NSAIDs in feline CKD

RE: NSAIDs in feline CKD

Martin Atkinson — Mon, 01 May 2017 21:37:28 GMT

[quote user="David Mills"]AKD following NSAIDS is recognised in humans as being idiosyncratic reaction. It's nothing to do with CKD which is a different disease process.[/quote] As I've said multiple times I've seen several healthy cats suffer AKD from NSAIDs. It doesn't mean I don't use them I'm not just as gung ho as you seem to be.

Most 'experts' I've listened to suggest that you don't use NSAIDs in cats with OA continuously because of the risk of CKD, unlike dogs where the risk of developing allodynia outweighs the risk, as CKD is rare in dogs. Heck, I even used NSAIDs in my own CKD cat crippled with severe OA and I feel it may have hastened his end but it is a balance and one the client should be made aware of.

RE: NSAIDs in feline CKD

David Mills — Mon, 01 May 2017 20:52:57 GMT

[quote user="Martin Atkinson"]

[quote user="David Mills"]Against all published evidence? You're doing your patients a disservice.[/quote]Keep dishing it out without any precaution and you won't be quite so smug when you do get a cat with NSAID induced AKD. I could publish my experience and the case reports for those that have been referred for emergency treatment to the QMH but you don't deserve it.

[/quote]

As I've said a hundred times before, go ahead and publish. You haven't taken this up as yet

AKD following NSAIDS is recognised in humans as being idiosyncratic reaction. It's nothing to do with CKD which is a different disease process.

But then why allow the truth to get in the way of a good story? Don't you market yourself as a feline specialist yet you haven't read important papers from a few years ago?

RE: NSAIDs in feline CKD

Julian Earl — Mon, 01 May 2017 20:09:46 GMT

Fair enough David if that is your experience. I am merely passing mine on that I used meloxicam drops in my own cat without apparent problems when she was aged 18-19 years. I felt so sorry for her painful hip I decided to use modest doses as well as Cartrophen but the latter made no noticeable difference to her limping. Withclient's cats Isometimes used very short courses, say for a few days only to offer relief. My belief is that reducing the pain over-rides the risk of aggravating renal damage, up to a point anyway?

RE: NSAIDs in feline CKD

Martin Atkinson — Sun, 30 Apr 2017 20:53:56 GMT

RE: NSAIDs in feline CKD

Julian Earl — Sun, 30 Apr 2017 10:33:18 GMT

I have used Metacam in cats with CKD, without apparent trouble. Two points: Ensure that they are always well hydrated, plus monitor blood parameters closely. Owners can be taught to inject fluids subcutaneously as well to ensure fluid intake is adequate, plus monitor the weight.

I think that this is a good example of what we do compared to doctors? We need to look at quality of life not [just?] quantity so even if NSAIDs are damaging in the long run, then if pain is reduced it is worth it.

RE: NSAIDs in feline CKD

David Mills — Sun, 30 Apr 2017 00:41:36 GMT

[quote user="Martin Atkinson"]I've equally seen AKD induced by it often enough in healthy cats to be wary under any circumstances let alone one already with renal failure.[/quote]

Against all published evidence? You're doing your patients a disservice.

RE: NSAIDs in feline CKD

Martin Atkinson — Wed, 26 Apr 2017 10:05:54 GMT

Bit of an old chestnut but I use Onsior. Although I have used meloxicam with no problems I've equally seen AKD induced by it often enough in healthy cats to be wary under any circumstances let alone one already with renal failure. Its a balance and I would pulse the Onsior so 6 days on/5 days off to reduce the worry of not following data sheets. My advice regardless in cats is to give NSAIDs only when necessary to avoid renal problems whereas in dogs, where renal concerns are a lot less, I would give continuously to avoid allodynia.

PS Bill's post appeared after I started mine and I agree with Omega 3 supplements, especially in Synoquin with their Dexahan, although I find the benefit is variable . The trouble with cats is they often have the soft tissue calcification associated with OA so joint supplements and Omega 3 doesn't seem to be of much benefit. Also like Cartrophen, it seems to work better in cats than dogs but benefits are limited for the same reason.

RE: NSAIDs in feline CKD

Bill Nolan — Wed, 26 Apr 2017 09:58:16 GMT

I'm sure these options may have already been discussed, but as far as alternatives go has Cartrophen and Omega-3 fatty acids been discussed? I've seen a few cats that started on NSAIDs and Omega-3 which were then taken off the NSAIDs. A recent paper evaluated them as safe in human patients with CKD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241408/. Let us know how you get on!

RE: NSAIDs in feline CKD

Anthony Dennison — Wed, 26 Apr 2017 09:46:36 GMT

There is a great paper in JFMS regarding the use of NSAIDs in CKD - think it is open access if you wantto look for it. Using a dose of 0.01-0.03mg/kg meloxicam was tolerated well with cats with CKD.

RE: NSAIDs in feline CKD

Stephanie Wellings — Tue, 25 Apr 2017 20:35:05 GMT

I have also used meloxicam, reduced dose, explaining the risks. I only use it if eating well so that I am sure the cat is relatively well hydrated. I don't have any experience with Onsior.

Stage 3 is quite far advanced though, so an alternative could be gabapentin (Summit do a 25mg tablet which is tiny) half a tab BID if you want to avoid NSAIDs, and acupuncture if it's a cooperative cat.

RE: NSAIDs in feline CKD

Katherine Creamer — Tue, 25 Apr 2017 20:16:42 GMT

I also use meloxicam in cats with CKD if needed. I try to guide owners to use the lowest effective dose. I have also not noticed any adverse effects.

RE: NSAIDs in feline CKD

Busybee — Tue, 25 Apr 2017 19:46:28 GMT

I'd opt for meloxicam. Have used it in a few cats with various grades of CKD with good success and I haven't noticed any deterioration in the CKD above and beyond what you might normally expect with disease progression (n = ~ 4). I explain the potential problems with the owner and start the cat at half dose. I will increase this if required, again, after discussion with the owner. You also have the EBVM behind you too :) I'd always choose quality over quantity!