Chronic renal disease? Give them a renewed appetite for life
New
renal protection through phosphate binding
www.renalzin.co.uk
Distribution of CRD in cats of different ages1 8G9^cX^YZcXZ
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Chronic Renal Disease (CRD) is a common health problem for cats, particularly as they grow older. It is the main cause of mortality in older cats and is becoming increasingly common1. The management of CRD is part of everyday veterinary practice and there is an increasing focus on intervening as early as possible.
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Chronic Renal Disease
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ts ~ 1 in 3 ca ge of over the a ve a 10 years 2h CRD
Bayer Animal Health is pleased to introduce Renalzin®, a new oral paste which binds to dietary phosphate, rendering it indigestible. Controlling phosphate levels is an essential part of the effective management of CRD.
The clinical signs... CRD is nt often prese without any s clinical sign
Cats with CRD can survive for months or years with a good quality of life, with the appropriate management. Signs may include:
Loss of body weight Decreased appetite Nausea and vomiting Polyuria/Polydipsia (PU/PD) Dehydration Lethargy Poor coat condition
Azotaemia occurs relatively late in the condition, due to the tremendous reserve capacity of the kidneys. Clinical signs are often not evident until 75–80% of the nephrons are non-functional.
Diagnostic investigation may reveal:
Azotaemia Hyperphosphataemia Hypokalaemia Altered urine specific gravity Hypertension
Although no treatment can repair the irreversible renal lesions, the clinical consequences of reduced renal function can be minimised by appropriate medical management.
IRIS3 Staging System for CRD The use of the IRIS staging system helps to monitor progression of renal disease. Early intervention is essential to slow further deterioration of renal function. Plasma creatinine concentration (µmol/l) 50
140 Stage 1 No azotaemia, some other renal abnormality present e.g. inadequate concentrating ability, renal proteinuria.
250 Stage 2 Mild azotaemia or values in normal range. Clinical signs usually mild (e.g. PU/PD) or may be absent.
Step 1 Staging is initially based on fasting plasma creatinine assessed on at least two occasions in the stable patient.
440 Stage 3 Moderate azotaemia. Many systemic clinical signs may be present.
Step 2 Cases are then substaged based on proteinuria and blood pressure.
Stage 4 Severe azotaemia. Many extra renal clinical signs may be present.
What do we know about phosphate and its role in Chronic Renal Disease? Chronic renal disease
Absorption of dietary P
is characterised by retention of phosphate
CRD
P GI tract Kidney reduced P excretion
P retention
Hyperphosphatemia
Ca
P Soft tissue calcification
Hypocalcaemia
P-Ca imbalance
Parathyroid Gland
P Ca
Resulting phosphate
imbalance leads to secondary hyperparathyroidism
Increased parathyroid hormone (PTH) mobilises calcium from bone and can result in soft tissue calcification
Elevated PTH may (secondary) Hyperparathyroidism
Bones PTH
also have direct harmful effects on the kidneys
Ca mobilisation
Survival of cats with CRD Cats fed a renal diet restricted in phosphate were shown to survive ~2.4 times longer than cats fed a diet without phosphate restriction.
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This is where Renalzin steps in...
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Restriction of phosphate plays an essential role in curbing renal secondary hyperparathyroidism, soft tissue calcification and progression of renal failure.4,5
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Introducing Renalzin Renalzin provides renal protection by binding to dietary phosphate rendering it indigestible
How it works Renalzin contains Lantharenol® (lanthanum carbonate), a new calcium-free and aluminium-free phosphate binder. -
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lanthanum
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phosphate
insoluble lanthanum salt
Lanthanum carbonate stems from human medicine. It binds phosphate in the gastrointestinal tract to form an insoluble lanthanum salt. This is unable to cross the intestinal wall rendering the phosphate indigestible.
Why Lantharenol? Renalzin is the only approved* phosphate binder for cats. A round-table discussion on phosphataemia management6 demonstrated the limitations of the existing options for phosphate-binding:
When using aluminium-containing
binders, drug-induced microcytosis, muscular weakness and encephalopathy are possible
The concern with calcium-containing
agents, is the risk of hypercalcaemia developing. Hypercalcaemia may lead to mineral deposition in the tissues
Lanthanum carbonate remains in the gastrointestinal tract and systemic absorption is negligible. Renalzin also contains additional supporting ingredients kaolin, a known toxin binder, and the antioxidant vitamin E. It can be used alongside other treatments as part of your renal management protocol. NB: Some oral medications may need to be given at a different time to allow sufficient time for their absorption.
Control of can phosphate nd prolong a e enhance th life quality of
*Commission Directive 2008/82/EC
Clinical studies in feline patients have demonstrated Renalzin’s beneficial effects Over a two-month period, cats given Renalzin together with a standard maintenance diet in which phosphate was not restricted, demonstrated:7
A decrease in serum phosphate levels
Increased appetite – 85% of cats given Renalzin with their normal diet displayed the same, or an increased level of food intake
An improvement in clinical examinations scores
When to restrict dietary phosphate? Hyperphosphataemia and early cases when values are in the ‘normal’ range
Phosphate levels in the normal
range could still be abnormal in early renal disease
What is the target plasma phosphate concentration? Plasma phosphate concentration
Renalzin effectively binds dietary Renalzin effectively binds phosphate even with normal feline diets dietary phosphate, even with normal feline diets8
in the lower end of the normal reference range
8
Mean Phosphorus Excretion (mg/day)
100 90
Specific targets have been
suggested for each IRIS stage (two months post-commencement of treatment)6:
