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Published on: November 7, 2017
Feline comorbidities: cardiovascular and kidney diseases
Amanda E Coleman1, Bianca N Lourenço1
1Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA.
Insights
Managing concurrent heart and kidney disease in cats requires careful fluid balance. Treatments for one condition can worsen the other, impacting prognosis and requiring careful veterinary consideration.
Area of Science:
- Veterinary Medicine
- Cardiology
- Nephrology
Background:
- Concurrent cardiovascular and kidney diseases are common in aging cats.
- Interactions between heart and kidney disease can lead to progressive organ dysfunction.
- Clinicians must consider the impact of treating one condition on the other organ system.
Purpose of the Study:
- To address the challenges in managing fluid balance in cats with coexisting heart and kidney disease.
- To highlight therapeutic conflicts between treating heart failure and kidney disease.
- To provide guidance for veterinary practitioners on managing these complex cases.
Main Methods:
- Recommendations derived from peer-reviewed literature.
- Inclusion of expert consensus guidelines where available.
- Synthesis of current knowledge for practical application.
Main Results:
- Therapies for kidney disease (e.g., fluid therapy) can conflict with heart failure management (e.g., diuretics).
- Improper fluid management can cause injury or stress to the contralateral organ.
- Balancing fluid therapy is critical for maintaining mean arterial pressure and renal blood flow while reducing capillary hydrostatic pressure.
Conclusions:
- Optimal management of cats with concurrent heart and kidney disease necessitates a delicate balance of fluid therapy.
- Understanding the interplay between cardiac and renal systems is crucial for successful case management and prognosis.
- Veterinary practitioners require awareness of potential iatrogenic complications arising from therapeutic interventions.
Practical Relevance:
Cardiovascular and kidney diseases are highly prevalent and frequently coexistent in cats, particularly those of advanced age. Several pathways of interaction between the heart and kidneys likely contribute to progressive functional decline of these systems during disease of one or both. Identification of heart or kidney disease in a cat should prompt the clinician to consider how the disease and its treatment might impact the function of the other organ and how coexisting primary disease of the other might impact case management and patient prognosis.
Clinical Challenges:
A common goal in the management of congestive heart failure, acute kidney injury or chronic kidney disease is to maintain optimal body fluid balance; however, many therapies for disease of one system are at odds with the best interests of the other. For example, treatment of kidney disease often includes parenteral fluid therapy with the goal of maintaining mean arterial pressure and adequate renal blood flow, while diuretics are almost always necessary to reduce capillary hydrostatic pressure in cats with heart failure. Overly aggressive volume expansion or reduction during the management of kidney or heart failure, respectively, can lead to injury to or excessive stress on the other organ system.
Evidence Base:
Recommendations are based on available peer-reviewed literature and expert consensus guidelines when available.
Audience:
This article is aimed at all veterinary practitioners who work with cats.
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