Clinical outcomes and association with disease progression and survival of subclinical bacteriuria in cats with chronic kidney disease: a multicenter retrospective study.

Abstract

BACKGROUND: Subclinical bacteriuria (SBU) is frequently encountered in cats with chronic kidney disease (CKD), but it remains unclear if it is associated with survival and disease progression. HYPOTHESIS/OBJECTIVES: To determine the association of SBU with survival time and disease progression in cats with CKD. ANIMALS: Two hundred eighty-seven client-owned CKD cats diagnosed according to the IRIS guidelines. METHODS: Retrospective multicenter study from January 2015 to May 2024. Cats were included from 4 veterinary teaching hospitals if they were diagnosed with CKD, had a documented urine culture result from cystocentesis and no signs of lower urinary tract disease (LUTS). Cats were divided into SBU group and control group, based on culture results. Medical records and long-term outcomes were reviewed. Multivariate Cox proportional hazards regression was used for survival analysis, and frequency of CKD progression was compared. RESULTS: SBU was not significantly associated with survival (hazard ratio [HR] = 0.68; 95% CI, 0.39-1.16; P = .16) or CKD progression (P = .84). Higher plasma creatinine (HR = 1.02; 95% CI, 1.00-1.03; P = .01) and lower body condition score (HR = 0.80; 95% CI, 0.67-0.95; P = .01) were associated with reduced survival. In SBU cats, antimicrobial treatment was prescribed in 85 cats (78%) and did not prevent bacterial persistence or recolonization. Progression to bacterial cystitis or pyelonephritis was observed with or without antimicrobial treatment. CONCLUSIONS AND CLINICAL IMPORTANCE: SBU in cats with CKD do not seem to be significantly associated with death or affect disease progression. These findings do not support routine antimicrobial treatment of SBU in cats CKD.