmaceuticals are the only treatment.

    2. Unfortunately most heart meds do cause kidney issues. My chihuahua is currently at the vet suffering from renal failure and has CHF, she has been monitored for 2 days now at my local animal hospital and my vet said that its tricky to figure out the right regimen for treatment for a dog suffering from CHF and kidney issues especially renal failure because you can not administer too much fluid because then the heart will give out but you can’t under administer fluids because then kidneys give out. According to my vet once e get her back and she is stable we still have to watch out for any constant coughing or hacking because that means the heart is giving out or if my dogs doesn’t seem to have an appetite and has lethargy and is fatigued then her kidneys are going to give out. They toxins in her body won’t have anywhere to go since the kidneys do not work to filter the toxins out, if that happens then unfortunately she won’t be with me that much longer. Its so sad even typing this and its bringing me to tears but if i can help one person with this information then it was worth it taking my time to type this up. If anyone has any information on a situation similar to mine and has found a solution to help your dog live a bette life and a lengthy one then please let me know, i would greatly appreciate it.

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