My older cat (15 years old), has some protein in his urine. The rest of his kidney biomarkers are quite good. However, kidney health in cats is very important, and it’s vital to slow down any deterioration - a frequent cause of death and QOL issues for our furry friends as they get older. I am going to be proactive. I am not willing to simply watch the downhill journey as my vet seems to fatalistically resigned to (a very good vet and full of empathy). Changing his diet to a “kidney” low protein diet is a non-starter. The idea that there’s “nothing you can do” for kidney health, is an oudated idea in both humans and animals - we have SGLT2i drugs. These drugs clearly slow down the deterioration of kidney function. This is why I settled on dapagliflozin 5mg/day for my older cat. Reasons:
(1)Slow down the decline in kidney function - doable with SGLT2i. Big cause of death and health decline. Getting ahead of that proactively is better than waiting - the earlier, the better. Why wait?
(2)The SGLT2i class of drugs seem overall to possibly have good outcomes in healthspan - and perhaps even lifespan (ITP - canagliflozin).
(3)The primary indication for SGLT2i is diabetes. I think that in an aging animal, regardless of glucose metabolizm status, the addition of SGLT2i is of a health benefit, especially that with age this control tends to deteriorate - I want to get ahead of that. There may be additional benefits (cardiovascular), which I am uncertain about, but I’ll take it.
(4)There may be synergies between rapamycin and an SGLT2i - my cat is on rapamycin already.
(5)The SGLT2i class of drugs have been specifically cleared by the FDA for cats - bexagliflozin and velagliflozin. So we at least know that they have some level of safety for Felis Silvestris Catus.
(6)There is a very small very short term study of specifically dapagliflozin in cats, with very good outcomes for kidney function:
The effect of the sodium-glucose cotransporter type-2 inhibitor dapagliflozin on glomerular filtration rate in healthy cats
“The objective of this report was to assess changes in glomerular filtration rate in healthy cats after treatment with a SGLT2i. Eight healthy research adult castrated male cats were used in a randomized, controlled, cross-over study design. We induced isolated renal tubular glucosuria by dosing cats with the SGLT2i dapagliflozin. The cats received by mouth 10 mg dapagliflozin or control every 24 h in each of the 4, 5-d trial periods that were separated by a 7-d washout period. We assessed glomerular filtration rate (iohexol clearance method), serum urea, creatinine, symmetric dimethylarginine, and 24-h sodium and chloride urinary excretion on the fifth day of each trial period. We analyzed the data with a mixed linear model that included the fixed effects of treatment (treated and control) and trial period, and the random effect of the cat. Compared with controls, cats treated with dapagliflozin had a significant increase in mean (±SE) glomerular filtration rate (3.1 ± 0.2 vs 2.5 ± 0.2 mL/kg/min; P = 0.01), whereas there were no significant differences in serum urea, creatinine and symmetric dimethylarginine, and 24-h urine sodium and chloride excretion. We propose that dapagliflozin-mediated delivery of sodium and glucose distal from the proximal convoluted tubule induced compensatory increased sodium absorption at the thick ascending loop of Henle that resulted in decreased sodium delivery to the distal tubule leading to tubuloglomerular feedback-mediated glomerular hyperfiltration.”
The study was in male castrated cats - my cat is a castrated male. Note, this is in healthy cats, not diabetic or otherwise sick - this is my cat. Note furthermore: the study used a 10mg/day dose. I am using only half that dose - 5mg/day, further possibly enhancing safety. The study is tiny and super short. However, it is encouraging that the filtration rate was affected beneficially and no side effects were observed.
Things to watch out for, perhaps not all cats are going to be suited to this. Is your cat a good drinker? If not, I would worry about administering a drug that has the potential to be a mild diuretic. My cat happens to be an excellent drinker. Watch for UTI and associated problems. Obviously monitor closely and test regularly - I already have several recent comprehensive blood tests to establish a baseline, and I will test how this drug is impacting his biomarkers. Staying on top of any intervention with close monitoring is essential.
Obviously, giving the cat dapagliflozin is a calculated intervention - this is not a drug that’s been cleared by the FDA for cats; but until recently, rapamycin has not been either. You take responsibility for yourself and your loved ones, including the furry ones, and you do the best you know how to. YMMV.
Btw. I am not advocating that anyone put their pet on any drug including dapagliflozin, I am explaining how and why I did so.
