Dietary sodium promotes increased water intake and urine volume in cats

Comparison of two software programs used to determine the relative supersaturation of urine ions

Introduction

Relative supersaturation (RSS) values for urine crystals are a measure of the risk of urinary stone formation and have been shown to be lowered in foods shown to aid in the management of urolithiasis. In order to calculate RSS in pets, computer programs have been developed to calculate RSS and aid in the understanding of stone formation in veterinary medicine. However, some older programs have not been updated for use in animals, and the specific coefficients used are not publically available. One of the first RSS programs was developed in BASIC computer language and published in 1985 which was called EQUIL2. The EQUIL2 program was updated to a compiled version compatible with a PC platform. However, the formulas could not be read or altered.

Methods

This study evaluates a new program with known coefficients to the original EQUIL2 program. The RSS values of the two programs were compared through a t-test, calculating the r² from correlation analysis, Lin's concordance correlation coefficient, and by a Bland-Altman analysis of outputs from the two programs using urine samples from healthy dogs and cats.

Results and Discussion

Our results show that for both magnesium ammonium phosphate (struvite) and calcium oxalate, the RSS values of the original program could be calculated from the new programs RSS values. Although the actual RSS values were different (as might be expected through the use of the updated coefficients and different thermodynamic stability constants in the calculations) the results were highly correlated, finding elevations and reductions in RSS proportionally in the same urine samples. The current work creates a foundation for using the modernized program to calculate RSS and provides a shared method for understanding the risk of struvite and calcium oxalate stone formation.

Young Adults with Higher Salt Intake Have Inferior Hydration Status: A Cross-Sectional Study

The body’s water and sodium balances are tightly regulated and monitored by the brain. Few studies have explored the relationship between water and salt intake, and whether sodium intake with different levels of fluid intake leads to changes in hydration status remains unknown. The aim of the present study was to determine the patterns of water intake and hydration status among young adults with different levels of daily salt intakes. Participants’ total drinking fluids and water from food were determined by a 7-day 24-h fluid intake questionnaire for 7 days (from Day 1 to Day 7) and duplicate portion method (Day 5, Day 6 and Day 7). Urine of 24 h for 3 days (Day 5, Day 6 and Day 7) was collected and tested for the osmolality, the urine-specific gravity (USG), the concentrations of electrolytes, pH, creatinine, uric acid and the urea. The fasting blood samples for 1 day (Day 6) were collected and measured for the osmolality and the concentrations of electrolytes. The salt intakes of the participants were evaluated from the concentrations of Na of 24 h urine of 3 days (Day 5, Day 6 and Day 7). Participants were divided into four groups according to the quartile of salt intake, including the low salt intake (LS₁), LS₂, high salt intake (HS₁) and HS₂ groups. In total, 156 participants (including 80 male and 76 female young adults) completed the study. The salt intakes were 7.6, 10.9, 14.7 and 22.4 g among participants in the four groups (LS₁, LS₂, HS₁ and HS₂ groups, respectively), which differed significantly in all groups (F = 252.020; all p < 0.05). Compared to the LS₁ and LS₂ groups, the HS₂ group had 310–381, 250–358 and 382–655 mL more amounts of water from the total water intake (TWI), total drinking fluids and water from food (all p < 0.05), respectively. Participants in the HS₂ group had 384–403, 129–228 and 81–114 mL more in the water, water from dishes and staple foods, respectively, than those in the groups of LS₁ and LS₂ (p < 0.05). The HS₂ group excreted 386–793 mL more urine than those in the groups of LS₁ and LS₂ (p < 0.05). However, regarding urine osmolality, the percentage of participants with optimal hydration status decreased from 41.0% in LS₁ and LS₂ to 25.6% in the HS₂ group (p < 0.05). Participants with higher salt intake had higher TWI, total drinking fluids and water from food. Nevertheless, they had inferior hydration status. A reduction in salt intake should be encouraged among young adults to maintain optimal hydration status.

Increased Water Viscosity Enhances Water Intake and Reduces Risk of Calcium Oxalate Stone Formation in Cats

The purpose of this study is to determine if water with increased viscosity results in increased water intake, thus lowering the risk of urolithiasis in cats. Twelve healthy adult cats were fed pre-trial standard dry maintenance food for 1 week and then randomized into two groups for the study phase. The cats continued to receive the same food but were provided either control (deionized) water or viscous (1% methylcellulose) water for two months and then switched to the other water type for two months in a cross-over study design with repeated measures. Complete blood counts, serum chemistry profiles, and urinalysis were performed at the initiation of the study and again at 1, 2, 3, and 4 months. Daily water consumption and energy intake for each cat were recorded. Body weights were assessed weekly. Cats consuming 1% methylcellulose water with increased viscosity had increased water intake (p < 0.001; 25% and 21% higher at 28 and 56 days, respectively). Increased consumption of water resulted in lower urine specific gravity (p = 0.04), serum creatinine (p = 0.02), and blood urea nitrogen (p = 0.002) concentrations (without changing serum albumin, glucose, and calcium concentrations or serum osmolality) and decreased urine calcium concentration (p = 0.01) compared with cats consuming control water. In addition, the increased water intake increased (p = 0.05) resistance to oxalate crystal formation.

Case Report: Application and Limitations of a Plant-Based Diet Formulated for a Cat With Feline Lower Urinary Tract Disease

A 2-year-old male castrated domestic shorthair cat was presented for recommendations for dietary management of chronic FLUTD using a strictly plant-based diet as per the stipulations of the cat's owner. The cat had a history of urethral obstruction of unknown etiology, persistent marked struvite crystalluria, and persistent inappropriate elimination. Commercial plant-based products meeting the nutritional recommendations for maintenance of adult cats with the lowest concentration of struvite precursors were identified, but the cat would not eat them. At the request of the client, a homemade plant-based diet was formulated with the intention of increasing water intake and promoting acidic, dilute urine. Urine concentration was able to be decreased somewhat and struvite crystalluria resolved, but the urine remained more alkaline than intended. The cat clinically improved and no further FLUTD episodes were reported by the client.

Effects of crude protein and sodium intake on water turnover in cats fed extruded diets

The comprehension of strategies to increase urine production may be important, especially in kibble diets to prevent urolithiasis in cats. The effects of increasing amounts of crude protein (CP) and sodium on the water turnover of cats were evaluated using the water balance (WB) method and the deuterium dilution technique. The study followed a randomized block design, with three blocks of eight cats, two cats per food type in each block, and six cats per food. Four extruded diets with different amounts of CP and sodium were evaluated (on DM basis): 28% CP and 0.58% sodium; 39% CP and 0.64% sodium; 52% CP and 0.76% sodium; and 64% CP and 0.87% sodium. Cats were individually housed in cages for 8 days to measure WB, urea excretion, and faecal and urine characteristics. Deuterium oxide was used to evaluate water turnover, and during the period cats were housed in a collective cattery. The data were analysed by an F test, and the means were compared by polynomial contrasts. The ɑ level of significance was set at 0.05. The methods were compared by Pearson correlation, and Bland and Altman analysis. The increase in the CP content elevated linearly the renal excretion of urea (p < .001), and, together with the higher sodium intake, elevated the renal solute load, which resulted in a linear increase in urine production and water intake (p < .01). The urine density, metabolic water, and faecal and insensible water losses did not differ (p > .05). The water flux increased linearly when using the deuterium method (p < .001), but the obtained values were 20.85 ± 11.11 ml/cat/day higher than those verified using the WB method (p = .001). Higher CP and sodium amounts in dry diets increased the urine production and water consumption of cats, and this can be explored as a possible option to increase urination.

Increasing dietary sodium chloride promotes urine dilution and decreases struvite and calcium oxalate relative supersaturation in healthy dogs and cats

Urolithiasis is highly prevalent in dogs and cats, with struvite and calcium oxalate being most commonly diagnosed. Some commercial diets aimed at reducing the risk of urolithiasis are based on inclusion of sodium chloride (NaCl) in an attempt to dilute the urine and the risk of crystallization, but more information on the effect of differing levels of sodium inclusion is needed. The objective of this study was to compare the short‐term effect of four diets differing only in NaCl content (base diet with 0.3% sodium and diets with added NaCl to achieve 0.7, 1.0 and 1.3% sodium as fed) on urinary ion concentrations and relative supersaturation (RSS) of struvite and calcium oxalate in dogs and cats. In both species, there was a significant increase in water intake and urine volume as dietary NaCl increased. Urine sodium concentration increased with increasing dietary NaCl. The highest sodium diet increased urinary calcium excretion in dogs only, while decreasing urinary calcium concentration. Calcium oxalate RSS and struvite RSS both significantly decreased, with the lowest RSS values reported on the highest sodium diet in both dogs and cats (p < .001). These results suggest that an increase in dietary NaCl decreases RSS values in both dogs and cats. Despite an increase in urinary calcium excretion in dogs, urinary calcium concentration and calcium oxalate RSS were lower on high sodium diets due to urine dilution. Long‐term studies are needed to confirm the relationship between RSS and stone occurrence and recurrence.

Quantified water intake in laboratory cats from still, free-falling and circulating water bowls, and its effects on selected urinary parameters

OBJECTIVES

The study objectives were to determine if the method of water presentation (still [S], circulating [C] or free-falling [FF] bowl systems) influences daily water consumption in cats in a controlled environment, and whether differences in water intake affect urine relative super saturation (RSS) for calcium oxalate and struvite, urine specific gravity (USG), urine osmolality (Uosmol) and urine volume.

METHODS

Sixteen healthy laboratory cats fed a dry diet were individually housed with urine collection systems. Each cat underwent a randomized 2 week crossover period with all bowl systems, allowing a 1 week acclimation period between each crossover. Water intake was measured daily by bowl weight, accounting for spillage and evaporation. USG and urine volume were measured daily, whereas other urinary parameters were measured at various time points throughout each 14 day crossover period.

RESULTS

Fourteen cats completed the study. Average daily water intake (ml/kg/day), urine volume, USG and urine RSS for struvite and calcium oxalate were not significantly different between water bowls. Uosmol was significantly higher in C compared with S and FF bowl systems (P = 0.009 for both). Three individual cats demonstrated a significant water bowl preference (Cat 4: C >S, P = 0.039; Cat 10: FF >C, P = 0.005; Cat 11: S >C, P = 0.037).

CONCLUSIONS AND RELEVANCE

Overall, water bowl type had no appreciable effect on water intake. Uosmol was the only urinary parameter found to be significantly different, and was higher for the C bowl. The implication of this is unknown, considering water intake did not differ significantly between bowls. Alternative methods to increase water intake should be implemented beyond providing unique water bowls in patients where augmented water intake would be beneficial for disease management.

Phosphorus and sodium contents in commercial wet foods for dogs and cats

It has been reported that wet foods for dogs and cats have high levels of sodium and phosphorus due to their composition. Therefore, this study aimed to evaluate the sodium and phosphorus contents in wet pet foods, and compare it to daily requirements for both species. Twenty‐five commercial wet foods for adult animals were evaluated, 13 for dogs and 12 for cats. The analyses’ results were compared to the European Pet Food Industry Federation (FEDIAF 2018) recommendations. All foods contained phosphorus and sodium amounts above minimum requirements. Three wet foods for dogs exceeded the safe upper limit for phosphorus, and four wet foods for dogs and three for cats exceeded 3.75 g of sodium/1,000 kcal metabolizable energy (ME), considered safe by FEDIAF. No studies were found at the present time evaluating whether higher sodium levels are safe for dogs and cats; however, consumption of high phosphorus diets has been associated with adverse effects on renal function parameters. Therefore, more studies are necessary to investigate the health implications of phosphorus and sodium concentrations observed in some foods evaluated in this research.

It has been reported that wet foods for dogs and cats have high levels of sodium and phosphorus due to their composition. Therefore, this study aimed to evaluate the sodium and phosphorus contents in wet pet foods, and compared to daily requirements for both species.

Evaluation of three herbal compounds used for the management of lower urinary tract disease in healthy cats: a pilot study

OBJECTIVES

Lower urinary tract disease (LUTD) occurs commonly in cats, and idiopathic cystitis (FIC) and urolithiasis account for >80% of cases in cats <10 years of age. Although several strategies have been recommended, a common recommendation is to induce dilute urine resulting in more frequent urination and to dilute calculogenic constituents. In addition to conventional therapy using modified diets, traditional Chinese and Western herbs have been recommended, although only one - choreito - has published data available. We evaluated three commonly used herbal treatments recommended for use in cats with LUTD: San Ren Tang, Wei Ling Tang and Alisma. We hypothesized that these three Chinese herbal preparations would induce increased urine volume, decreased urine saturation for calcium oxalate and struvite, and differences in mineral and electrolyte excretions in healthy cats.

METHODS

Six healthy spayed female adult cats were evaluated in a placebo-controlled, randomized, crossover design study. Cats were randomized to one of four treatments, including placebo, San Ren Tang, Wei Ling Tang or Alisma. Treatment was for 2 weeks each with a 1 week washout period between treatments. At the end of each treatment period, a 24 h urine sample was collected using modified litter boxes.

RESULTS

Body weights were not different between treatments. No differences were found in 24 h urinary analyte excretions, urine volume, urine pH or urinary saturation for calcium oxalate or struvite between treatments.

CONCLUSIONS AND RELEVANCE

The results of this study do not support the hypothesis; however, evaluation of longer-term and different dosage studies in cats with LUTD is warranted.

Effects of a nutrient-enriched water on water intake and indices of hydration in healthy domestic cats fed a dry kibble diet

OBJECTIVE To evaluate the effects of drinking nutrient-enriched water (NW) on water intake and indices of hydration in healthy domestic cats fed a dry kibble diet ad libitum. ANIMALS 18 domestic shorthair cats. PROCEDURES Group-housed cats were assigned to tap water (TW; n = 9) or NW (9) groups. All cats received TW at baseline (days -7 to -1). No changes were made to the food-water regimen for the TW group. The NW group received NW instead of TW from days 0 through 10, then received TW and NW in separate bowls (days 11 through 56). Food intake was measured through day 10; liquid consumed by drinking was measured throughout the study. Blood and urine samples were collected at predetermined times for analyses; 48-hour urine collection (days 28 through 30 or 31 through 33) was performed to assess output volume and aid endogenous creatinine-based glomerular filtration rate (GFR) determination. Data were analyzed with linear mixed-effects models. RESULTS Baseline TW and calorie intake were similar between groups. The NW treatment was significantly associated with increased liquid consumption during the treatment phase. Mean urine output was significantly higher in the NW group (15.2 mL/kg/d) than in the TW group (10.3 mL/kg/d). Mean GFR (1.75 vs 1.87 mL/min/kg, respectively) did not differ between groups. Effects of treatment and time were each significant for urine specific gravity and osmolality and urine creatinine, phosphate, and urea nitrogen concentrations, with lower values for the NW group. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that consumption of the NW can increase liquid intake and improve measures of hydration in healthy cats. These effects may offer health benefits to some cats in need of greater water consumption.

Influence of protein concentration and quality in a canned diet on urine composition, apparent nutrient digestibility and energy supply in adult cats

BACKGROUND

Protein concentration and quality in cat food can vary considerably, and the impact on feline urine composition and nutrient supply is of high practical relevance. In the present study, 6 canned diets with varying protein concentrations and qualities were fed to 10 healthy adult cats. Protein quality in the diet differed depending on the amount of collagen-rich ingredients. Hydroxyproline concentrations were 2.56-4.45 g/kg dry matter in the high quality and 3.76-9.44 g/kg dry matter in the low quality diets. Protein levels were 36.2, 43.3 and 54.9% in the high quality and 36.7, 45.0 and 56.1% in the low quality groups. Each diet was fed for 6 weeks, using a randomized cross-over design. In the last 2 weeks of each feeding period, urine and faeces of the cats were collected.

RESULTS

Renal calcium (Ca), oxalate (Ox) and citrate excretion were unaffected by the dietary protein concentration, possibly mediated by a high urine volume (24.2-34.2 ml/kg bodyweight (BW)/day) in all groups. However, renal Ox excretion was lower when the high quality diets were fed (P = 0.013). Urinary relative supersaturation (RSS) with calcium oxalate (CaOx) was low in general, but reduced in the high quality groups (P = 0.031). Urinary RSS values for magnesium ammonium phosphate (MAP) were high (2.64-5.00) among all groups. Apparent digestibility of crude protein and most minerals was unaffected by the different diets. Feed intake was higher in the low quality groups (P = 0.026), but BW of the cats did not differ depending on dietary protein quality. BW of the cats increased with increasing dietary protein concentrations (P = 0.003).

CONCLUSION

In conclusion, a high protein canned diet might not be a specific risk factor for CaOx urolith formation in cats. In contrast, all diets resulted in high RSS MAP values, which might be critical concerning MAP crystallization. Protein quality had a minor, but significant impact on urine composition, necessitating further research on this subject. A lower energy supply when feeding a low protein quality can be assumed. Changes in BW were only small and require a careful interpretation.

Use of Purina Pro Plan Veterinary Diet UR Urinary St/Ox to Dissolve Struvite Cystoliths

The objective of this study was to determine the efficacy of feeding the commercially available diet, Purina Pro Plan Veterinary Diets UR Urinary St/Ox, for the dissolution of struvite cystoliths in cats with naturally occurring disease. Twelve cats with clinical signs of lower urinary tract disease and cystoliths confirmed via radiographs were enrolled. The cats were fed the study diet ad libitum and assessed by abdominal radiographs weekly. Cats with cystoliths that resolved based on radiographs and confirmatory ultrasound examination were considered diet successes. Cats with no change in cystolith size after 2-6 weeks underwent cystotomy for stone removal, aerobic culture and antimicrobial susceptibility testing, and analysis. All cats accepted the study diet, and weight loss was not noted over the course of the study. Total cystolith dissolution was achieved by week 2 for 5 cats, which were presumed to have struvite cystoliths. All other cats underwent cystotomy for stone removal after radiographic evidence of cystoliths were still present at 2 weeks (1 cat with severe signs), 4 weeks (5 cats), or 6 weeks (1 cat). The cystoliths that were surgically removed were calcium oxalate (5 cats) and mixed (2 cats) and would not be expected to dissolve with this diet. Follow-up radiographs from 6 cats fed the diet long term (3 presumed struvite and 3 with other cystoliths removed surgically) were collected from 1 to 6 months after beginning the study and showed no evidence of cystolith recurrence. While larger case numbers are needed, these results suggest that feeding Purina Pro Plan Veterinary Diets UR Urinary St/Ox can successfully dissolve cystoliths that are likely struvite and may lessen the risk of recurrence of struvite and calcium oxalate cystoliths.

Sodium in feline nutrition

High sodium levels in cat food have been controversial for a long time. Nonetheless, high sodium levels are used to enhance water intake and urine volume, with the main objective of reducing the risk of urolithiasis. This article is a review of current evidence of the putative risks and benefits of high dietary sodium levels. Its secondary aim is to report a possible safe upper limit (SUL) for sodium intake. The first part of the manuscript is dedicated to sodium physiology, with a focus on the mechanisms of sodium homeostasis. In this respect, there is only few information regarding possible interactions with other minerals. Next, the authors address how sodium intake affects sodium balance; knowledge of these effects is critical to establish recommendations for sodium feed content. The authors then review the consequences of changes in sodium intake on feline health, including urolithiasis, blood pressure changes, cardiovascular alterations and kidney disease. According to recent, long-term studies, there is no evidence of any deleterious effect of dietary sodium levels as high as 740 mg/MJ metabolizable energy, which can therefore be considered the SUL based on current knowledge.

[Effects of a supplementation on sodium chloride or ammonium chloride on urolithic potential in the rabbit]

AIM

Reduction of urolithic potential by means of increased water intake and urine dilution through supplementation of sodium chloride (NaCl) or decrease of urine pH by supplementation of ammonium chloride (NH4Cl) in rabbits.

MATERIALS AND METHODS

Sixteen female, 6-month-old dwarf rabbits received the following three feeding regimens in a random order: complete feed without supplements = control; complete feed + 10 g NaCl/kg feed = NaCl; complete feed + 2.5 g NH4Cl/kg feed = NH4Cl. The diets were fed ad libitum over a period of 27 days without roughage. Water was provided ad libitum by a drinker. A 14-day wash-out-period (hay feeding) was performed between the different diets. Blood, faeces, and urine were collected at the beginning of each feeding period, after 21-day adaptation to the respective diet, and after the 3-day collection period. The following parameters were analysed: water and food intake as well as acid-base balance and mineral content in blood, urine, and faeces.

RESULTS

NaCl supplementation numerically increased the daily water intake from 40.5 ± 14.4 ml/kg body weight (BW) (control) up to 49.5 ± 14.3 ml/kg BW and significantly increased the daily urine volume from 16.9 ± 7.8 ml/kg BW (control group) to 21.1 ± 7.4 ml/kg BW. The specific gravity of urine samples from NaCl supplementation decreased from 1.060 ± 0.008 to 1.044 ± 0.008. NH4Cl supplementation did not induce significant changes in urine pH, blood acid-base parameters, or calcium retention. Relative supersaturations (RSS) for calcium oxalate and calcium phosphate showed no significant changes after treatment. RSS for struvite increased from 360 ± 735 (after hay feeding) to 3312 ± 6188 on control feeding, 2910 ± 4913 with NaCl supplementation, and 3022 ± 6635 with NH4Cl supplementation (p < 0.05).

CONCLUSIONS

NaCl supplementation significantly increased the urine volume and decreased its specific gravity. Therefore, NaCl supplementation might be an additional dietary treatment to increase the elimination of urine crystals in rabbits. NH4Cl supplementation did not induce acidification of the urine.

Effects of two calculolytic diets on parameters of feline mineral metabolism

OBJECTIVES

To evaluate the influence of two feline calculolytic diets on selected parameters of mineral metabolism.

MATERIALS AND METHODS

Two dry commercial diets designed for struvite urolith dissolution were evaluated in 14 cats. The study was designed as a two-sequence, four-period crossover protocol with a baseline period, two 60-day "run-in" periods in which calculolytic diets (Diet 1 and Diet 2) were fed and one 30-day "wash-out" period. Data are expressed as median (range).

RESULTS

Feeding the calculolytic diets for two months did not alter plasma concentrations of calcium, phosphorus, magnesium and parathyroid hormone. A significant (P < 0.05 in each case) decline in calcitriol was observed after administering both diets from 236.4 (122.4-429.6) to 170.4 (108.0-394.3) pmol/L (Diet 1) and from 278.4 (153.6-492.0) to 177.1 (87.6-392.4) pmol/L (Diet 2). Cats fed Diet 1 showed a significant increase in urine calcium concentration (from 0.3 (0.2-0.5) to 0.4 (0.3-0.7) mmol/L). Magnesium concentration in urine was significantly increased with both diets, from 1.4 (0.1-1.7) to 1.5 (1.3-2.4) mmol/L (Diet 1) and from 1.1 (0.4-1.9) to 2.0 (0.1-3.1) mmol/L (Diet 2).

CLINICAL SIGNIFICANCE

Both diets resulted in an increased urinary concentration of magnesium, through different mechanisms: urine acidification (Diet 1) and increased sodium load (Diet 2).

Cardiovascular effects of dietary salt intake in aged healthy cats: a 2-year prospective randomized, blinded, and controlled study

High salt dry expanded diets are commercially available for cats to increase water intake and urine volume, as part of the prevention or treatment of naturally occurring urinary stone formation (calcium oxalates and struvites). However, chronic high salt intake may have potential cardiovascular adverse effects in both humans, especially in aging individuals, and several animal models. The objective of this prospective, randomized, blinded, and controlled study was to assess the long-term cardiovascular effects of high salt intake in healthy aged cats. Twenty healthy neutered cats (10.1±2.4 years) were randomly allocated into 2 matched groups. One group was fed a high salt diet (3.1 g/Mcal sodium, 5.5 g/Mcal chloride) and the other group a control diet of same composition except for salt content (1.0 g/Mcal sodium, 2.2 g/Mcal chloride). Clinical examination, systolic and diastolic arterial blood pressure measurements, standard transthoracic echocardiography and conventional Doppler examinations were repeatedly performed on non-sedated cats by trained observers before and over 24 months after diet implementation. Radial and longitudinal velocities of the left ventricular free wall and the interventricular septum were also assessed in systole and diastole using 2-dimensional color tissue Doppler imaging. Statistics were performed using a general linear model. No significant effect of dietary salt intake was observed on systolic and diastolic arterial blood pressure values. Out of the 33 tested imaging variables, the only one affected by dietary salt intake was the radial early on late diastolic velocity ratio assessed in the endocardium of the left ventricular free wall, statistically lower in the high salt diet group at 12 months only (P = 0.044). In conclusion, in this study involving healthy aged cats, chronic high dietary salt intake was not associated with an increased risk of systemic arterial hypertension and myocardial dysfunction, as observed in some elderly people, salt-sensitive patients and animal models.

Short term effects of increasing dietary salt concentrations on urine composition in healthy cats

High dietary salt (NaCl) concentrations are assumed to be beneficial in preventing the formation of calcium oxalate (CaOx) uroliths in cats, since increased water intake and urine volume have been observed subsequent to intake. In human beings, dietary NaCl restriction is recommended for the prevention of CaOx urolith formation, since high NaCl intake is associated with increased urinary Ca excretion. The aim of the present study was to clarify the role of dietary NaCl in the formation of CaOx uroliths in cats. Eight cats received four diets that differed in Na and Cl concentrations (0.38-1.43% Na and 0.56-2.52% Cl dry matter, DM). Each feeding period consisted of a 21 day adaptation period, followed by a 7 day sampling period for urine collection. Higher dietary NaCl concentrations were associated with increased urine volume and renal Na excretion. Urinary Ca concentration was constant, but renal Ca excretion increased from 0.62 to 1.05 mg/kg bodyweight (BW)/day with higher dietary NaCl concentrations (P ≤ 0.05). Urinary oxalate (Ox), citrate, P and K concentrations decreased when NaCl intake was high (P ≤ 0.05), and urinary pH was low in all groups (6.33-6.45; P > 0.05). Relative supersaturation of CaOx in the urine was unaffected by dietary NaCl concentrations. In conclusion, the present study demonstrated several beneficial effects of high dietary NaCl intake over a relatively short time period. In particular, urinary Ca concentration remained unchanged because of increased urine volume. Decreased urinary Ox concentrations might help to prevent the formation of CaOx uroliths, but this should be verified in future studies in diseased or predisposed cats.

Companion Animals Symposium: dietary management of feline lower urinary tract symptoms

Experimental and clinical investigations have confirmed the importance of dietary modifications in medical protocols designed to treat and prevent feline lower urinary tract signs (LUTS). The objective of this review is to discuss common medical conditions contributing to feline LUTS and to present currently used and potential preventative dietary modifications. Feline LUTS are a set of clinical conditions with similar symptoms related to inappropriate urine elimination due to a combination of genetics, stress and frustration reactions, environment, and medical condition or conditions, for example, idiopathic cystitis, urolithiasis, urethral obstruction, and urinary tract infection. The main goals of dietary modifications to prevent LUTS are 1) promote large dilute volumes of urine, 2) decrease the relative supersaturation of urine for specific stone types, and 3) promote healthy bacterial populations in the gastrointestinal and urogenital tracts. The impact of dietary composition, including dietary moisture, protein concentration and digestibility, mineral concentrations (i.e., Na, Cl, Ca, P, and Mg), inclusion of acidifiers and alkalinizing agents, inclusion of vitamin B6, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and γ-linolenic acid, fiber concentration and characteristics, and oxalate degrading probiotics, on these outcomes is discussed, and dietary guidelines for cats are provided. Because of the complex interaction of diet composition, environment, and animal physiology, there is a need for clinical research linking current recommendations or dietary options for the treatment and prevention of LUTS with physiological outcomes (i.e., decreased relative supersaturation and LUTS recurrence). Additionally, for many recommendations (e.g., probiotic administration, EPA, DHA), extrapolation from other species was necessary. Research is needed in feline patients with LUTS on these dietary components.

Changes in dietary macronutrient profile do not appear to affect endogenous urinary oxalate excretion in healthy adult cats

The progressive increase in calcium oxalate uroliths reported in cats diagnosed with urolithiasis may partly be due to changes in nutrition. Since cats have a predominant mitochondrial alanine:glyoxylate aminotransferase 1 (AGT1) location, high carbohydrate intake may induce endogenous oxalate synthesis. This hypothesis was tested by feeding 12 adult, female cats three diets differing in macronutrients, namely, high protein (HP), high carbohydrate (HC) and high fat (HF), using a randomised Latin square design in a 36-day study. In addition to plasma, urine was collected quantitatively using modified litter boxes. A pilot study with four cats, conducted to determine the adaptation time of urinary oxalate (Uox) excretion to a dietary change, indicated a mean (± SEM) adaptation time of 5.9 ± 0.7 days, with the urinary oxalate:creatinine (Ox:Cr) ratio increasing from 36.1 ± 3.7 to 81.6 ± 2.3 mmol/mol. In the main study, plasma oxalate concentration was significantly lower when feeding the HP compared to the HF (P=0.003) diet, whereas Uox excretion (μmol/kg BW(0.75)/day) and the urinary Ox:Cr ratio were unaffected by diet. The Uox concentration (mmol/L) was significantly lower when feeding the HP compared to the HC (P=0.004) and HF (P=0.001) diets. The results indicate that changes in macronutrient profile may not influence endogenous Uox excretion in cats but high dietary protein did reduce Uox concentration and may therefore help to lower the risk of calcium oxalate formation.

Influence of nutrition on feline calcium oxalate urolithiasis with emphasis on endogenous oxalate synthesis

The prevalence of calcium oxalate (CaOx) uroliths detected in cats with lower urinary tract disease has shown a sharp increase over the last decades with a concomitant reciprocal decrease in the occurrence of struvite (magnesium ammonium phosphate) uroliths. CaOx stone-preventative diets are available nowadays, but seem to be marginally effective, as CaOx urolith recurrence occurs in patients fed these diets. In order to improve the preventative measures against CaOx urolithiasis, it is important to understand its aetiopathogenesis. The main research focus in CaOx formation in cats has been on the role of Ca, whereas little research effort has been directed towards the role and origin of urinary oxalates. As in man, the exogenous origin of urinary oxalates in cats is thought to be of minor importance, although the precise contribution of dietary oxalates remains unclear. The generally accepted dietary risk factors for CaOx urolithiasis in cats are discussed and a model for the biosynthetic pathways of oxalate in feline liver is provided. Alanine:glyoxylate aminotransferase 1 (AGT1) in endogenous oxalate metabolism is a liver-specific enzyme targeted in the mitochondria in cats, and allows for efficient conversion of glyoxylate to glycine when fed a carnivorous diet. The low peroxisomal activity of AGT1 in cat liver is compatible with the view that felids utilised a low-carbohydrate diet throughout evolution. Future research should focus on understanding de novo biosynthesis of oxalate in cats and their adaptation(s) in oxalate metabolism, and on dietary oxalate intake and absorption by cats.

Effect of water source on intake and urine concentration in healthy cats

Increasing water intake and decreasing urine concentration are recommended for cats with urolithiasis and with idiopathic cystitis. Fountains are advocated to encourage drinking; however, effects on drinking of fountains have not been reported in cats living in pet owners homes. Thirteen healthy cats were assigned to have 24-h water intake and urine osmolality and specific gravity measured when water was offered from a bowl or fountain. One cat developed excessive barbering, vomiting, and refusal to drink water offered from the fountain. For the remaining 12 cats, intake was slightly greater from the fountain. However, urine osmolality was not significantly different. In this study, a fountain failed to substantially increase water intake and dilute urine in cats. A similar study including a greater period of time and additional cats may clarify the results of this study.

Urinary iodide concentration in hyperthyroid cats

OBJECTIVE

To compare concentrations of urinary iodide (UI) in euthyroid and untreated hyperthyroid cats.

ANIMALS

118 euthyroid and 88 hyperthyroid client-owned cats from 2 nonreferral veterinary practices.

PROCEDURES

Iodide concentration was measured in 5 urine samples collected every 3 to 12 months from selected cats, and variability of results between euthyroid cats and hyperthyroid cats prior to the diagnosis of hyperthyroidism was evaluated via 1-way ANOVA, after logarithmic transformation of UI concentrations (logUIs). The UI concentration in hyperthyroid cats was measured at diagnosis and 2 to 6 weeks and 3 to 6 months after treatment for hyperthyroidism. The pretreatment logUI in hyperthyroid cats was compared with that in euthyroid cats, taking into account the effects of renal function on UI concentration. Iodine intake was estimated in euthyroid cats following calculation of the volume of daily urine output, with a fixed value for iodine concentration in feces.

RESULTS

The variability of UI concentrations did not differ significantly between hyperthyroid (n = 10) and euthyroid (8) cats. The logUI increased 2 to 6 weeks after initiation of treatment in hyperthyroid cats (n = 80) and was lower in azotemic versus nonazotemic cats. Hyperthyroid cats had a lower logUI than euthyroid cats, and there was no evidence of deficient iodine intake in euthyroid cats.

CONCLUSIONS AND CLINICAL RELEVANCE

The logUI was lower in cats with azotemia and with untreated hyperthyroidism, compared with that in euthyroid cats from the same population. Additional studies are needed to determine whether iodine intake plays a role in the development of hyperthyroidism in cats.

Effects of dietary sodium chloride on health parameters in mature cats

High sodium diets have been shown to enhance water intake and urine output, a potential benefit in the management of lower urinary tract diseases. However, one study suggested that high salt (sodium chloride) diets might have adverse effects on the kidneys [Kirk CA, Jewell DE, Lowry SR. Effects of sodium chloride on selected parameters in cats. Vet Ther 2006; 7: 333–46]. Therefore, the objective of this controlled, prospective study was to evaluate the effects of diets with different salt content (1.11% sodium and 1.78% chloride versus 0.55% sodium and 1.02% chloride, dry matter (dm)) when fed to mature cats (mean age 7.0 years; 12 cats per group) over a 6-month period. Food intake, body weight, bone mineral content, total body hydration status, blood pressure, and markers of renal function were unaffected by salt intake, and no adverse effects were observed. When a subset of cats ( n=9) with an initial serum creatinine ≥1.6 mg/dl was evaluated separately, there remained no evidence of adverse effects associated with increased salt intake. These results are consistent with the majority of other studies evaluating sodium intake in cats, as well as with the National Research Council's assessment, all of which indicate that sodium at 1.5% of the diet dm is not harmful to healthy cats.

Evidence-Based Management of Feline Lower Urinary Tract Disease

Many treatments have been recommended for managing cats with feline urinary tract disease (FLUTD). Veterinarians making therapeutic decisions should consider the quality of evidence supporting a recommendation to use (or not use) a particular treatment for cats with FLUTD. Whenever possible, recommendations should be based on results of randomized and well-controlled scientific studies performed in clinical patients with the spontaneously occurring disease of interest. In the absence of such studies, one is left to make the best recommendation possible with consideration of all information, including the quality of the evidence. At this time, additional studies are needed to evaluate evidence for many currently recommended treatments for cats with FLUTD.