Page 770 - Small Animal Clinical Nutrition 5th Edition

798 Small Animal Clinical Nutrition

VetBooks.ir Box 37-5. Tips for Encouraging Acceptance of Veterinary Therapeutic Renal Foods in
Patients with Chronic Kidney Disease.

Educate pet owners about the effectiveness of nutritional manage- food aversion may develop causing decreased acceptance of the
ment for prolonging survival time and improving quality of life in food when the patient is feeling better. Stated another way, while
patients with kidney disease. For treatment to succeed, owners patients are hospitalized, do not feed them (especially cats) the food
must commit their time and money, which is more likely to occur if you want them to eat for the rest of their lives. In this situation, one
they understand the benefits of their efforts. option would be to feed a maintenance food that avoids excessive
Begin nutritional management sooner rather than later. Current protein, phosphorus and sodium until the patient is feeling better
evidence supports feeding a veterinary therapeutic renal food when and then gradually transition to a therapeutic renal food.
serum creatinine is ≥2 mg/dl. Waiting until later (e.g., when there Use fresh food at room temperature. Some patients may eat
are signs of uremia) is not advised because patients with more refrigerated food that is warmed, but others will only eat food from
advanced disease may be less likely to accept a change in treat- a newly opened container. Some patients may eat food that has
ment and therefore will not receive optimal benefits of a renal ther- been refrigerated and stored in a plastic container vs. food stored in
apeutic food. the original can.
Probably the single most important thing you can do to increase Offer foods with different textures (e.g., minced formulas) or form
patient acceptance of a veterinary therapeutic renal food is gradually (dry vs. moist). Some pets may prefer dry or moist food all their lives
transition to the new food.The transition period should be a minimum and when they develop kidney disease, their preferences may
of seven days; however, some patients (especially cats) need a tran- switch (e.g., a cat that has eaten dry food all its life may eat moist
sition of three to four weeks or longer. It is critical to discuss the need food after kidney disease occurs and vice versa).
for this transition with pet owners, otherwise, they are likely to buy a Add flavor enhancers (low-sodium chicken broth or tuna juice) or
new food, go home and switch from the old food to the new food at a small amount of maintenance food to encourage the patient to eat
the next meal. In this scenario, many patients will refuse to eat the all the veterinary therapeutic food. Excessive use of other foods will
new food, which results in an unhappy owner and a patient that will likely decrease the beneficial effects of the veterinary therapeutic
likely not receive the benefits of nutritional management. renal food; therefore, the smallest amount possible should be used.
One option for transitioning to a renal food is to mix the old and If you have followed the steps above and there is still reluctance
new food, gradually adding more of the new food over time. Another to eat a veterinary therapeutic renal food, switch to a different
approach is to provide both foods (old and new) in side-by-side food brand. Although commercially available renal foods have general
dishes. This technique assists with gradual transition and also allows features in common, they are not the same. In addition, individual
cats to express their preferences. For more information, visit pets may express a preference for one brand over another. Avoid
www.vet.osu.edu/indoorcat for The Indoor Cat Initiative. giving the owner samples of several different brands of foods at
If transitioning cats from dry to moist food, use a flat food dish once; this could result in a food aversion to all veterinary therapeu-
(e.g., saucer) instead of a bowl.This avoids rubbing the cat’s whiskers tic renal foods, especially if owners offer each sample at successive
on the food dish, which could affect acceptance of new food. meals or on consecutive days. Tables 37-11 and 37-12 can be
Avoid offering veterinary therapeutic renal foods in stressful envi- used to select foods with the best key nutritional factor profiles for
ronments (e.g., sick and/or hospitalization, during force-feeding); a dogs and cats, respectively.

ments are high in sodium content (e.g., clam and tuna juice); be influenced by the person feeding the patient (server). The
however, and should not be used long-term due to excessive likelihood of eating increases in direct proportion to the time
sodium intake above the amount in the veterinary therapeutic the patient has spent with the server in a nonstressful situation
food. Environmental factors should also receive consideration (Delaney, 2006). For hospitalized pets, the ideal server is likely
when transitioning pets to a veterinary therapeutic renal food. the pet owner followed by either a technician or kennel assis-
Owner compliance and pet acceptance of the food must be ade- tant who has not restrained or otherwise antagonized the
quate for nutritional management to be effective. Knowing patient.
who feeds the patient is important for compliance, and limiting Food aversion is possible if a nauseated pet is force-fed or if
the patient’s access to other foods improves acceptability (e.g., a painful or unpleasant experience is associated with feeding.
a dog having access to cat food or a cat living in a multi-cat Unpalatable medications (e.g., some phosphate binders) should
household). Feeding location and presentation are important. not be mixed with veterinary therapeutic foods. Managing
Timid animals should be fed in a quiet place. Cats should be underlying abnormalities in fluid, electrolyte and acid-base bal-
fed away from loud, persistent barking or other distracting ance will help minimize nausea and vomiting. Pharmacologic
noises. Food bowls should not be kept in close proximity to lit- agents (e.g., ranitidine, famotidine, metoclopramide and sucral-
ter boxes and noisy areas. Food for cats should be offered in fate) can be used to limit uremic gastritis, nausea and vomiting.
wide bowls or on a plate to avoid stimulation of tactile whiskers. Veterinary therapeutic foods intended for long-term manage-
Placing small quantities of palatable food in a patient’s mouth ment of patients with CKD should not be offered during peri-
or on its paws (moist food) to stimulate licking or swallowing ods of nausea and vomiting to prevent possible food aversions.
(i.e., hand feeding) may facilitate eating. Patients’ appetite can Consider using an appropriate, alternative food temporarily