Angel update

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Hi Janet,
Angel's phosphorus are UK 1.17 which is US 3.63, so much better, they were US 9.14 before!
The Integra protect is 0.16 phosphorus and I know they recommend less than 0.05 so that is why I've been giving the binders. Do you think it's ok to stop them?
With the kidney disease, even for a diabetic cat I'm supposed to feed 35% or less protein dry matter, the only food that addresses that and is borderline ok for carbs (right on 10%) is the integra protect renal.
Any advice would be welcome
x
 
Hi Janet,
Angel's phosphorus are UK 1.17 which is US 3.63, so much better, they were US 9.14 before!
The Integra protect is 0.16 phosphorus and I know they recommend less than 0.05 so that is why I've been giving the binders. Do you think it's ok to stop them?
With the kidney disease, even for a diabetic cat I'm supposed to feed 35% or less protein dry matter, the only food that addresses that and is borderline ok for carbs (right on 10%) is the integra protect renal.
Any advice would be welcome
x

His phosphorus levels are quite resonable and if you are giving him low phosphorus food I don't think giving phosphorus binders is necessary unless you start seeing his numbers raise, an regarding the 35% or less protein that may not be very accurate, what you need is low phosphorus it really doesn't matter how much % protein you give actually for a cat the higher the protein the better if you want to avoid muscle loss. Sometimes people (even vets) suggest lowering the protein as a way to lower the phosphorus ( there's a relationship between the amount of protein and the amount of phosphorus) but there are ways to not lower the protein and still have low phosphorus and that would be giving high quality protein (that not necessarily means expensive, for example egg whites are way high in protein and almost no phosphorus ) that is why you can actually find low phosphorus, low carb diets which is what you want to aim for

Usually renal diets which are low in protein and usually high in cabs are recommended when the kidney problems are more advanced than what Angel is ( that would be end stage 3 or stage 4)
 
Hi Cassandra,

The Integra protect is 0.16 phosphorus and I know they recommend less than 0.05 so that is why I've been giving the binders.
Assuming that you're feeding the wet Integra Protect Renal foods, the DMB values are as follows:

Protein: 33.9% dry matter (Tanya's Site CKD target - 35.0% DM).
Phosphorus: 0.7% dry matter (Tanya's Site CKD target - <0.5% DM)
Sodium: 0.74% (Tanya's Site CKD target - as close to 0.20% DM as possible, though less critical than protein and phosphorus content).

Carbohydrates: 10.9% dry matter | 7.0% of kilocalories from carbs (FDMB FD target - <10% kcals from carbs).

Angel's phosphorus are UK 1.17
With regard to using a phosphorus binder, Angel's most recent serum phosphorus level of 1.17mmol/L is in the lower part of the normal reference range. The recommendations from Tanya's Site for initiation of binder use are:

* if P >1.9mmol/L

- OR -

* if P x Ca >= 5.0 (serum levels in mmol/L)

Angel's latest phosphorus result alone wasn't high enough to indicate a binder being required at present. You'd need to check where his calcium levels were at in the same set of blood tests. Did you get the calcium result from your vet in the last round of blood tests? Giving a binder when it's not needed could potentially result in phosphorus levels getting too low.


Mogs
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hi Janet and Mogs,
Angel's bloodwork https://docs.google.com/spreadsheet...kJ1bHU6OZB7aOU27SAH-hp-1E/edit#gid=2009190441
Latest results to left, calcium normal. sodium borderline high.
I am holding off on the binders.
Getting conflicting advice about protein, people at Tanya's site say less than 35% but I'll ask again pointing out he seems to be in early stage 3. He needs to continue putting weight on, can't believe at his heaviest he was over 8 kilos. After the diabetic remission he has stayed more or less steady at 3.8 and I always felt he was too skinny but his bloods were fine. He should have had them taken earlier last year but due to lockdown he didn't. When I took him he'd gone down to 3.5 kilos but now he's up to 3.78.
Mogs, thanks for integra protect info, yes it is the wet renal in trays. I took the values from zooplus but probably didn't work them out correctly, that is great that they are below 7 carbs but depending on next bloodwork I may need to look at reducing his sodium so an advice re that would be appreciated.
I've held off on the b complex as his folate was high. I've also held off on the oral b12 as he's getting a course of weekly injections, but wondered if it would help to give it on the other 6 days.
At the moment the integra protect does seem to be the food to address all issues, but obviously if it's safe to give a higher protein one I would do that.
If I free fed him the integra and also gave him 1 pouch of 85g royal canin chicken in gravy a day do you think weekly bg checks are enough for now?
He's being referred to the Ralph clinic after his bloodwork, and my support bubble friend in Cambs will shedule her stays with me to coincide with his visits. Just hope insurance pays up although if not I would live on gruel for the rest of my life if it meant a happy healthy Angel for as long as possible.
Re prognosis for early stage 3 I've heard average 6 months to a year, best case 2-3 years. Cera was gone within weeks so by rights the universe should give us at least the 3 years, but who knows.
I'm just making the most of the time with all my babies. Also breaking my heart that I haven't been able to see my 93 year old dad since August when Warrington went into teir 3. He still hasn't had his first vaccine neither have his carers!!! He's all there mentally but a bit forgetfull due to old age not alzheimers. I hate this virus, if it wasn't for that Angel would have been diagnosed earlier, people I know would not have lost loved ones.
xx
 
I'm wondering about feeding Angel a low carb low phos but 50% protein food once a day. I know with ckd they recommend 35% protein for diabetic cats, but he needs to put on weight. The one I'm thinking of is Feringa Lamb from the UK list. Any advice?
 
I'm wondering about feeding Angel a low carb low phos but 50% protein food once a day. I know with ckd they recommend 35% protein for diabetic cats, but he needs to put on weight. The one I'm thinking of is Feringa Lamb from the UK list. Any advice?
There are different opinions about what to feed CKD kitties. The 'old school' approach is to reduce protein whatever the stage of the disease; the emerging approach (for all the but the later stages of the disease) is to feed a decent amount of good quality protein to maintain muscle mass. In both instances keeping phos under control is also important.
In my experience - just as with managing diabetes - it ultimately comes down to gathering information, weighing up the options, and then making a choice about what path to take.

With my own cats I have never restricted protein. I have just used a phos binder if the blood phos level got above normal range. And I've fed good quality foods with as low a phos content as the cat would eat and enjoy (for me, 'quality of life' is a major consideration, and I don't want to have to feed my cats stuff that they don't really want and would prefer not to eat).

And sometimes additional factors also affect the food choices, especially if there are other concurrent conditions, such as diabetes...
My previous diabetic, Bertie, had early kidney disease. In his case I made a choice to keep feeding low carb foods to try to keep his blood glucose in a good range, since that meant less work for his kidneys.
It was also important that he maintained his body weight for as long as possible (he became very prone to weight loss). He also had gut issues, and ultimately could only eat raw food (a commercial brand that he was particularly fond of). That food was not particularly low in phos, but it kept his diabetes and gut issues under control. This strategy worked well for us.

Another cat I fostered (and later adopted) came to me as an emergency case. Elliot was a completely emaciated and weak CKD kitty who was no longer wanted. His physical condition was so bad that the vet who examined him suggested to me that we just have him PTS straight away, since there was little chance of improvement and no chance of getting him adopted. Instead I said I'd keep him for just a little while first, just so he had the chance to feel loved.
I put him on a higher protein diet against the advice of the vet. Over the next month Elliot gained half a kilo in weight. Over the following month he gained another half kilo. He went on to regain his body weight and a lot of his strength. And his kidney values actually improved.

My current diabetic girl, Bonbon, only has one functioning kidney (after an episode of acute kidney failure about 18 months ago). And the remaining kidney isn't in great condition. I feed her a good quality low carb cat food. And I also add lots of extra water to her food to help keep her hydrated. At the moment her blood phos is still in normal range. But if/when it goes up I'll add a binder to her food.

Some cats live for years with kidney disease and it develops only slowly over time, maybe even improving for a while at certain times; and a cat will end up eventually dying of something else entirely. In other cats it will develop more quickly. Sometimes it's just 'the luck of the draw'. Sometimes the way we choose to care for them can make a considerable difference to the outcome. But it is up to us to weigh up the options and then choose how best to proceed. We just do the best we can, and try to let love guide our choices. :bighug:
 
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Hi Cassandra,

Can't help on the Feringa food question. It might be worth asking on the CKD support group about whether supplementing one of the renal foods with a little additional protein might be an option. From what I've read, some people use cooked egg white but I've no direct experience to share.

I don't know what you've been feeding previously but the Integra Protect Renal food is quite calorie-dense: 127kcal/100g. A significant chunk of the calories are from fat. Maybe it might help Angel to gain a bit of weight? BTW, I asked Zooplus to send me info on the ME of those foods and they sent me this very helpful table of the Integra Protect Renal analytical constituents from Animonda, and I thought you might find it helpful:


Animonda Integra Protect Renal - Analytical Constituents.png




Mogs
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@Elizabeth and Bertie I remember meeting your lovely Bertie. Angel is early stage 3 so I could probably risk giving him a higher protein food for part of his daily allowance. So glad you gave Elliot the chance of being loved and cared for. Sorry to hear about Bonbon (that is my Bonnie's nickname) but she couldn't wish for a more loving caring mum, and I know she has the best chance with you.

@Critter Mom the renal food I decided to go for is the integra protect as it is the only one that seems to address both issues. I'll keep a close eye on Angel's phosphorus levels. I did try the egg white but the one vet who was so negative (the one that told me to ignore his diabetes) said that was basically undoing all the good work of a renal diet and he might as well not be on one.
I do have some of the Feringa lamb and was going to wait and see what the people at Tanya's site suggested but no one's got back to me about that, so I'll see if he's put more weight on and if not I will probably give it a go.

With all this going on I forgot to order my anti depressants (I metabolise meds like crazy and am on the max dose) and ended up going cold turkey for a week. I've been having mini meltdowns for the past few days, but got them today and am going to try and be sensible and ease back into them. Honestly I forgot how awful it is coming off them, the cats were trying to get into each others food, I cried, I stepped into a large pile of fox poo, I cried (and swore), the civvies tried to eat Angel's food, I asked them if they were trying to make themselves ill, Angel tried to eat their food, I asked him if he was suicidal!!

Anyway Bonnie is snuggling right next to me on the sofa, going off to bed in a minute and Angel (and probably Shakira) will be there, and some time in the early hours Romeow will jump on me (and most likely trump in my face!!!) so nite, Bonnie says goodnight in Birman cat language
 
Some good news, Angel is putting on weight. He's now almost 4 kilos. His body condition is still underweight but at least he's on the right track. I'm grateful he has always loved his food (and anyone elses!). I gave him a small amount of the feringa lamb and feeding him mainly the integra renal and just a tiny touch of the royal canin with his porus one in the morning and his semintra in the evening.
 
Great to hear Angel's regaining some weight, Cassandra. :cat:

How is he taking to the Porus One? What sort of texture does it have and how voluminous is the daily dose? (Thinking about it for the Noodle.)


Mogs
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@Critter Mom I'd definitely try it. Its like a black powder in a little sachet.
I mix it in with Angel's food and he eats it no problem, but they sent me some free cat treats to mix them in. I haven't tried them on him yet.
xx
 
Angel is now just over 4 kilos and still enjoying life. I'm feeding him a mixture of renal food and low phos food, but I'm struggling to find a low phos food that the others like, so I can leave it out and not worry about Angel getting into it. I've been getting the ferringa lamb but Shakira turns her nose up at it. They would eat the Lily's kitchen but it's crazy prices. Any suggestions? I think Shakira has a slightly delicate tummy too.
Romeow had his check up for iris melanosis and there was no progression so he will be keeping both eyes for now. I guess when he has to have it removed I will get a catio.
 
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