I actually agree with you that cats with CKD need acid suppressants based on clinical experience of an improvement in appetite, GI symptoms, etc. However, I do think that more research needs to be performed to determine what level of acid suppression they need. My guess is that they do not need twice daily omeprazole therapy since they don't appear to have erosive or ulcerative disease. This is the reason for not mentioning CKD in the introduction. In fact, I have some concern that this degree of acid suppression may be harmful to them. I would reserve twice daily omeprazole for cats with suspected or documented ulcerative disease. We do have a study (grant proposal pending) to start to piece out some of the questions regarding gastric acid and use of acid suppressants in cats with CKD. We are very excited about this study as it will be a bi-hospital study involving UTK CVM and a private practice in Tennessee.