? Help for kitty with CKD

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Sue484

Sue484

Member Since 2015
My friend's cat Scully has just been diagnosed with CKD and a possible tumour on the kidney. He doesn't have diabetes and has been prescribed the wet KD food and a phosphorous binder. Is there a site for CKD that I can point her in the direction of and which UK food are suitable low in phosphorous that he can be fed?
 
Absolutely there is, Sue. It's Tanya's Site. - an extremely comprehensive, well-researched, and much respected CKD resource. They have a support group, too. The link is in the left hand column on the home page. They have food lists, too.

There are some highly knowledgeable people in the support group.


Mogs
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I'd tend to agree with Lyresa about the combination of low phosphorus food and phosphorus binder. Unlike blood glucose one cannot monitor phosphorus levels in real time at home, only with regular blood tests. The trick is to keep phosphorus levels neither too high nor too low. Depending on the CKD stage, perhaps the k/d food and binder combo could potentially reduce phosphorus levels too much (speculating here).

Obviously the appropriate treatment is dependent on the CKD stage, the cat's current blood work, and its full clinical history, but it's something I'd consult the support group about: the experienced members there regularly review and give feedback on kitties' lab results - very helpful.

It's worth noting that both ProNefra and Ipakitine - the most commonly prescribed phosphorus binders in the UK - also contain ingredients intended to deal with other waste products so as to reduce the toxic load on the cat's system.


Mogs
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@Sue484 Tell your friend that if she's on Facebook there is a good FB group too, called FELINE CHRONIC KIDNEY DISEASE. It is a closed group, but if she clicks on join they will add her right away. People on the FB page treat Tanya's CRF site like the Bible (as well we should!). There is great support in the group and it is a good place to ask questions. VERY active group.
 
Thanks very much. I have told her about both the sites. I hope she can get Scully well again, even if it is for a short time, as the vet seems to think because of the tumour, time is limited.
 
That was my worry (hence why the vet may be taking a very aggressive approach to phosphorus management?).

Given the circumstances I strongly recommend that she registers to join the support group (can take a day or two for them to review the joining request). It takes an awfully long time to go through the site itself - there's so much information there. Perhaps by sending a message to the support group explaining the urgency of the situation might lead to them giving some time-saving pointers about what to do first? As I said above, there are some very, very experienced members there and they see a fair number of CKD cats, all with varied histories.

I'm just throwing an idea out here: maybe your friend should ask her vet about possible supplementation with curcumin (active component of turmeric)? It's supposed to have anti-carcinogenic properties. I know it can be used in cats but I have NO experience of using it, or idea how CKD status would impact on its potential viability as a useful supplement. Just brainstorming.


Mogs
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Sue484 said:
My friend's cat Scully has just been diagnosed with CKD and a possible tumor on the kidney. He doesn't have diabetes and has been prescribed the wet KD food and a phosphorous binder. Is there a site for CKD that I can point her in the direction of and which UK food are suitable low in phosphorous that he can be fed?
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All great suggestions. Unlike my newly diagnosed cat with Diabetes, this, I can help with. CKD is Chronic Kidney Disease which typically is caused by Nefron damage and the kidney's inability to cleanse the body from natural toxins...PKD is Poly-cystic Kidney Disease, which might be what your friends cat has. If so, the kitty was born with these little tiny cycts that did not get activated until adulthood (typically). Tany's site is wonderful...Blood testing every 3-4 months is crucial. Keep protein low, phosphorus low and vitamin b-12 +. KD is good but Royal Canin is better. RC just came out with 3 kidney flavors, E, F and S. Slippery Elm bark for nausea. Famantodine (Pepcid) for acid reducer. Aluminum Hydroxide powder (Entirely Pets) and this should only be okay'd by your vet to give based on the phosphorus numbers. BUN- should be kept lower than 30 but a cat could live a happy life around 50-90. I had a cat that was diagnosed at age 5 with PKD and crashed hard at 7 years old. She lived a life for 3.5 years till about 10.5. Of course there was the last year with fluid therapy ongoing just about everyday. (also, check potassium and calcium...there are binders for those too) BUN should naturally fall with kidney food but since this is for Diabetes, watch out...Royal and Hills are loaded with carbs...Test sugar/glucose periodically.
 
Good luck to your friend and Scully!

We have had 3 cats now with CKD. It is what we lost Smokey to because it couldn't be managed aggressively alongside her heart disease, we lost her about 3 months after the diagnosis when her numbers got high, symptoms got bad, and attempts to use fluids to flush everything out taxed her heart to much. We adopted a geriatric blind mess of a girl who had CKD in 2013 and enjoyed a year with her before she succumbed to old age.
Smokey's lifelong adopted sis Taz was diagnosed right around the time we lost Smokey. She is still with us over 3 yrs later at age 18 with numbers that have dropped from upper stage 4 to the border of normal (her numbers were actually well within normal the last b.w. but she also had high thyroid and hyperthyroidism can mask kidney disease so I discount those numbers). We treat her very aggressively. We use a high dose of binder, daily subQ fluids and calcitriol (which I think has made the difference in her CKD not just staying stable, but numbers improving). We only used the prescription foods on Taz during the beginning right after diagnosis as a supplement to her high protein foods. We have kept her protein up through these earlier stages of CKD to keep her body mass up. We've feed her low phosphorus foods at times along with her binder. We've not had any problems with her numbers getting too low.
CKD can be very manageable long term.

Tanya's site is invaluable for information. I go there for information that helps with other diseases as well.
 
Melanie and Smokey said:
We use a high dose of binder, daily subQ fluids and calcitriol (which I think has made the difference in her CKD not just staying stable, but numbers improving).
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Melanie, I'm always looking for new options for Rosa to keep her CKD stable for as long as possible - do you know if calcitriol is OK to use with an OTJ diabetic cat? I've seen it suggested several times on the Tanya's site support group, but I haven't seen anyone with a cat that's also diabetic using it.
 
manxcat419 said:
Melanie, I'm always looking for new options for Rosa to keep her CKD stable for as long as possible - do you know if calcitriol is OK to use with an OTJ diabetic cat? I've seen it suggested several times on the Tanya's site support group, but I haven't seen anyone with a cat that's also diabetic using it
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I can't think of a reason why not. Phosphorus needs to be low enough in order to use it, 6.0 or under I believe, but I have not heard any contra indications for sugar cats. My vet tried to use it in Smokey (FD) but we couldn't keep her phosphorus down. Another vet pulled it from Sophia (nonFD) when she got sick once and nothing else to blame it on.
 
Thank you. Rosa is due new blood work in a week or so and I'm hoping her phosphorus will have come down enough by then for us to give it a try. We're still calibrating her dose of binder, but now I know her phosphorus needs to stay under 6.0, that gives me an idea of when to approach the subject with our vet.
 
Critter Mom said:
@Melanie and Smokey - I read your post with great interest, especially about Calcitriol. Do you know whether it is OK to give to a cat with liver issues?
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I am not sure, its worth a discussion with your vet. The only thing I am aware of is the concern for calcium /phosphorus imbalance when using it, thus the need for a certain phosphorus level. Monitoring calcium levels early in treatment is essential to see how they handle it because too high of calcium could affect the liver.

This article talks a little bit about calcitriol and why it helps https://www.vetinfo.com/calcitriol-for-cats.html
 
@Melanie and Smokey -

Thank you for the reply and the link to the article. I found it very helpful. Saoirse's calcium levels have been sitting in the middle of the reference range for well over a year. I'll ask our vet about the Calcitriol next visit.

I really appreciate you sharing your experiences here, too. While I find Tanya's Site an absolute goldmine of information (and not just for CKD) I can't seem to get to grips with - or follow - the email-based support group structure, especially the latest support group platform; I can't make head nor tail of how to use it, so I end up not able to ask for help with things. :( (I really, really wish they had a forum-style set-up.)


Mogs
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manxcat419 said:
Melanie, I'm always looking for new options for Rosa to keep her CKD stable for as long as possible - do you know if calcitriol is OK to use with an OTJ diabetic cat? I've seen it suggested several times on the Tanya's site support group, but I haven't seen anyone with a cat that's also diabetic using it.
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When using Calcitriol you need to watch the iCA. If your cat has high calcium Calcitriol would not be ideal for use.
 
Critter Mom said:
@Melanie and Smokey -

Thank you for the reply and the link to the article. I found it very helpful. Saoirse's calcium levels have been sitting in the middle of the reference range for well over a year. I'll ask our vet about the Calcitriol next visit.

I really appreciate you sharing your experiences here, too. While I find Tanya's Site an absolute goldmine of information (and not just for CKD) I can't seem to get to grips with - or follow - the email-based support group structure, especially the latest support group platform; I can't make head nor tail of how to use it, so I end up not able to ask for help with things. :( (I really, really wish they had a forum-style set-up.)


Mogs
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The yahoo support group is much easier to navigate and many of the members are also in Tanya's group. https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info
 
Anitafrnhamer said:
When using Calcitriol you need to watch the iCA. If your cat has high calcium Calcitriol would not be ideal for use.
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Rosa's Ca is all good - it's 9.8 on a scale of 8.2 to 11.2 so I've no worries there. Her phosphorus was at 6.6 on her last blood work, so that would need to come down a little, but she's been on an increased dose of binder since the last set of results so I'm hoping that will be back down by next week too.
 
Critter Mom said:
I really appreciate you sharing your experiences here, too. While I find Tanya's Site an absolute goldmine of information (and not just for CKD) I can't seem to get to grips with - or follow - the email-based support group structure, especially the latest support group platform; I can't make head nor tail of how to use it, so I end up not able to ask for help with things. :( (I really, really wish they had a forum-style set-up.)
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I am also on the forums for CKD, stomatitis, and lymphoma. I mostly stopped trying to post and just read those because (a) a person can only keep up with so many forums! and (b) I find the others so hard to navigate. Not just posting, even reading and following threads is hard IMO. Our diabetic kitties are often susceptible to kidney issues, so it is a relevant topic here too. Another one of those diseases that you hate to deal with for so long that you learn a lot, but happy too because of the alternative.

In the article I linked about Calcitriol it talks about the injectable being easier to give so most people use that. We've always given the oral. Its compounded and the taste must be good 'cause she smacks her lips and takes a bath afterwards :smuggrin: One of the easier meds to give our little wild child.
 
Melanie and Smokey said:
I mostly stopped trying to post and just read those because (a) a person can only keep up with so many forums! and (b) I find the others so hard to navigate. Not just posting, even reading and following threads is hard IMO.
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Oh, I'm glad it's not just me. I joined the Tanya's site support group but I find it so difficult to navigate and keep track of posts - it doesn't feel anywhere near as user-friendly as the format here. I'm usually a fairly proficient computer and forum user, but I just can't keep track on that one too well.
 
@Melanie and Smokey and @manxcat419 -

Thank you so much for sharing that you found it problematic to navigate and follow that support group format. I have felt like such a numpty. And embarrassed, too. After the recent change to the new group software I posted a question and then tried to thank the people that replied to me. I could not fathom out how to do it. I did reply to them as best I could but I have no idea whether or not they received my acknowledgement and thanks. I felt awful. :(

I really do wish it was more forum-y, because I'd like to contribute a little to the group as well as looking for help (e.g. sharing experience of pancreatitis management with other members whose cats have similar problems).

Mogs
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Melanie and Smokey said:
Our diabetic kitties are often susceptible to kidney issues, so it is a relevant topic here too. Another one of those diseases that you hate to deal with for so long that you learn a lot, but happy too because of the alternative.
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Indeed it is relevant here, Melanie. I'm very glad when I see posts like yours where I can learn more about managing the two conditions - plus the chronic pancreatitis. :(

I must admit that I've struggled much more trying to get my head around Saoirse's CKD diagnosis than I did with her diabetes Dx last year. I was fairly overwhelmed with the reading and the practicalities of FD at the beginning but not so much fazed by the condition itself (my best friend and his mum are diabetics, so I had some bit of exposure to the condition). I think the ability to home monitor blood glucose in real time and having the ability to respond quickly with food and insulin dose changes made me feel more like "I've got this". Trying to learn to be an external kidney with only three-monthly blood work-ups for feedback is something I'm finding much harder to come to terms with: I feel more powerless to help my belovéd girl. (((Saoirse)))


Mogs
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Critter Mom said:
I must admit that I've struggled much more trying to get my head around Saoirse's CKD diagnosis than I did with her diabetes Dx last year.
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I agree. With the diabetes, we really are so used to being able to get numbers whenever we need to - having to wait to get blood work run and just hoping that everything is OK between vet visits is incredibly nerve-wracking. Especially because Rosa has never had any obvious CKD symptoms - I really do feel I'm working blind in between sets of blood work results!
 
Oh, I wish! In fact I'd quite like to have a full blood analysis system right here in the house. Our vet seems fairly unconcerned by Rosa's numbers, but of course anything that reads even 0.1 high or low terrifies me! And if I could have one wish, it would be for a blood pressure meter and the expertise to use it - Rosa measured high at the vet and they don't want to treat it because she was stressed. And we just lost our Shadow, the other CKD girl...and the ER vet said her BP was really really high and probably was the cause of the blood clot she ended up with. So of course, I'm now having to fight with them to get treatment for Rosa's BP.
 
manxcat419 said:
And if I could have one wish, it would be for a blood pressure meter and the expertise to use it - Rosa measured high at the vet and they don't want to treat it because she was stressed.
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I had a similar problem with Saoirse. The vets have a terrible time measuring her BP at the surgery because Saoirse is so stressed, and also she has never been a fan of having her paws handled. Found a solution: home visit. The difference was like night and day, and a fairly pleasant experience for Saoirse instead of a traumatising one. BP at the surgery was 190, and at home 140 (reference range 135-170). And because it's critical that her BP is monitored and it was impossible to get a valid measurement in the surgery our insurance covers the home visits.

Is there any way that your vet could do a home visit. After losing Shadow like that, I can understand how much more worrying it must be for you not to be able to get the right treatment for Rosa. Had similar problems myself this year - had to wait most of the year to get Saoirse back on insulin and the wait has made her pancreatitis problems much worse. I'm bulling about it because she was so healthy this time last year with the benefit of insulin treatment. I really feel for you. :bighug:


Mogs
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I don't think our regular vet does home visits, but I will ask them to see if there's someone they work with who does - even if they could send one of their techs out here to check Rosa's BP I'd be happy with that, and more than happy to pay for their travel time and expenses on top of the BP check itself. She measured 220 at the vet, so I'm 100% sure she's going to be on the high side of normal even at home, but because they won't prescribe anything to bring it down we're at a bit of a stand-off with treating it right now. I want to give some treatment a try, but they just won't prescribe it...it makes me wonder why they agreed to test it in the first place if they weren't going to do anything about it regardless! :mad: Especially after what happened with Shadow, I really need to see an accurate reading on Rosa - we couldn't deal with losing 2 the same way. :( They do have one very good tech who is great at getting blood tests taken on Rosa without stressing her more than necessary - she's a trained behaviorist as well as a tech so she knows exactly how to handle her and how to talk to her to keep her calm. If I can persuade them to let me borrow her for half an hour, that would be ideal! :)

I'm so sorry you're still having problems getting everything under control for Saoirse. I know you were worried about her BG for months before you could persuade your vet to do anything about it - it's just so stressful when our vets won't do what we know we need them to do for our cats. And she'd been doing so well for you until then too! I really hope her pancreatitis settles down for you soon. :bighug:
 
Thank you Chris! I will definitely have to look into that - even if they're not 100% accurate, it has to be better than getting a high reading at the vet and having it disregarded every time! I'd imagine that, just as with human meters, they can be calibrated for accuracy against the vet's own machine too. I had seen one or two on other sites, but they were much, much more expensive (as in out of my range expensive) and were listed as being very complicated to use!
 
Thanks, April. It has been dreadful being forced to watch Saoirse deteriorate when I knew there was something that had helped her and could still be helping her. Frankly speaking, I was incandescent with rage that the specialist who had just diagnosed Saoirse with renal insufficiency insisted that Saoirse not get insulin again until glucose started tipping into her urine; her justification being that it was completely unsafe to give a cat any insulin whatsoever unless it had a fasting preshot BG of over 11 mmol/L (vet meter). What adds insult to injury is that this woman had seen Saoirse's data which proved the opposite. Our own main vet is fairly progressive and he knows full well that I knew what I was doing with Saoirse's insulin therapy but he couldn't overrule the specialist. The practice have strict instructions now that under no circumstances are they to consult with external specialists about Saoirse unless and until they have my express permission to do so - on a case by case basis.

This time last year Saoirse was mad for tree climbing and she was in top notch physical nick. She looked better than she had in years. Saoirse was a bit poleaxed for the first few weeks back on Lantus, between the pancreatitis, the pain meds and and constipation problems and getting used to having endogenous insulin in her system again. I was really worried about her over Christmas because the constipation got worse and her clinical signs deteriorated again. I was able to pin the cause down to the different generic of ondansetron I had had to give her because the pharmacy were out of her normal one. I stopped giving her the new generic and, thankfully, she has improved a lot since. I've added a good bit of pumpkin to her meals since and that seems to be helping, too. In the last few days I've managed to get her almost completely into euglycaemic numbers after a few wobbles earlier in this latest phase of Lantus treatment. With the better numbers, I've been able to phase out the bupe and also I've been able to reduce her daily ondansetron dose by 75%. Just wish her abdominal distension would go down more ...

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That vet tech sounds just the ticket: I hope the practice will accommodate your request for a home visit - it makes such a difference! (Our main vet did Saoirse's home visit. it's the first time he got to see 'the real Saoirse'; she's always a very stressed-out grouch at the surgery.) Let me know how you get on. I really can relate to how worrying this most unacceptable situation must be for you. Will keep fingers and paws crossed for you in the Shire. :bighug:


Mogs
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Oh Mogs, I'm so sorry the specialist wouldn't listen to you. I've been very, very lucky with most of the vets I've dealt with for Rosa - even the IM specialist we saw was prepared to at least listen to what I had to say and adjust her treatment plan to work with the things I really did or didn't want to do. And of course your own vet knows that you would never do anything unsafe for Saoirse - you work so hard to keep her healthy. I, too, have had a couple of run-ins with just one vet at the practice we go to - I'm sure he thinks I'm the worst pet owner he's ever dealt with because I question everything and insist on treatments that he thinks won't work. The owner is listed as one of the best cat vets in the area though, so I'm reluctant to go elsewhere - I just try and make sure I can speak to her if there's anything I'm not happy about or want more information on.

I'm so glad to hear that things are improving for Saoirse, although it's never as quickly as we'd like. I can well imagine she had a few not so good weeks with everything she had going on. But being able to stop the bupe and reduce the ondansetron by so much must mean that the pancreatitis is starting to settle which is great news. I hate it when I have to change a medication to one that isn't formulated quite the same - I know the active ingredients are identical, but it can and does happen that the generic doesn't always work the same for everyone so I'm glad to hear you were able to get her back onto the one she's used to and does well on. And you already did a great job with her on Lantus the first time around, so I know you'll be doing just as well this time now you've got her numbers to settle back down.

I really hope the practice will help me with a home visit for Rosa - I know they'd get much more meaningful numbers from her that way as she's incredibly friendly with anyone who comes into the house...she just hates vets - all vets and everything about them - on principle. She gets very scared, but with her it tends to come out as aggression. Our current practice is very good with her and try not to react to it with anything other than kindness, but it still makes it a very unpleasant experience for her. I will definitely let you know how I get on - I know I'm going to have to put in a request for the owner to call me this time as I very much doubt anyone else there can authorize a home visit, but I've spoken to her enough and shared enough information and informed discussion with her that I really hope she'll understand that I'm only asking for Rosa's sake.

Big hugs for you and Saoirse and I hope she continues to improve in leaps and bounds until she's back to the energetic cat you know her to be. :bighug: :bighug:
 
@manxcat419 -

Thank you, April, for such a warm and thoughtful post. I really appreciated it. :bighug: I couldn't reply yesterday because Saoirse wasn't as good and my heart was sinking. Again. :(

Forgot to put 'anti-jinx' into my previous post, didn't I ... Stupid, stupid Mogster. :banghead:


Mogs
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Thanks for all your help folks. Unfortunately, Scully crossed the Bridge on Friday night.
 
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