Abstract
We at the JFMS team are delighted to have the opportunity to bring you this first-ever clinical supplement of the journal, the focus of which is feline chronic kidney disease (CKD). Despite the fact that CKD is an extremely common problem in cats – indeed, one of the most frequent diagnoses in middle- to old-aged cats – crucial questions about the disease remain unanswered, and many therapeutic interventions are under-explored.
This supplement, which comprises a series of four review articles, has the simple aim of providing a comprehensive overview of the current state of knowledge regarding CKD in cats. The articles have been authored by a group of leading clinicians and scientists and cover all the major aspects of the disease, from its aetiopathogenesis and diagnosis through to current and future treatment options and possibilities. While designed to provide a valuable clinical resource for practising veterinarians, and while there is much within these articles that can usefully impact day-to-day diagnosis and management of CKD in cats, one thing that comes through clearly from the reviews is that there are many areas where knowledge of the disease in cats is inadequate.
Despite being such a common disease, critical questions remain; for example, about the underlying causes of CKD in cats. Intriguingly, as mentioned by Brice Reynolds and Hervé Lefebvre in their article, a group of scientists working in Hong Kong have identified a novel paramyxovirus in cats and their initial findings (published last year) suggested this infection could be linked to the development of CKD in cats. This was a preliminary study, but serves to highlight the uncertainties that surround the underlying aetiology in most cases of CKD at present, and the possibility that novel infectious agents might be involved in at least some cases.
Screening of human patients at risk of developing CKD is an important part of management in the medical field. The article by Dominique Paepe and Sylvie Daminet summarises current and possible future screening tests applicable to cats. Certainly it seems there is much that can be done in routine practice to improve our detection of CKD and to try to make diagnoses at an earlier stage, but an inevitable question that follows on from this is whether earlier intervention in these cases will improve overall management and survival.
The final two articles address management of CKD, with an evidence-based review of current therapeutic options, contributed by Rachel Korman and Joanna White, and a look at future possibilities and needs by Samantha Taylor and Andrew Sparkes. These reviews highlight the importance of many interventions used in managing CKD and/or the complications that arise from CKD, but again point to gaps in knowledge about the applicability and/or efficacy of a number of treatments. Compared with their human medical counterparts, veterinarians have relatively few studies to draw on that have evaluated the efficacy of different treatments in feline CKD; and those studies that have been published often involve relatively small numbers of cats.
Recent years have seen more drugs and newer (modified) diets become available to manage feline CKD, and undoubtedly there will be further additions to the therapeutic armoury in the future. An important challenge for all involved in this field will be to design studies that will adequately evaluate the clinical impact of both current and future therapies so that treatment decisions can be made based on robust scientific data, with knowledge of what may be most important for each patient in the light of their individual circumstances.
Having set the scene, we hope that this supplement will play its part in improving the quality of life and prognosis for an important subset of the general clinic population, and raise awareness of where practice might be heading for feline CKD patients. We hope, too, that it will pave the way for future supplements of the unique feline resource that is JFMS!