ArticleFrontiers in veterinary science2026
Severity, etiology and outcomes of ionized hypocalcemia in azotemic cats and dogs.
Article in Frontiers in veterinary science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To describe the severity, timing, etiology, and outcome of ionized hypocalcemia in a population of dogs and cats with all-cause azotemia. Methods: Medical records of dogs and cats with concurrent ionized hypocalcemia and azotemia, in which ionized calcium (iCa) was measured within 24 h of serum biochemistry testing were retrospectively reviewed from a single institution over a 10-year period (January 1st, 2014, to December 31st, 2023). Ionized hypocalcemia was defined as iCa < 1.21 mmol/L in cats and < 1.30 mmol/L in dogs. Moderate hypocalcemia was defined as iCa < 1.00 mmol/L and severe hypocalcemia as iCa < 0.75 mmol/L. Azotemia was defined as a creatinine concentration ≥ 141 μmol/L (1.7 mg/dL). The primary cause of azotemia was determined by review of the medical record, and diagnostic criteria for acute kidney injury and chronic kidney disease were based on International Renal Interest Society guidelines. Data extracted included signalment, clinicopathologic variables, etiology of azotemia, and outcome. Outcome was defined as survival to discharge or non-survival. Results: 302 cats and 646 dogs met the inclusion criteria. Ionized hypocalcemia was mild in 229/302 (75.8%) cats and 551/646 (85.3%) dogs, moderate in 69/302 (22.8%) cats and 83/646 (12.8%) dogs, and severe in 4/302 (1.3%) cats and 12/646 (1.9%) dogs. The lowest iCa occurred within 48 h of admission in 155/223 (69.5%) cats and 338/465 (72.7%) dogs hospitalized for at least 48 h. In cats, both renal (176/302, 58.3%) and postrenal (126/302, 41.7%) causes of azotemia were common, whereas renal causes predominated in dogs (602/646, 93.2%). Inflammatory/ischemic etiologies were the most common cause of acute kidney injury in both cats (54/90, 60.0%) and dogs (230/383, 60.1%). Ionized calcium showed weak correlations with blood phosphorus ( Conclusion: Ionized hypocalcemia in azotemic cats and dogs is generally mild and occurs early in hospitalization. It is only weakly associated with higher blood phosphorus and creatinine concentrations and lower blood pH. Routine monitoring of iCa in azotemic patients is recommended. These findings may not be generalizable to all azotemic patients, as iCa measurement was performed at the discretion of the attending clinician.
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