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For the four existing presentations (Azodyl, Ipakitine, Renalzin and Rubenal) prehension was shown to be rather low in healthy cats. Voluntary prehension is not always easy to achieve in cats, but is clearly the first requirement in cases where the owner is unwilling or unable to use a forced administration for the animal. Tablet presentations are often more adapted to forced administration unless they are highly palatable.
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Additionally it could be emphasised from the data obtained in this study that in cases where a practitioner wishes to supplement a feline patient with not only IPB, but also with a uremic toxin binder and eventually with a supplement to help maintain normal kidney architecture with the presentations which are currently available on the market he/she will face the necessity to administer three different formulations each with a rather low inherent palatability. This low palatability may compromise compliance with supplement use in patients and owners and may help explain the very poor market penetration of CKD supplements [22,23]. For the products containing IPB, the lack of palatability could be easily explained by the nature of IPB, which are known to have a lack of smell and taste: mostly they are simple molecular entities or polymeric structures able to form insoluble compounds with digestible phosphorus. Lack of smell could be easily justified to human patients by medical necessity, but it is not the case for animals. Thus, for the manufacturers of supplements designed for CKD animals and especially for cats, palatability should be one of the highest priorities unless the product is designed only for use when mixed with highly palatable food.
The results of this study suggest that the galenic form of the supplements could be an important factor. Rubenal is presented as a tablet, where, once again, if the owner is experienced enough, forced administration could ensure that the complete dose was received on each occasion. However not all cats are amenable to this. The refusal of the product by the majority of the cats may be linked to the absence of a specific palatability agent and the large size of the tablet (approximately 15 mm). It could have been possible to try to crush the tablet to form a powder, and it may have been interesting to have observed whether this may have reduced the proportion of cats which totally refused to consume the product. Likewise, the co-administration with highly palatable food may have had an impact on the results with this product.
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