Abstract
Plasma total magnesium concentration (tMg) is a prognostic indicator in cats with chronic kidney disease (CKD), shorter survival time being associated with hypomagnesemia. Whether this risk factor is modifiable with dietary magnesium supplementation remains unexplored.
Objectives
Evaluate effects of a magnesium-enriched phosphate-restricted diet (PRD) on CKD–mineral bone disorder (CKD-MBD) variables.
Animals
Sixty euthyroid client-owned cats with azotemic CKD, with 27 and 33 allocated to magnesium-enriched PRD or control PRD, respectively.
Methods
Prospective double-blind, parallel-group randomized trial. Cats with CKD, stabilized on a PRD, without hypermagnesemia (tMg >2.43 mg/dL) or hypercalcemia (plasma ionized calcium concentration, (iCa) >6 mg/dL), were recruited. Both intention-to-treat and per-protocol (eating ≥50% of study diet) analyses were performed; effects of dietary magnesium supplementation on clinicopathological variables were evaluated using linear mixed effects models.
Results
In the per-protocol analysis, tMg increased in cats consuming a magnesium-enriched PRD (β, 0.25 ± .07 mg/dL/month; P < .001). Five magnesium supplemented cats had tMg >2.92 mg/dL, but none experienced adverse effects. Rate of change in iCa differed between groups (P = .01), with decreasing and increasing trends observed in cats fed magnesium-enriched PRD and control PRD, respectively. Four control cats developed ionized hypercalcemia versus none in the magnesium supplemented group. Log-transformed plasma fibroblast growth factor-23 concentration (FGF23) increased significantly in controls (β, 0.14 ± .05 pg/mL/month; P = .01), but remained stable in the magnesium supplemented group (β, 0.05±.06 pg/mL/month; P =.37).
Conclusions and Clinical Importance
Magnesium-enriched PRD is a novel therapeutic strategy for managing feline CKD-MBD in cats, further stabilizing plasma FGF23 and preventing hypercalcemia.
| Original language | English |
|---|---|
| Pages (from-to) | 2180-2195 |
| Number of pages | 16 |
| Journal | Journal of Veterinary Internal Medicine |
| Volume | 38 |
| Issue number | 4 |
| Early online date | 1 Jul 2024 |
| DOIs | |
| Publication status | Published - Aug 2024 |
Bibliographical note
Publisher Copyright:© 2024 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Funding
Pak\u2010Kan Tang received a PhD studentship funded by Royal Canin SAS. Rebecca Geddes received funding from Petplan, Royal Canin, an RVC Internal Grant, The Academy of Medical Sciences and The Everycat Foundation; has previously had a consultancy agreement with Boehringer Ingelheim; has received speaking honoraria from Boehringer Ingelheim, Idexx and Royal Canin. Rosanne Jepson received funding from PetPlan, Feline Foundation for Renal Research, RVC Internal Grant, PetSavers, and consultancy agreements: Boehringer Ingelheim, Merial, CEVA. Speaking honoraria: Boehringer Ingelheim, Hills Pet Nutrition, CEVA. Jonathan Elliott has Consultancy agreements with: Elanco Ltd, CEVA Animal Health Ltd, Boehringer Ingelheim Ltd, MSD Animal Health Ltd, Orion Incorp, Idexx Ltd, Waltham Petcare Science Institute, Invetx Inc and Zoetis Ltd received grant funding from Elanco Ltd, Waltham Centre for Pet Nutrition, Royal Canin SAS, Idexx Ltd, CEVA Animal Health. He is a member of the International Renal Interest Society which receives sponsorship from Zoetis.
| Funders |
|---|
| Elanco Ltd |
| Idexx Ltd |
| Merial |
| Boehringer Ingelheim |
| Royal Canin SAS |
| Royal Veterinary College |
| Waltham Centre for Pet Nutrition |
| PetPlan |
| Ceva Santé Animale |
| Feline Foundation for Renal Research |
| Everycat Foundation |
| Academy of Medical Sciences |
Keywords
- CKD-MBD
- anti-calcemic
- calcium
- fibroblast growth factor-23
- hypercalcemia
- magnesium oxide