Comparison of foods with differing nutritional profiles for long-term management of acute nonobstructive idiopathic cystitis in cats

John M. Kruger Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824.

Search for other papers by John M. Kruger in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
,
Jody P. Lulich Minnesota Urolith Center, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108.

Search for other papers by Jody P. Lulich in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
,
Jennifer MacLeay Hill's Pet Nutrition Center, Hill's Pet Nutrition Inc, 1035 NE 43rd St, Topeka, KS 66617.

Search for other papers by Jennifer MacLeay in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
,
Jane Merrills Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824.

Search for other papers by Jane Merrills in
Current site
Google Scholar
PubMed
Close
 DVM
,
Inke Paetau-Robinson Hill's Pet Nutrition Center, Hill's Pet Nutrition Inc, 1035 NE 43rd St, Topeka, KS 66617.

Search for other papers by Inke Paetau-Robinson in
Current site
Google Scholar
PubMed
Close
 PhD
,
John Brejda Alpha Statistical Consulting Inc, 4501 S 54th St, Lincoln, NE 68516.

Search for other papers by John Brejda in
Current site
Google Scholar
PubMed
Close
 PhD
, and
Carl A. Osborne Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824.

Search for other papers by Carl A. Osborne in
Current site
Google Scholar
PubMed
Close
 DVM, PhD

Abstract

Objective—To evaluate the effect of nutrition on recurrent clinical signs of lower urinary tract (LUT) disease in cats with idiopathic cystitis.

Design—Randomized, controlled, masked clinical trial.

Animals—31 cats with acute nonobstructive idiopathic cystitis.

Procedures—Cats were assigned to receive 1 of 2 foods (a cystitis prevention or control food) that differed in mineral (calcium, phosphorous, and magnesium), antioxidant, and fatty acid profiles. Owners documented LUT signs daily for up to 1 year. The primary endpoint was the number of recurrent episodes in which a cat had multiple (≥ 2 concurrent) LUT signs within a day (defined as multiple-sign day). Consecutive days in which a cat had multiple LUT signs were considered as a single episode.

Results—4 cats fed prevention food and 2 cats fed control food were excluded from analysis because of noncompliance, gastrointestinal signs, food refusal, or owner voluntary withdrawal. The proportion of cats fed prevention food that had ≥ 1 recurrent episode of multiple-sign days (4/11) was not significantly lower than that of cats fed control food (9/14). However, cats fed prevention food had significantly lower mean incidence rates for recurrent episodes of multiple-sign days (0.7 episodes/1,000 cat-days) and episodes of hematuria (0.3 episodes/1,000 cat-days), dysuria (0.2 episodes/1,000 cat-days), and stranguria (0.2 episodes/1,000 cat-days) as single LUT signs, compared with cats fed control food (5.4, 3.4, 3.1, and 3.8 episodes/1,000 cat-days, respectively). Significantly fewer cats fed prevention food required analgesics (4/11), compared with cats fed control food (12/14).

Conclusions and Clinical Relevance—Foods with differing nutritional profiles appeared to impact mean incidence rates of recurrent feline idiopathic cystitis-associated signs.

Abstract

Objective—To evaluate the effect of nutrition on recurrent clinical signs of lower urinary tract (LUT) disease in cats with idiopathic cystitis.

Design—Randomized, controlled, masked clinical trial.

Animals—31 cats with acute nonobstructive idiopathic cystitis.

Procedures—Cats were assigned to receive 1 of 2 foods (a cystitis prevention or control food) that differed in mineral (calcium, phosphorous, and magnesium), antioxidant, and fatty acid profiles. Owners documented LUT signs daily for up to 1 year. The primary endpoint was the number of recurrent episodes in which a cat had multiple (≥ 2 concurrent) LUT signs within a day (defined as multiple-sign day). Consecutive days in which a cat had multiple LUT signs were considered as a single episode.

Results—4 cats fed prevention food and 2 cats fed control food were excluded from analysis because of noncompliance, gastrointestinal signs, food refusal, or owner voluntary withdrawal. The proportion of cats fed prevention food that had ≥ 1 recurrent episode of multiple-sign days (4/11) was not significantly lower than that of cats fed control food (9/14). However, cats fed prevention food had significantly lower mean incidence rates for recurrent episodes of multiple-sign days (0.7 episodes/1,000 cat-days) and episodes of hematuria (0.3 episodes/1,000 cat-days), dysuria (0.2 episodes/1,000 cat-days), and stranguria (0.2 episodes/1,000 cat-days) as single LUT signs, compared with cats fed control food (5.4, 3.4, 3.1, and 3.8 episodes/1,000 cat-days, respectively). Significantly fewer cats fed prevention food required analgesics (4/11), compared with cats fed control food (12/14).

Conclusions and Clinical Relevance—Foods with differing nutritional profiles appeared to impact mean incidence rates of recurrent feline idiopathic cystitis-associated signs.

Contributor Notes

Address correspondence to Dr. Kruger (kruger@cvm.msu.edu).

Supported by a grant from Hills Pet Nutrition Inc.

Presented in part as an oral presentation at the Annual Forum of the American College of Veterinary Internal Medicine, Seattle, June 2013.

The authors thank Sarah Davidson, Carmon Koenigsknecht, Sharon Steck, Heidi Schiefelbein, and Holly Monroe for technical assistance.

  • 1. Kruger JM, Osborne CA, Goyal SM, et al. Clinical evaluation of cats with lower urinary tract disease. J Am Vet Med Assoc 1991; 199: 211216.

    • Search Google Scholar
    • Export Citation
  • 2. Buffington CAT, Chew DJ, Kendall MS, et al. Clinical evaluation of cats with nonobstructive urinary tract diseases. J Am Vet Med Assoc 1997; 210: 4650.

    • Search Google Scholar
    • Export Citation
  • 3. Defauw PAM, Van de Maele I, Duchateau L, et al. Risk factors and clinical presentation of cats with feline idiopathic cystitis. J Feline Med Surg 2011; 13: 967975.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4. Gerber B, Boretti FS, Kley S, et al. Evaluation of clinical signs and causes of lower urinary tract disease in European cats. J Small Anim Pract 2005; 46: 571577.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5. Gerber B, Eichenberger S, Reusch CE. Guarded long-term prognosis in male cats with urethral obstruction. J Feline Med Surg 2008; 10: 1623.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Lekcharoensuk C, Osborne CA, Lulich JP. Epidemiologic study of risk factors for lower urinary tract diseases in cats. J Am Vet Med Assoc 2001; 218: 14291435.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. Sævik BK, Trangerud C, Ottesen N, et al. Causes of lower urinary tract disease in Norwegian cats. J Feline Med Surg 2011; 13: 410417.

  • 8. Kruger JM, Osborne CA. Managing feline idiopathic cystitis. In: Bonagura J, Kirk RW, eds. Current veterinary therapy XIV. Philadelphia: WB Saunders Co, 2009; 944950.

    • Search Google Scholar
    • Export Citation
  • 9. Westropp JL, Buffington CAT. Lower urinary tract disorders in cats. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 7th ed. St Louis: Elsevier Saunders, Elsevier Saunders; 20692086.

    • Search Google Scholar
    • Export Citation
  • 10. Barsanti JA, Finco DR, Shotts EB, et al. Feline urologic syndrome: further investigation into therapy. J Am Anim Hosp Assoc 1982; 18: 387390.

    • Search Google Scholar
    • Export Citation
  • 11. Gunn-Moore DA, Shenoy CM. Oral glucosamine and the management of feline idiopathic cystitis. J Feline Med Surg 2004; 6: 219225.

  • 12. Kruger JM, Conway TS, Kaneene JB, et al. Randomized controlled trial of the efficacy of short-term-amitriptyline administration for treatment of acute, nonobstructive, idiopathic lower urinary tract disease in cats. J Am Vet Med Assoc 2003; 222: 749758.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Markwell PJ, Buffington CA, Chew DJ, et al. Clinical evaluation of commercially available urinary acidification diets in the management of idiopathic cystitis in cats. J Am Vet Med Assoc 1999; 214: 361365.

    • Search Google Scholar
    • Export Citation
  • 14. Osborne CA, Kruger JM, Lulich JP, et al. Prednisolone therapy of idiopathic feline lower urinary tract disease: a double-blind clinical study. Vet Clin North Am Small Anim Pract 1996; 26: 563569.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Kruger JM, Osborne CA. Recurrent nonobstructive idiopathic feline lower urinary tract disease: an illustrative case report. J Am Anim Hosp Assoc 1995; 31: 312316.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Osborne CA, Kruger JM, Lulich JP, et al. Feline lower urinary tract disease: the Minnesota experience, in Proceedings. 15th Annu Am Coll Vet Intern Med Forum 1997; 338339.

    • Search Google Scholar
    • Export Citation
  • 17. Beata C, Beaumont-Graff E, Coll V, et al. Effect of alpha-casozepine (Zylkene) on anxiety in cats. J Vet Behav 2007; 2: 4046.

  • 18. Buffington CAT, Westropp JL, Chew DJ, et al. Risk factors associated with clinical signs of lower urinary tract disease in indoor-housed cats. J Am Vet Med Assoc 2006; 228: 722725.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Forrester SD, Kruger JM, Allen TA. Feline lower urinary tract diseases. In: Hand MS, Thatcher CD, Remillard RL, et al, eds. Small animal clinical nutrition. 5th ed. Topeka, Kan: Mark Morris Institute, Mark Morris Institute; 927976.

    • Search Google Scholar
    • Export Citation
  • 20. Osborne CA, Caywood DD, Johnson GR, et al. Perineal urethrostomy versus dietary management in prevention of recurrent lower urinary tract disease. J Small Anim Pract 1991; 32: 296305.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21. Osborne CA, Lulich JP, Kruger JM, et al. Feline urethral plugs: etiology and pathogenesis. Vet Clin North Am Small Anim Pract 1996; 26: 233253.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22. Lulich JP, Kruger JM, MacLeay J, et al. Efficacy of two commercially available, low-magnesium, urine-acidifying dry foods for the dissolution of struvite uroliths in cats. J Am Vet Med Assoc 2013; 243: 11471153.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23. Hanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol 2011; 185: 21622170.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24. Freidman LM. The randomization process. In: Friedman LM, Furberg CD, DeMets DL, eds. Fundamentals of clinical trials. 2nd ed. St Louis: Mosby-Year Book, Mosby-Year Book; 5169.

    • Search Google Scholar
    • Export Citation
  • 25. Gross KL, Becvarova I, Armstrong PJ, et al. Feeding young adult cats: before middle age. In: Hand MS, Thatcher CD, Remillard RL, et al, eds. Small animal clinical nutrition. 5th ed. Topeka, Kan: Mark Morris Institute, Mark Morris Institute; 373387.

    • Search Google Scholar
    • Export Citation
  • 26. Buffington CAT, Westropp JL, Chew DJ, et al. Clinical evaluation of multimodal environmental modification (MEMO) in the management of cats with idiopathic cystitis. J Feline Med Surg 2006; 8: 261268.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27. Neilson JC. Behavioral management of cats with idiopathic cystitis. Available at: www.hillsvet.com/HillsVetUS/v1/portal/en/us/content/research/feline-lower-urinary-tract-disease-flutd/conf-pro-behav-mgmt-cats-idiopathic.pdf. Accessed Apr 15, 2014.

    • Search Google Scholar
    • Export Citation
  • 28. Stella J, Croney CC, Buffington CA. Effects of stressors on the behavior and physiology of domestic cats. Appl Anim Behav Sci 2013; 143: 157163.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29. Stella JL, Lord LK, Buffington CAT. Sickness behaviors in response to unusual external events in healthy cats and cats with feline interstitial cystitis. J Am Vet Med Assoc 2011; 238: 6773.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30. Stroup WW. Generalized linear mixed models: modern concepts, methods and applications. Boca Raton, Fla: CRC Press, 2013.

  • 31. Hurvich CM, Tsai CL. Regression and time series model selection in small samples. Biometrika 1989; 76: 297307.

  • 32. Thrusfield M. Describing disease occurrence. In: Thrusfield M, ed. Veterinary epidemiology. 3rd ed. Singapore: Blackwell Publishing, Blackwell Publishing; 4674.

    • Search Google Scholar
    • Export Citation
  • 33. Wallius BM, Tidholm AE. Use of pentosan polysulphate in cats with idiopathic, nonobstructive lower urinary tract disease: a double-blind, randomized, placebo-controlled trial. J Feline Med Surg 2009; 11: 409412.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34. Freiman JA, Chalmers TC, Smith H Jr. The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial. Survey of 71 “negative” trials. N Engl J Med 1978; 299: 690694.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35. Bauer JE. Therapeutic use of fish oils in companion animals. J Am Vet Med Assoc 2011; 239: 14411451.

  • 36. Calder PC. n-3 polyunsaturated fatty acids, inflammation, and inflammatory disease. Am J Clin Nutr 2006; 83: 1505S1519S.

  • 37. Singh U, Devaraj S, Jialal I. Vitamin E, oxidative stress, and inflammation. Annu Rev Nutr 2005; 25: 151174.

  • 38. Cameron ME, Casey RA, Bradshaw JWS, et al. A study of environmental and behavioral factors that may be associated with idiopathic cystitis. J Small Anim Pract 2004; 45: 144147.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39. Buffington CA, Chew DJ. Intermittent alkaline urine in a cat fed an acidifying diet. J Am Vet Med Assoc 1996; 209: 103104.

  • 40. Gevaert D, DeSmet B, DeWilde RO. Dietary treatment of progressive feline struvite crystalluria. J Small Anim Pract 1994; 35: 575580.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41. Rich LJ, Kirk RW. The relationship of struvite crystals to urethral obstruction. J Am Vet Med Assoc 1969; 154: 153157.

  • 42. Buffington CA. Feline struvite urolithiasis: effect of diet, in Proceedings. Eur Soc Vet Nephrol Urol Annu Symp 1988;60112.

  • 43. Finke MD, Litzenberger BA. Effect of food intake on urine pH in cats. J Small Anim Pract 1992; 33: 261265.

  • 44. Tarttelin MF. Feline struvite urolithiasis: fasting reduced the effectiveness of a urinary acidifier (ammonium chloride) and increased the intake of a low magnesium diet. Vet Rec 1987; 121: 245248.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45. Taton GF, Hamar DW, Lewis LD. Evaluation of ammonium chloride as a urinary acidifier in the cat. J Am Vet Med Assoc 1984; 184: 433436.

    • Search Google Scholar
    • Export Citation
  • 46. Bartges JW, Osborne CA, Lulich JP, et al. Methods for evaluating treatment or uroliths. Vet Clin North Am Small Anim Pract 1999; 29: 4557.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47. Bartges JW, Kirk CA, Cox SK, et al. Influence of acidifying of alkalinizing diets on bone mineral density and urine relative supersaturation with calcium oxalate and struvite in healthy cats. Am J Vet Res 2013; 74: 13471352.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48. Khan SR. Heterogeneous nucleation of calcium oxalate crystals in mammalian urine. Scanning Microsc 1995; 9: 597614.

  • 49. Kirk CA, Ling GV, Franti CE, et al. Evaluation of factors associated with development of calcium oxalate urolithiasis in cats. J Am Vet Med Assoc 1995; 207: 14291434.

    • Search Google Scholar
    • Export Citation
  • 50. Lekcharoensuk C, Osborne CA, Lulich JP, et al. Association between dietary factors and calcium oxalate and magnesium ammonium phosphate urolithiasis in cats. J Am Vet Med Assoc 2001; 219: 12281237.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51. Lulich JP, Osborne CA, Carvalho M, et al. Effects of urolith prevention diet on urine compositions of glycosaminoglycans, Tamm-Horsfall glycoprotein, and nephrocalcin in cats with calcium oxalate urolithiasis. Am J Vet Res 2012; 73: 447451.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement