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Antacid Therapy in Cats with Chronic Kidney Disease

JD Foster, VMD, DACVIM, Friendship Hospital for Animals, Washington, DC

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In the Literature

Gould E, Klos J, Price J, Harris T, Vaden S, Tolbert MK. Retrospective analysis of the effect of acid-suppressant therapy on clinicopathologic parameters of cats with chronic kidney disease. J Feline Med Surg. 2018;20(6):520-527.


Administration of proton pump inhibitors (PPIs) has recently been demonstrated to be associated with an increased risk for development of chronic kidney disease (CKD) in humans.1 Antacid use is common in veterinary medicine, and many patients are prescribed antacids without clear indication. Although a common practice among veterinarians, use of antacids to treat nonulcerative GI disease is not warranted.2 Cats with CKD are thought to be at increased risk for GI ulceration; however, several recent studies have shown that these cats rarely develop ulcers and often have more neutral gastric pH than cats with normal kidney function.3,4 Despite this, many veterinarians continue to administer antacids to cats with CKD.5

This retrospective medical record review from 2 hospitals examined the effect of antacids in cats with CKD. Of the 89 cats included in the review, most (≈70%) had IRIS stage 1 or 2 CKD. Antacid therapy (H2-receptor antagonists and/or PPIs) was not found to result in a more rapid progression of kidney disease as compared with cats with CKD not receiving antacids. However, serum sodium concentration increased over time in cats that received a PPI. In addition, concurrent administration of a PPI and H2-receptor antagonist resulted in decreased serum magnesium concentration in cats with IRIS stage 1 or 2 CKD.


Key pearls to put into practice:


Although use of PPIs was not associated with a changing rate of CKD progression, PPIs may play a role in electrolyte and bone–mineral metabolism. Because CKD has been demonstrated to negatively affect bone density in dogs,6,7 veterinarians should recognize that bone and mineral disorders might occur in CKD patients8 and be aware of potential negative consequences of PPI therapy.


Routine prophylactic use of antacids in patients with CKD is not indicated.2 Their use should be reserved for patients with evidence of GI bleeding (eg, melena, iron deficiency) or esophagitis.



Twice-daily administration of a PPI is the most effective protocol for neutralizing gastric acid in cats with GI ulceration.9


For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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