This study collects information about the physical status, blood pressure and selected laboratory parameters of cats that belong to one of two groups: a) they are healthy; b) they have been confirmed to have chronic kidney disease (CKD). The purpose of the study is to assess whether administration of a probiotic changes the natural gut microbial flora (microbiome) of these cats, and influences markers of renal (kidney) health and phosphate homeostasis through this microflora change.

This project wishes to recruit cats that have CKD, IRIS Stage 2-4. We will be assessing the microbiome, and effect of a probiotic on CKD status, in particular calcium/phosphate metabolism. The study is a blinded (owner) cross-over prospective trial.

Inclusion Criteria:

• Must be either voluntarily eating, or being fed through a feeding tube, a renal therapeutic diet for the past 6 weeks (no specific diet brand or stage required) up to 80-90% total daily caloric intake.
  
• Owners willing to commit to supplementing their cat a probiotic (or placebo product) for two 8-week periods, maintain current diet, keep a home diary of clinical status, collect and post a stool sample from their cat 3 times (at no cost) and to visit the MSU Veterinary Medical Center for 4 visits.
• Must be current on parasite (endo- and ecto-) control.
• Confirmation of CKD status within past 3 months.

Exclusion Criteria:

• Other systemic illness (please note not all are excluded; please check if uncertain).
• Evidence of acute or acute-on-chronic kidney disease.
• Evidence of severe periodontal or gastrointestinal disease.
• Hospitalization longer than 24 hours in the last 6 weeks.
• Treatment with proton-pump inhibitors, antibiotics, phosphate binders, laxatives or supplements that may alter the microbiome in previous 6 weeks (please note that we could assess these cats after that timeframe).
• Receiving an exclusively raw diet in the previous 6 weeks.
• Unable to safely or in a fear-free manner obtain blood samples.

We anticipate being able to provide the client with overall treatment plans and will update the referring veterinarian on findings and recommendations at each time point.

What will be the benefit for the client?

• All costs are covered for specialist evaluation, with exception of any medication or diet that may be considered necessary.
• All relevant test results will be available (and shared with referring veterinarian and the client) within 3-4 days of each consultation.
• At the end of the study, the treatment group will be revealed to the client as well as assessment of clinical response to determine if ongoing probiotic supplementation is recommended.
• Ongoing management and recommendations for the client to continue at the referring clinic will be sent following completion of the study.

What is the process?

If you have a case that you think may be suitable, we would be delighted to find out more. Options include:

• Discuss the case with your client (a client info flyer can be found here) and if they are interested, then send through clinical records to Dr. Caroline Mansfield at mansfi77@msu.edu. If suitable, we will contact the client directly.
• If you would like to discuss the project more, or if you are uncertain about whether a case will be eligible, please email mansfi77@msu.edu to set up a time to discuss further.