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Feline cardiorenal syndrome - is fibroblast growth factor 23 associated with left ventricular hypertrophy and dysfunction in cats with chronic kidney disease?

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Chronic kidney disease (CKD) is common in cats, affecting ~30% of senior cats. The functions of the heart and the kidneys are closely linked, with disease in one often leading to complications in the other. This is known as the cardiorenal syndrome and is of crucial importance in human patients with CKD, in whom cardiovascular complications are the most common cause of death. However, cardiac complications related to CKD remain unstudied in cats.

Blood concentrations of a hormone, fibroblast growth factor 23 (FGF-23), increase in cats and humans with CKD. FGF-23 directly causes heart muscle cell growth (hypertrophy) in rodents, and increasing circulating FGF-23 concentrations are associated with increased heart muscle thickness in human patients with CKD leading to reduced cardiac function. The effect of increased FGF-23 on the hearts of cats with CKD is unknown.

Determining whether FGF-23 is associated with heart muscle hypertrophy in cats, as in people, will advance our knowledge of heart and kidney disease and provide evidence for one of the proposed mechanisms contributing to the feline cardiorenal syndrome.

We hypothesize that cats with CKD exhibit a higher prevalence of left ventricular hypertrophy (LVH) and reduced left ventricular function than in the general population. We also hypothesize that plasma fibroblast growth factor 23 (FGF-23) concentration is correlated with LVH and left ventricular function in cats with CKD.

We aim to recruit cats with CKD in the absence of significant comorbidities and measure concentration of FGF-23 from residual blood samples. Enrolled cats will also have biochemistry, haematology, blood pressure urinalysis and echocardiography performed. The relationship between FGF-23 and LVH and left ventricular function will then be explored.

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