Renal disease is present in approximately 1% of our canine patients (Roura 2019). Unfortunately, osteoarthritis occurs in around 20% of dogs over the age of 12-months-old, and has been reported to increase to as much as 80% of dogs over the age of 8-years-old (Anderson et al. 2020). Osteoarthritis can affect our patients to a clinically significant extent that causes an overall reduction in quality of life (QoL). It is common practice by veterinarians to prescribe NSAIDs, carprofen and gabapentin to manage signs of pain in patients with osteoarthritis. Yet, due to the potentially deleterious effects these medications can have on renal function, we are often left with few suboptimal analgesia.  

Having one of your favourite patients suffer from avoidable pain can be a strain on your emotional wellbeing and our relationship with our clients. In Chronic Kidney Failure (CKD) patients we can feel our hands are tied and that we need to reach for S8 medications, which can cause another set of undesirable side-effects (like an unbalanced S8 book). Yet, even in patients suffering from CKD we can help achieve a good QoL for them if we have a quantitative and qualitative pain management plan, as well as the appropriate analgesia protocol.  

Josie(16.4 y/o, 8.7kg FS Cavoodle)

Josie is a gorgeous cavoodle that belongs to a loving and dedicated family. Unfortunately, Josie suffered from recurrent UTIs throughout most of her life that were treated with intermittent short courses of antibiotics and NSAIDs by various veterinarians. At the age 11 Josie was diagnosed with osteoarthritis and was prescribed ongoing cartrophen courses, as well as daily oral carprophen (2mg/kg SID) and gabapentin (10mg/kg SID).  

Intermittent blood tests detected elevated SDMA fairly early on in her life. At age 16 her elevated Urea and SDMA led her to having her cartrophen and carprophen stopped, however, she was unable to ambulate effectively due to her crippling arthritis. Codeine was prescribed, which seemed to improve her clinical signs only slightly, but she was effectively being carried out to the toilet multiple times per day and was only able to move on level carpeted surfaces.

Two months after her 16th birthday Josie presented with an inability to rise and ambulate, as well as constipation. The new Veterinary Director of the hospital repeated blood tests to assess her renal function and prescribed CBD oil made in Australia (for humans) under stringent Good Manufacturing Practices (GMP). This CBD oil was used in conjunction with her codeine and gabapentin. The owner was aware of the risk of continuing these medications but opted to provide some pain relief until they were convinced the CBD would have a clinical effect. A stool softener was also prescribed.

Two months after her 16th birthday Josie presented with an inability to rise and ambulate, as well as constipation. The new Veterinary Director of the hospital repeated blood tests to assess her renal function and prescribed CBD oil made in Australia (for humans) under stringent Good Manufacturing Practices (GMP). This CBD oil was used in conjunction with her codeine and gabapentin. The owner was aware of the risk of continuing these medications but opted to provide some pain relief until they were convinced the CBD would have a clinical effect. A stool softener was also prescribed.

Her dosing regimen was as followed:
• 10mg/kg gabapetin orally, twice daily
• 1.5mg/kg codeine orally, twice daily
• 2mg/kg CBD oil orally, every 12-hours.

Within 7-days of the CBD oil the owner reported that Josie had improved drastically and was walking and defecating. The owner stated that Josie was far more mobile and as good as she was when she was taking the carprophen, which was a huge leap forward for her QoL. Over the course of the next two weeks, the gabapentin and codeine were tapered out of her dosing regimen with no discernible impact to her mobility and QoL.

The blood tests were repeated 4 weeks later, and Josie’s renal parameters had all reduced significantly and shifted her toward dropping down an entire IRIS Staging level. Her owners have now commenced physiotherapy for Josie, and at the time of writing she continues to do brilliantly.

References:
Anderson K, Zulch H, O’neill D, Meeson R and Collins M. (2020). Risk Factors for Canine Osteoarthritis and Its Predisposing Arthropathies: A Systematic Review, Frontiers in Veterinary Science, vol. 7, p. 220.
Roura X. (2019). Risk factors in dogs and cats for development of chronic kidney disease. International Renal Interest Society, United Kingdom, http://www.iris-kidney.com/education/risk_factors.html