[00:00:00] Feline Veterinary Medical Association: Welcome to All Cats Considered, a podcast from the Feline Veterinary Medical Association.
Here we interview professionals from across the veterinary world and take deep dives into the latest evidence-based research, developments, studies, and guidelines that improve feline health and well being.
We are the home for veterinary professionals seeking to enhance the care of cats through high standards of practice, continuing education and evidence-based medicine. In each episode you'll hear interviews with a variety of experts in our field covering a wide range of topics and the latest developments in feline health. We'll share the key points you need to know to improve your patients care.
Let's dive in and listen to this week's experts.
[00:00:47] Gómez-Mejías: Welcome back to Chatting with iCatCare. I'm I'm Yaiza Gómez, iCare Veterinary Community Coordinator and today I have the privilege to interview Sam Taylor and Natalie Finch about the new guidelines on feline chronic kidney disease.
The aim today is not reviewing all the content, but simply introduce the guidelines so you can then read them if you feel interested.
We will also be reviewing these guidelines or coming back to these guidelines and other urinary tract related topics in the next three months as part of the membership benefits in the iCatCare Veterinary Society because our overarching topic in Q3 in July, August and September will be Renal Disease. So thank you very much Natalie and Sam for joining us today.
And it has been 10 years since the last consensus. In general terms, how has the clinical approach to feline chronic kidney disease changed between then and now?
[00:01:45] Finch: Well thank you Yaiza for doing this interview with me. I'm absolutely delighted to be here and to be here with Sam.
I'm really excited about these guidelines. We've got a great panel of authors including well known specialists in feline chronic kidney disease and also nutritionists. And we've also got input from anesthesia and pain specialists as well.
To answer your question, I'm going to spend a little bit of time answering this question and split it into three different sections. So I'm going to talk about the most recent things in diagnosis and aetiologies and risk factors and then also management.
So in terms of diagnosis then I think what hasn't changed is our use of creatinine. So it is our most widely used and established surrogate marker of GFR. We know lots about how to use it, we've got lots of information on it, but what has evolved perhaps is our understanding of the benefits of the repeated measurements of creatinine. So using a cat where it serves as its own baseline to look for progressive increase in creatinine concentration that might alert us to the possibility of either progressive disease or the development of azotaemic chronic kidney disease. Ten years ago we did have SDMA available, and at that time the initial studies were suggesting that SDMA had a greater detection for decreased renal function than creatinine. But we've had lots more studies since that time. And so now we know that actually the correlations between SDMA and GFR and creatinine and GFR are probably similar.
SDMA is probably less affected, well, is less affected by muscle mass than creatinine. And so it can be beneficial when we're using it in those cats with chronic kidney disease that may have lost muscle mass, those underweight cats. So perhaps we want to consider SDMA in our interpretation of our renal profile more in those cats. But we do also know now that it's affected by other non renal factors and most importantly for our older cat population. And that's going to be hyperthyroidism.
So we need to interpret it with caution in a cat where we may think that there's underlying hyperthyroidism.
And now we've also got increasing evidence that perhaps the standard commercial assay cut off the 14 micrograms per deciliter may not be appropriate for the older cat population either. And perhaps we should be using a higher diagnostic cutoff of 18 micrograms per deciliter in our older cats.
In terms of aetiologies and risk factors for chronic kidney disease in cats, then we've got increasing evidence both in humans and wild and domestic cats, because we know that wild cats too also get a lot of tubular interstitial nephritis and chronic kidney disease. We've got increasing evidence that dietary phosphate is playing a role in the development and progression of chronic kidney disease. And that's because the high dietary phosphate which we might see in some diets will mean that there's more phosphate within the renal tubules and that phosphate in the renal tubules is causing cellular stress and nephron death and interstitial fibrosis and inflammation.
We now have a better understanding of nephrolithiasis in feline chronic kidney disease. So we can see incidental nephroliths in lots of cats with chronic kidney disease. And that doesn't seem to be associated with progression of chronic kidney disease. Where the problem is if they move, they cause a uretheral obstruction and that urethral obstruction can cause renal injury.
And I just want to, at this
[00:05:24] Gómez-Mejías: point, you said ureteral or urethral.
[00:05:30] Finch: Urethral. So a nephrolith, so a lift, a stone within the kidney, usually within the renal pelvis. That if we see that, incidentally, that's probably not an issue for a cat with chronic kidney disease. It's if it moves and blocks in the ureter that we're going to see renal injury.
And I think at this point also I just want to discuss the difference between nephrolithiasis and nephrocalcinosis, because these terms are becoming increasingly common.
So nephrolithiasis is a stone, a lith that we're seeing within the kidney, whereas nephrocalcinosis, that's the deposition of calcium within the renal parenchyma. And we know that hypercalcemic cats are much more likely to develop nephrocalcinosis and that may be a risk factor for progression in cats with chronic kidney disease as well.
And then finally, there's a few really important management changes or things that we recognize now that's really important for management of cats with chronic kidney disease.
So chronic kidney disease, minimal and bone disorder.
So this is the biochemical changes, the soft tissue changes, the bone changes that we see in patients with chronic kidney disease, we see it in bone, all species with chronic kidney disease.
And the pathophysiology is quite complex, but it's been really well described in the guidelines. So if that is something that you're interested in, we've got lots of detail and also some really great visual diagrams to help with understanding of that.
And the reason it's important to recognise in our clinical patients is because we know it contributes to progression of chronic kidney disease.
And if we recognise it, then the primary management is going to be around phosphate restriction and trying to achieve the phosphate targets, the phosphate concentrations for the iris target for that stage.
We will also have FGF 23, which is available now as a commercially available marker, and that's helpful in determining whether or not that phosphate restriction is required for cats that may be an early stage disease where they don't have phosphate above the iris target, we need to know is phosphate restriction going to be beneficial? And so IRIS have made some recommendations for cutoff, which we've described in the guidelines for when actually measuring FGF23 to guide us about whether or not we need further phosphate restriction, whether that's going to be helpful.
Another thing in the management of chronic kidney disease that's becoming a really hot topic is the diet induced hypercalcemia.
So this is different from cats that are hypercalcemic at diagnosis. These are cats that we recognize when we feed them a standard renal diet, that they will develop hypercalcemia. And we think this is related to the calcium phosphate ratio of the diet. So the standard renal diets will have a higher calcium phosphate ratio because they're more restricted in phosphate. And so that higher calcium phosphate ratio we think is leading to more increased absorption of calcium through the gastrointestinal tract. And that's contributing to the development of hypercalcemia. And so actually, if we can feed them a diet that has a lower calcium phosphate ratio, they're going to absorb less calcium and then they will hopefully resolve that hypercalcemia. And indeed, actually, in the studies where they've looked at feeding, transitioning from what we would call a standard renal diet to then an early renal diet, those cats that have developed hypercalcemia, that hypercalcemia will resolve when they're fed an early renal diet with a lower calcium phosphate ratio.
I think anaemia is becoming increasingly important.
We know that anaemic cats, cats with a PCV less than 27%, will have a reduced quality of life. And previously we've only really had access to things like darbopoietin and recombinant human erythropoietin, which we know have been really significantly associated with the production of anti erythropoietin antibodies, particularly for recombinant human erythropoietin. But now we've got the HIF inhibitors, so Molidustat or Varenzin, which is now available on the market. And these HIF inhibitors work by essentially mimicking hypoxia in the body so that there is stimulation of erythropoietin production.
And we've now got several studies where cats with chronic kidney disease have been giving Molidustat and they've demonstrated a significant increase in their pcv. And we've included protocols in the guidelines about dosages, how to monitor the cats when you're giving this medication.
And then the final thing I wanted to talk about is the gut microbiome. I think that's really important for so many diseases in cats.
We know that cats with chronic kidney disease will have fecal dysbiosis, and that's probably a contributing factor to uremic toxin accumulation, things like indoxyl sulfates and p-cresol sulfate. The uremic toxin buildup is important because it's associated with progressive chronic kidney disease. And we want to do everything that we can to preserve renal function and stop progressive chronic kidney disease in our cats.
So by maintaining a healthy gut microbiome, by potentially giving probiotics and prebiotics, hopefully we can reduce that. And another consideration in that is monitoring defecation in cats. So cats with chronic kidney disease may be more prone to becoming constipated and so that can exacerbate this buildup of uremic toxins because we've got feces sitting within the colon for longer. So monitoring hydration status, defecation in the cats, getting, giving laxatives and making sure they're staying well hydrated if we're concerned about constipation.
[00:11:21] Gómez-Mejías: Wow, thank you so much.
That's a brilliant information overlay.
[00:11:26] Finch: But these were some of the key things I really wanted to get out to the listeners.
[00:11:31] Gómez-Mejías: Not at all. I think it's brilliant.
I followed it up and I'm not particularly fast and I found everything extremely interesting. So I think it's a great, great summary. Would you like to add something, Sam?
[00:11:46] Taylor: Well, no, I mean, Natalie has been very, very comprehensive there and I think it's funny, it is an area of feline medicine that thankfully has had lots and lots of research, partly thanks to Natalie and the groups at the Royal Vet College. When I do some guidelines, we don't have as much to go on, if you know what I mean. Whereas this one, I think I have beaten my record for number of references in a guideline. So that shows you how much, how much research there has been. And often, as we know, cats are behind dogs in research.
But I think this might be one. I don't know if you agree, Nat, that there might be a bit more research in cats than there is in, in dogs. So for once we're probably ahead of the game. So, yeah, I think it was well due an update. All of those reasons that have been, have been mentioned. But also, as I'm sure you're going to discuss with us later, that just being more proactive and the things we've learned about simple things like constipation, you know, things that really affect cats quality of life, I think we've just got a lot better at. And hopefully these new guidelines will refresh everybody's interest in this topic.
[00:12:59] Gómez-Mejías: And what do you think there's more research now about chronic kidney disease in cats than in dogs. What's the ultimate motivation there behind the research on the funding? I guess because the funding matters every time you talk about research.
[00:13:13] Taylor: Well, Nat, you're more of an expert on funding of projects than I am, but I think it's more common, probably, and although you could argue it's maybe underdiagnosed in older dogs. What do you think?
[00:13:25] Finch: Yeah, I agree. I think it probably is more common and more recognized. I think if you speak to anyone, members of the public, they've all either had a cat or they know someone with a cat with chronic kidney disease and, and people feel really passionate about it. And I think it's really great that the funders recognize how important it is and how beneficial the research can be in improving the quality of life and survival for our cats with chronic kidney disease.
[00:13:54] Gómez-Mejías: And getting back to what Sam said, why is it important to move from a reactive to a proactive approach where instead of waiting for the azotaemia to appear, we screen more often?
[00:14:05] Finch: A lot of the signs in chronic kidney disease are perhaps not very obvious to owners. Things like polyuria, polydipsia, inappetence.
Those signs may be quite subtle and insidious. Also quite non specific. We know actually that many cats with chronic kidney disease will have weight loss that's gone unnoticed for a large period of time and before the diagnosis. So one study showed that weight loss of about 9% in the 12 months prior to the lead up to diagnosis.
Then if actually we screen those cats where the owners have noticed no signs at all, cats that are considered to be apparently healthy, then quite a significant proportion will have evidence of chronic kidney disease, nasotaemic chronic kidney disease, and then many more. If you were to follow those cats over a one to two year period, will develop azotaemic chronic kidney disease by having a more proactive approach and we can hopefully detect the disease earlier. We can monitor the cats to look for signs of progression that might alert progressive changes in the creatinine that might alert us to the development of azotaemic chronic kidney disease. But I do just want to highlight at the moment that if we have early detection, maybe we can implement management strategies, but we don't have, we have quite limited evidence at the moment for early intervention in early stage chronic kidney disease. So we've actually only got one study, one very recent 2026 study, a retrospective study looking at a really large number of cats to see whether or not early intervention with a renal therapeutic diet is beneficial. And that study was able to show that the cats did stage one and early stage two chronic kidney disease that were fed that renal therapeutic diet and did have slower progression and increased survival compared to the cats that were not fed the renal diet. That is just one study that we have. We need a lot more research in that area where it will be important that if we have recognized that a cat has early chronic kidney disease, then we can start to consider that in the home environment and the hospital environment. We can start to consider it in if we're prescribing any medications for cats, if we're thinking about the cat needing any procedures requiring a sedation or a general anaesthetic, thinking about anything that might have an insult, an injury, whether that's ischemic or something else to the kidney that's going to worsen that kidney disease. And so thinking about making sure cats stay nice and hydrated, particularly in hot weather like this, making sure there's lots of sources of fluids within the home environment, maybe early intervention in a cat that's developing vomiting and diarrhea or inappetence, and to make sure that they're maintaining that renal perfusion when they do have early chronic kidney disease that might contribute to progressive chronic kidney disease if we don't address it early on.
[00:17:11] Gómez-Mejías: Would you like to add something, Sam?
[00:17:14] Taylor: Yeah. I think it probably also comes back to early detection of chronic kidney disease is of course important, but we also might detect other diseases as well. So I suppose I just broaden it also to getting cats into the clinic and getting senior cats into the clinic. So even if I think it's right, what Natalie says, that it might not mean that we do an enormous intervention and can cure the problem, but it's starting to notice those cats, it's getting them in, it's looking at their body weight, their body condition, detecting if they have dental disease, as Natalie said, does that need management? Let's do that now rather than leave that. So I think it's part of a whole sort of attitude, really, I suppose, to getting these cats into the clinic and of course, being more cat friendly, as we know, will help us to do that. So I think, of course we're talking about chronic kidney disease, but to me, I would broaden it to just knowing our senior cats a bit more that are on our, on our books. You know, we often lose them a little bit, don't. We might see them as young cats for vaccination and they're healthy adults. And then you start to get in this period where they say, well, I don't want. They're a bit older now, I don't want to take them into the clinic and stress them out or they look fine or they're just getting old, that whole thing, you know, they're just getting it. I see cats every week because, well, I don't know If I, you know, if there's anything wrong or they're just getting old, you know, that, that classic sort of attitude. Whereas actually we can do a bit better, we can identify illness. And I'm still constantly amazed how much difference you can make by doing that. For example, doing dental treatment in a cat with early chronic kidney disease, it can, that can improve their appetite, it can just improve their demeanor. And then they drink a bit more, they eat a bit more. I feel like it would make a big impact on potentially even progression, as we said, by encouraging them to just improving their general health at that point that you've diagnosed it to me is a positive thing.
[00:19:08] Gómez-Mejías: Cholesterol levels are monitored closely in human patients with chronic kidney disease.
Is this something that we should be paying attention to in cats as well?
[00:19:19] Finch: We don't usually where we potentially might look at cholesterol a little bit more, and this is probably more in relation to dogs would be if we've got sort of hyperlipidemia and we wonder that there might be a lipid changes within the glomerular structure, within the glomerular filtration barrier that's then causing proteinuria.
So that's probably more of a dog issue than a cat issue.
Cats do seem to have this lipid accumulation within their renal tubules that seems to be cat thing, possibly related to evolutionary changes or the way that we feed them now.
And maybe that's a factor within progression of chronic and development of chronic kidney disease. That's the sort of field of emerging.
[00:20:09] Gómez-Mejías: I'm more like a dog. I'm more like a dog than a cat. Okay, that's very sad to hear.
[00:20:19] Taylor: Right.
[00:20:19] Gómez-Mejías: And the guidelines emphasize a team based approach where not only vets get involved, but also nurses and caregivers. Could you explain why was it important to include nursing guidelines and caregiver resources?
[00:20:33] Taylor: We have started now with our guidelines to always produce a guide for caregivers and some nursing guidelines. And I think that really reflects the importance of that, as you say, that team approaching chronic disease, not just chronic disease, kidney disease, but in chronic disease in general. Because you and me in the clinic, we see a small snapshot, don't we? The work is done at home mainly, and chronic kidney disease is one of those conditions. And there is a little bit of nice research showing that it can cause this caregiver burden that we talk about, which means essentially to me, I've probably not the scientific definition, but the impact of that disease on that caregiver.
So that can be in terms of financial impact it can be in terms of giving medication, it can be in terms of those canceled holidays because you're worried about the cats. So you've got to medicate the cats. And that we know in chronic kidney disease can be quite significant.
And we also know from some lovely work that basically the more medications you prescribe, the more medication the cat is on, potentially that can lower quality of life, which makes sense to me. I wouldn't fancy giving several medications to my cat in one go.
So I think that we've really moved away from this sort of you and me seeing cases prescribing a ton of medications.
That's the end of it. It's now got to be much more interactive. We need that feedback. We need to know how that cat is at home. We need to know how things are going. We need to know if they can't give that medication.
We need to know. Obviously in chronic kidney disease, diet's very important, but simply sending someone away with a bag of renal diet is not, you know, is not, we now know, is sort of not good enough, is it? They need support in introducing that diet, the caregivers need support in giving medications or we need to review it and we need to cut that number of medications and what prioritize those that are most important.
And this is where the nursing team can be super, super helpful to those caregivers. They should be involved in a lot of the monitoring, they should be involved in that support, those check ins, nutrition discussions, medication discussions. We're simply missing a huge opportunity if we don't involve the nursing team. So I think that's what we're really trying to communicate. And also it's very emotive, isn't it? You know, we give a diagnosis of chronic kidney disease and that can be very upsetting for clients if they go away. And we now obviously know people Google and people find information, let's try and help them find good information.
And that's why we'd like to support them with our caregiver guide, you know, so they can read correct information and again, the nursing team can take them through some of those fears, you know, and reassure them on that, that it isn't a death sentence. It is something that can progress very slowly and that these cats can have an awesome quality of life for a long time. I really hope people find those resources useful when they're managing these, these patients.
[00:23:31] Gómez-Mejías: That's so important because if it wasn't because of the caregivers, the cats wouldn't be getting the treatment and the management.
[00:23:38] Taylor: Exactly, exactly. What we do is minor. What we do is minor. It's what they do at home that is heavy load for them.
[00:23:46] Gómez-Mejías: Exactly. And what you said about the polypharmacy, about giving different drugs at the same time is also. I mean, it's super important from the cat's point of view because. And the caregiver's point of view, because it affects the bond between them and it affects the cat, because it is a pain to be medicated if you're a cat or not necessarily, but it can be. But also it increases the risk of adverse events, I guess. And then when we've got something unexpected. What I find in practice is that it's much more difficult to manage a patient. The decision making comes across a little bit more difficult when the patient is on several different medicines than when it's not on any medication because you have to check out for more interactions and potential adverse effects and everything. So, yeah, sometimes. What do you say about, you know, this demand of a pill that addresses every single problem?
[00:24:40] Finch: Yeah.
[00:24:42] Taylor: And particularly in the later stages. I don't know if Natalie will agree, but if you have a cat in. I think we did put this in the guidelines. If you have a cat that's, you know, approaching a higher stage of CKD, then of course we're still worried about progression, but we need to manage symptoms, do you know what I mean? So maybe we're going to slack off on some other things. You know, we're going to make sure that they eat. If they don't want to eat a renal diet, we might accept that. So it doesn't mean we're obviously not going to do anything, but we need to prioritize in those later stage cats, managing their appetite and their nausea and their constipation, things that will truly impact their quality of life. I don't know if you agree on that, Natalie.
[00:25:25] Finch: It really comes back to having this really strong, trusting relationship with the owner, because I think a lot of owners, often they get this diagnosis and then they just feel quite lost. They're not sure where to get the information from. And we want them to be getting the correct information.
We want to be recognizing that some of these owners are going to have caregiver burden and that they should feel that they're able to talk to us about that and that we can empathize and listen. I think it was really quite startling in our study of owner's experiences of caring for a cat with chronic kidney disease that 99% of owners reported experiencing feelings of anxiety, with 58% saying those feelings were severe, that's really shocking to me. And I think anything that we can do to try and alleviate that and reduce the anxiety, is it only going to strengthen the pet-owner bond and improve the relationship between the vet and the owner? Because I think having a pet should be a pleasure and not a burden. I think what we also recognized in that study is that often owners are giving a lot of medications.
Sometimes they're giving supplements because they've read online that supplements going to be particularly good for chronic kidney disease. And most of these supplements don't have any evidence base at all. And some of them, actually some of the supplements that the owners were giving to their cats would actually be considered harmful to the kidneys.
But also those owners were reporting that they didn't feel that they could have that kind of open conversation with their vet about the supplements that they're giving. They felt that the vet would be really dismissive.
So we need to have that relationship so that we can talk to the owners about what are the priorities for their cats, what medications should they be prioritizing so that they're not feeling overwhelmed and burdened and that they are doing the best for their cat with chronic kidney disease.
[00:27:25] Gómez-Mejías: So important to keep in mind the mental health of our caregivers and the role the, their potential anxiety plays in our communication with them since we spend so much time communicating with them and it's so important. So central to our work.
[00:27:44] Taylor: Yeah.
[00:27:44] Gómez-Mejías: And a unique addition to these guidelines is the focus on the mental well being of the cat as well. How do the five pillars of a healthy environment influence the health and the management of chronic kidney disease patients?
[00:28:00] Taylor: Ah, well, this was, this was my sort of addition because I think actually we've touched on some points on this and we do all know this sort of stuff, but it's kind of trying to write it down and make sure that it's really well communicated. So if anyone's not familiar with the sort of five pillars model, to me, and I'm not a behaviorist, I'll probably get it all wrong. But to me it's a sort of guideline on the things that are important to cats and the things that we can optimize in the home environment to make it the best it can be. Because there are some environments that cats live in that isn't perfect. Of course, probably for my cats as well. We can make them better and we can really make sure that the cats have what they need. And there are a few reasons that that is particularly important for cats with chronic kidney disease. And I know that sounds, sounds so silly, but I think it's really impactful. So, for example, if you have CKD, you need to drink and urinate more frequently than another cat, than a healthy adult cat. Now, if you live in an environment that does not have easy access to those resources because maybe you have only one litter tray and you have three cats, then maybe that cat doesn't pee as often as it should and therefore it's hanging onto its urine and longer than it would normally and that could be potentially detrimental. And maybe they're not drinking as much as they would quite like to because there is only one water source and maybe it's up some stairs and they're also a bit arthritic. And there's another cat that stands in front of it and near it and it's a bowl they don't particularly like. So therefore, each day they drink a little bit less and therefore they get a little bit dehydrated and then they get a little bit constipated. And you can see how it's like a knock on. It sounds like such a minor thing, but I think it could be an important thing. And on that note of constipation as well, of course, if they don't poo as often as they should because their litter tray is dirty or there aren't enough, or you know, there are again positioned somewhere that's not cat suitable because what's suitable for us might not be suitable for cats. And litter trays often get put in sort of noisy kitchens next to the washing machine, etc. Then they just hold that poo for a bit longer and then it gets a bit drier and it's harder to par. And you can see again, it's just this sort of knock on. So one of the pillars is talking about providing multiple and separated resources. So that just means we've got lots of water bottles.
And to me that means that if that cat is walking past a bowl more frequently, they might think about having a drink a bit extra. And each day that small thing makes kind of a big difference.
And of course, mental wellbeing is so crucially linked to physical health.
We talk about that a lot with International Cat Care. Definitely having sort of better mental health will help their physical health. So things like making sure that they still have some activity and they can engage in some play opportunities, just because they're older, they might still want to do a little bit of playing, they might want to have a walk around the garden. So all of these things that improve kind of mental wellbeing, I just think are really kind of extra important for these little cats.
So that's why we wanted to include that. So it's basically a guide and a kind of reminder of things that are important to cats. Ramped up for cats with CKD.
[00:31:15] Gómez-Mejías: Thank you both Sam and Nat for joining us today. Would you like to share something before we finish?
[00:31:21] Finch: If it's okay, I'd just like to mention our Feline Kidney Health Initiative that we're starting running at Langford Vets at University of Bristol.
So this is a really unique clinic. So we are going to be seeing cats with chronic kidney disease, any stage of chronic kidney disease, and we're going to be doing comprehensive testing to stage their chronic kidney disease and monitor their chronic kidney disease. We'll be seeing them every three months. We'll do blood testing, urine testing, blood pressures, imaging the kidneys.
And then what we're also interested in is the development of cognitive dysfunction in chronic kidney disease, because we know this happens in people and probably it's a factor in cats as well. So we're also going to be doing lots of cognitive function testing in the older cats as well, trying to validate better methods, but then also monitoring the changing cognitive dysfunction in our cohort of cats over time. And then we're also interested in looking at pain in these cats and how cognitive dysfunction may affect our interpretation of pain scoring and what we can do to better manage pain in cats with chronic kidney disease. Because I think we've got quite limited evidence for what's the best approach for managing pain.
And so what we'd like to invite any owners of any cats with chronic kidney disease. They're very welcome to come to the clinic. You can look up the clinic as Feline Kidney Health Initiative at Bristol University at the vet school.
And so please do get in touch. The clinic is very generously funded by Zoetis and so we're able to offer all of the diagnostic testing, cognitive function testing, imaging free of charge. We just charge a 50 pound consult fee. And so please do get in touch if you would like to become part of this study. We'd love to hear from you.
[00:33:15] Gómez-Mejías: Sounds brilliant, sounds brilliant. Thank you so much for sharing that and thank you again for joining us today.
To the audience, this is just the first step in our series. Those who are members of the iCatCare Veterinary Society will be able to listen to three more podcasts around renal disease in cats from monitoring CKD, urinary tract infections and nutrition. So keep an eye on future episodes and thank you for listening. Please leave your feedback on social media and see you next month.
[00:33:51] Feline Veterinary Medical Association: Thank you for listening to this episode of All Cats Considered. We hope you enjoyed this interview. For more information on the topics discussed in this episode, please head over to catvets.com/ podcasts and explore the links in the show notes. Don't forget to subscribe to this podcast on your platform of choice, so you won't miss any episodes as we release them. Have thoughts or ideas about the Internet interview you heard today? Share them with us by leaving a comment on our Facebook page or shoot us an emai
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