PHOTOBIOMODULATION THERAPY IN CANINE AND FELINE PATIENTS WITH CHRONIC RENAL DISEASE:
A PILOT STUDY
Background: Chronic Renal Disease (CRD) has high morbidity and mortality in feline and canine species. Greater than 30% of all feline patients will
be afflicted by 11 years of age and nearly 50% of all cats over 15. The disease is characterized by an interstitial tubulonephritis resulting in progressive
nephron loss as the kidney attempts to compensate by nephron hypertrophy. Although initially increasing GFR (glomerular filtration rate) this
hypertrophic process results in increased hydrostatic pressure in the glomerular capillary ultimately causing endothelial damage and nephron death.
Serum creatinine level is the standard of care monitored parameter and generally increases steadily as the disease progresses. Elevated serum
phosphorous levels are also indicative of the steadily progressive nature and chronicity of CRD. Current standard of care includes initial rehydration,
protein and phosphorous dietary restriction, hypertensive medication and appetite stimulants. There is currently no known proactive treatment which
appears to slow the disease process..
Objective: To ascertain whether PBMT (Photobiomodulation Therapy) has a role in the management of CRD in canine and feline patients.
Methods: Eleven feline and canine patients in Stage III or IV renal disease were entered into this study as staged according to International Renal
Interest Society (IRIS) standards. This is not a blinded, randomly controlled study but rather pilot work to evaluate PBMT as a proactive adjunct to
standard of care treatment of patients with CRD. Light therapy treatments included LED as well as Laser depending upon target depth and in all cases
were in addition to the above current accepted standards of care.
Results: Two patients, one canine with Stage IV and one feline with Stage III CRD were euthanized at one month and six months, respectively, prior to
conclusion of the study. All other patients showed an enhanced quality of life with no requirement for appetite stimulants, additional fluid therapy or
hypertensive medications. Several patients showed improved biochemical parameters in the form of declining serum creatinine and phosphorous
levels (a rare occurrence in CRD patients) with two Stage IV enrollees surviving well beyond any patient from a large population university study. One
Stage IV feline patient (Ginger) and one canine (Terra) have survived 515 days and 230 days, respectively, considerably longer than the 99 days of the
longest survivor of two hundred and eleven patients at a Kansas State University School of Veterinary Medicine study. Both Ginger and Terra continue
to do well as do all other patients in this population.
Conclusion: Results from this pilot work indicate that PBMT could play an important role in the management of Chronic Renal Disease in canines and
felines. Further broad based clinical and laboratory studies should help to further evaluate effectiveness, identify mechanisms of action as well as to
ascertain which patients are likely to receive maximum benefit from this therapy.
Creatinine Trending Over Time
15
IRIS staging of
Died at 1 month CKD
Chewy
] Creatinine mg/dl
China
10
I Ginger
[
V Grandma
Jake
Maestro
5 Misty
Nomar
III Spider
II Stella
Terra
0
0 6 12 18 24
Time [months]
*Note that creatinine levels for most patients are generally stable throughout the study
Phosphorous Trending Over Time
20
Died at 1 month
Phosphorous [mg/dl]
15 Chewy
China
Ginger
Grandma
10 Jake
Maestro
Misty
Nomar
5
Spider
Stella
Terra
00
6 12 18 24
Time [months]
*Note that phosphorous levels for most patients are generally stable throughout the study
Additional Discussion and Information
Diagnosis: Once diagnosed with chronic renal disease (no evidence of infectious agents, active urinary sediment or other acute renal injury) and
stabilized as necessary, patients were staged according to International Renal Interest Society (IRIS) standards.
Treatment: Patients were treated as outpatients receiving light therapy twice weekly for the first two weeks, once weekly for two weeks and then once
every other week.
Treatment Protocols: Each light therapy treatment consisted of a series of placements using LED and Laser devices. All placements with LED
device were as follows:
Bilateral treatment of inguinal, popliteal, and sub lumbar lymph nodes
Bilateral treatment of medial aspect of tibiae and ventral sternum
All placements with Laser were as follows:
Bilateral treatment of kidneys dorsal to their anatomic location
Light Therapy Parameters:
LED 69 diode Cluster Probe Laser Cluster Probe
1390 mW 5x200 mW diodes (1000mW total)
34 diodes 660 nm 35 diodes 810 nm Irradiance (each) 5000mW/cm2
Irradiance: 50 mW/cm2 Pulse Rate 2.5 Hz
Pulse Rate 2.5 Hz Duty Cycle 90% Treatment time: 60 seconds/placement
Treatment time: 60 seconds/placement Fluence 300J/cm2
Fluence 3J/cm2
Proposed Mechanisms of Action:
Though no histopathological information was available to assess the specific mode of action of light therapy on renal tissue, the following seem
plausible:
• Improved renal blood flow resulting in increased GFR (afferent and efferent vasculature)
• Reduction in inflammatory process (tubulo interstitial nephritis) allowing sparing of nephrons undergoing hypertrophic stress
• Stem cell mobilization targeting damaged nephrons.