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Appetite stimulants in chronic kidney disease

02 September 2018
8 mins read
Volume 9 · Issue 7


Poor appetite is a common clinical complaint in patients with chronic kidney disease. Nurses can play an important role by helping to perform regular nutritional assessment to identify patients that require intervention. This article aims to discuss the importance of this clinical problem and the different mechanisms by which appetite may become abnormal in chronic kidney disease. Recent research on pharmacologic options for appetite stimulation offer new options such as mirtazapine for cats and capromorelin for dogs.

Clinical signs of nausea, vomiting and dysrexia are common in patients with chronic kidney disease (CKD). In a recent survey of owners of cats with CKD, 43% of respondents reported abnormal appetite in their cat necessitating 77% of owners to coax the pet to eat more than half the time (Markovich et al, 2015). Sufficient caloric support is crucial for chronically ill patients, and there is evidence that CKD results in an increased metabolic state making adequate nutrition even more of a challenge (Neyra et al, 2003). In humans CKD protein energy wasting and poor body condition is associated with decreased survival, even in patients receiving dialysis (Carrero et al, 2013). Poor body condition score (BCS) is also associated with a poorer prognosis in dogs and cats with CKD (Parker and Freeman, 2011; Freeman et al, 2016). A recent study documented that not only do cats commonly lose weight before CKD diagnosis and subsequently continue to lose weight during the disease process, but decreased weight is associated with a poorer prognosis (Freeman et al, 2016). Assessment of quality of life parameters in CKD cats revealed that CKD cats score significantly lower than healthy young or geriatric cats in the categories of ‘appetite’ and ‘liking food’ (Bijsmans et al, 2016). Additionally, poor appetite is perceived as a significant quality of life concern and can cause significant emotional distress to owners (Reynolds et al, 2010).

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