best foods for CRF?

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kotek

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Hi there,

I'm new to posting but have been "lurking" and getting advice from the site for a while. Thanks so much to all of you for your wonderful advice and support, which has helped far more than only the folks you've originally replied to!

My cat B was diagnosed with diabetes and hyperthyroidism at the end of April. Did lots of research (and lurking) and with low carb food got her almost off Caninsulin -- she was down to 0.125 units a day, and I'm sure we would have gone OTJ. Then her next bloodwork showed high kidney values...sigh. I knew this was a risk, but still, profoundly disappointing. Note that her BUN was high and the main concern (17), while creatinine was only slightly high (225) and her phosphorous was well within normal (1.53) (I'm in Canada BTW). (Although the vet said her creatinine was falsely low, given she's a pretty tiny cat and has lost weight recently).

The vet strongly recommended I switch her to low protien food. I've read the debates and reviewed much research, and it seems like the main arguments against the low protein food is that many cats won't eat it. Mine both eat it pretty enthusiastically, though (other has kidney issues as well, although nothing else complicating -- both seniors) -- so it seemed to make sense to at least try following the vet's advice and see if the different food brings the BUN down at least.

We are on the dry k/d food, free feeding -- she's always been on dry, although I am switching her to wet snacks. (Not sure if we might be able to shift to wet eventually...both B and my poor brain can only take so much change at once!). I was worried about her losing weight not getting enough protein and wanting to supplement a bit and the vet actually recommended a/d for this, so I've just shifted her to a supplement of 1/3 of a can of a/d a day (fed in two sessions right after her injection) as well.

We switched to the k/d slowly and I have sadly watched her BG go up and increased her caninsulin dose accordingly. Now we're on 100% k/d, and I'm having trouble regulating her again. We're up to 1 unit of Caninsulin, which drops her around 15 points right now (I am hope testing before every shot) -- so for example, we went yesterday from a pre-shot BG of 24.3 to 9.6 at +4 (I haven't had a chance to do a more complete curve recently, but typically +4 has been her peak insulin time). This seems like quite a swing, but it gets her down to a decent level for a little while at least.

I have to add that she's extremely perky, even swinging up to the 20s. She's awesome!

So my question is: do I keep raising the dose until she goes down to 5-7 at her nadir, and try and adjust daily as appropriate if her pre-shot BG goes down? Or do I let the 1 unit "settle in" for a few days and see if her BG shifts lower? Is there a "settling in" with the dose when we're upping it like this and she's been on the insulin for a while? When we were first regulating her, her BG was really high but even on relatively high carb food (30% -- although k/d is 43%, cringe) she did seem to eventually settle into a 1 unit dose and her BG didn't raise more than around 16, and was usually less. I understand how to lower the dose with the low protein food, but raising it with the high carb is confusing the heck out of me.

I would greatly appreciate any advice you may have!
 
Re: help regulating after a switch to k/d

I haven't had experience with crf, but I know that many others have on this board. I'm pretty sure that the dry food is not actually going to help, and you already see what it has done to your excellent management. Are you giving any subq fluids? Others will be along soon with suggestions.
 
Re: help regulating after a switch to k/d

The dry food is not good for diabetics and it's most likely causing the increase in the insulin dose.
Also, Caninsulin is not the best of insulins, and you may want to talk to your vet about using a better insulin, like Lantus, Levemir or even Prozinc. I am not sure why so many Canadian vets still suggest Caninsulin - my previous vet started Shadoe on Caninsulin and we had poor results compared to after a switch to Lantus.

Hopefully others who know about the other issues affecting B will be able to offer you more help.
 
Re: help regulating after a switch to k/d

If you could switch to a low carb and low protein all canned diet, would that be an option?
See my sig for a link to the food charts, both wet and dry. There are lots of options that could probably give you the best of both worlds. Hard to find a food that is lower in protein than what you're using, but if it were just a bit higher protein, it could be a huge bit lower in carbs, and you might get back to the place you were not long ago - almost OTJ.
There are members who are dealing with kidney issues. Hopefully they'll see this and chime in.
You might edit your original subject header to say something along the lines of "Best foods for CRF?" That'll catch their eye.
Carl
 
Re: help regulating after a switch to k/d

Thanks so much everyone!

Not giving subqs to her yet -- the vet advised not changing everything at once, which seemed sensible. We are giving subqs to the other cat, though, and are prepared to do it for her too if it will help.

When we almost got her in remission she was actually totally on dry food -- Nature's Variety Rabbit Meal. I don't think her body really wants to be diabetic, but the 43% carbs are giving her a tough time (my lay theory is her hyperthyroid made her eat so she overloaded her pancreas, but that's really just wild speculation). I totally hear you about Caninsulin, and will definitely consider switching to Lantus depending on how things go. She responded super well to Caninsulin -- for a while it was lasting about 14 hours in her -- so that's why I've stuck with it for now.

I didn't think a low carb low protein diet existed! That is definitely worth exploring. I will check out the food charts -- thank you! I'm assuming the %kcal is the same as a dry matter analysis? I've been mostly using the food charts at www.felinecrf.org/canned_food_usa.htm, which are super up-to-date, but they don't have any carb info.

I will change the subject as suggested, too. Again, many, many thanks!
 
Actually, early in kidney insufficiency, low protein diets are overkill. More recent thinking is that low protein diets are not needed until end stage renal disease, and that low phosphorus levels of the food are more important.
Please scroll down the board or search for Holly and Spaders excellent CRF links post.

Cats are obligate carnivores, and its important to treat the whole cat, not just the kidneys. Starting low protein diets can lead to the cat catabolizing its own muscle mass to get protein.

Merlyn ate Wellness canned, starting about halfway thru his diabetes dx, thru his kidney dx, and heart dx..
 
As you probably know, dry is terribly hard on the kidneys - failing kidneys need lots of moisture. If not doing subQs, then she really must get her moisture in her food. Those kidney values may be skewed by dehydration - simply increasing the fluids may help.

Going low protein is no longer the school of thought for renal failure. They know now that it's the byproducts of low quality protein that causes the problem. So high quality protein food - preferably canned - is the way to go. Have you read Dr. Lisa's section on this? http://www.catinfo.org/#Kidney_Failure

Having diabetes just complicates things - 43% carbs is horrendous, and diabetes is hard enough on the kidneys! Try a food with real meat - no byproducts- low in phosphorus, and supplement her diet with some high quality protein like boiled chicken or cooked egg whites.

May I also suggest you read Melissa and Popcorn's fabulous CRF and Diabetes primer? http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=47190&p=507674#p507674

Best of luck! Will you keep us posted? Thanks.
 
Honestly, I find it really hard to go against my vet on the protein issue. I totally agree with everything said. And thanks for the pushes to wet food...I think that makes a lot of sense and will keep moving on this -- she wasn't eating wet food at all until this month, only fish, and now she eats it excitedly so that's a victory!

I did come across Dr. Lisa's info, which I wish I would have read years ago -- but thank you for referring to it. However, I don't think she makes specific recommendations for crf that's already in play -- unless I missed it? I will check out the primer also -- thanks!

What it comes down to is that I am intensely panicky and terrified about making decisions that effectively take my kitty's life in my hands when there is an expert with 20+ years of experience telling me to do the opposite. I feel really torn about this -- I would do pretty much anything for B, and find the conflicting opinions on what is best for her extremely stressful. :(

I have tried to go to as much original source research as possible (I'm a bit of a research addict) and it has still seemed to leave a lot of room for debate. Oh what I would give for a definitive answer!

And so my thought was to try the low protein for 4 weeks, see how regulated she gets (or not), watch her weight very closely, re-do the blood tests, then if the numbers haven't shifted convincingly discuss a high-quality protien/low phosphorous/low carb option (and the subQs too). But meanwhile, as you say, I feel terrible when I think of how even the temporarily high BG is for her kidneys.

Hope that makes sense...
 
Totally understand the reluctance to go against the vet and the 20+ years experience. But consider this:

How many diabetic cats has your vet treated in 20 years?
My vet has 30+ years under her belt. She told me she averages 3 cases a year. So 100 tops, in 30 years. Right now, I (after only 3 months) have more hands-on experience with treating and testing a diabetic cat than she does. She's never had one of her own. I love my vet, and deeply respect her wisdom and knowledge. But she knows a little about everything, but doesn't know everything about anything. Know what I mean?
She pushed home testing on me. She gave me an easy insulin to deal with (PZI). She showed me how to give shots, and to give sub-q fluids and when I read about stuff here, she listened to everything I said and never told me to "not" do anything I wanted to try based on things I learned here. She never insisted that I follow her advice. All Points in her favor.
She was totally overjoyed the last time I saw her when I told her that Bob was OTJ. The most important decision I made along the way was to stop using the Hills Prescription Diet canned and dry food that she sent me home with, and instead switched Bob to an all wet diet of Fancy Feast Classics. That more than any other single thing "fixed" him. She took back the 'scrip junk food, and the next time she diagnoses a sugarcat, that kitty is going home with a link to Binky's Food Charts instead of Hills MD.

Now maybe your vet has dealt with a lot more FD cases than mine has, but I still think I would trust the advice here over his. This site has been around for almost as long as your vet has, and deals for the most part with diabetes and associated conditions. Put 100 vets together, and they still don't have the collective knowledge or expertise with feline diabetes that this message board has on any given day.

Just my thoughts,
Carl
 
I complete agree about the feline diabetes -- there is so much collective wisdom here, and it's with a tremendous amount of help from background research from this site and others that I got B regulated and almost OTJ. One of the vets was extremely cautious about home testing but I was determined to do it anyway, with great success. Again, many thanks to everyone here for that great help and support!

It's the CRF that scares me. From what my research indicates, it seems to be far more complex and controversial. And given it's among the most common ailments of senior cats my sense is that the vet has seen a lot of cats with this issue (one of them, if not both, actually do have cats with it -- and they both agree on the low protein) and so is basing things on her/their experience.

Also the ultimate consequences of the CRF are so severe. Her kidneys aren't coming back, whereas her BG can be managed. So I'm scared the wrong decision will shorten her life. :(

I was actually relieved when she was initially diagnosed with diabetes because I didn't want it to be CRF, for that very reason. But that's the way the wind blows sometimes.

But I do take your point that the vets may not have dealt with both diabetes and CRF very often, and I will press that issue when we decide how things go next. That's why I was originally asking about how to manage the insulin dosing with the prescription food -- this seemed like a great resource for that aspect of things.

Meanwhile, my insulin has greatly decreased its effect on her over the past few days (almost by 50%) and so I wonder if part of the issue may be that it has lost its effectiveness? I think I will start a new bottle tomorrow and see how that might work.

Thanks again!
 
I understand completely. I think the moisture issue is probably more important than anything right now, so what about canned K/D? That way you are still using the recommended food, but you are eliminating the dry. It may be a compromise you can feel comfortable about, while you ask your vet to do some research on the new school of thought for treating CRF. Feel free to point her to Dr. Lisa's site - she may be more willing to read what another vet has written (and the link I gace you takes you directly to Dr. Lisa's section on active CRF).

Does that sound workable?
 
Here's an up to date list that contains many foods without byproducts and low carb, low phosphorus values: https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50

You want to look for foods that have less than 250mg/100kcal of phosphorus. I always stayed under 200mg/100kcal with my CRI cat.

Low protein is not necessary--in fact, it can cause muscle wasting in senior cats. When my Gabby was diagnosed with CRI, my vet also recommended low protein food. The research I did caused me to disagree. I went against my vet's advice and fed foods with no byproducts, high protein, low carb, and low phosphorus. In 2 years on that diet, her kidney values stayed exactly the same--did not worsen in the least. She passed away from an unrelated illness (cancer).

You have to look at your risk factors in this situation. If you feed a low protein diet, there will be loss of muscle and uncontrolled diabetes to contend with. These conditions are far more dangerous to me than feeding a high quality/low phos/low carb food that *might* (and that is a HUGE might) cause a slightly less faster rate of deterioration of the kidneys. Even if that *might* is true, your cat will have long since deteriorated from the other conditions before it will make any difference.
 
Thanks so much -- the food tables combined with your comments have given me much to consider. I think I may be able to find a wet food solution that at the very least a far better balance...very promising!

And I think I am going to gather research and present to my vet...she's been very surprised/impressed by my BG chart, so we'll see what she thinks of the CRF research. Also this will help me more solidly make up my own mind.

As I ponder another (sigh) change of foods, I'm wondering if you all can help further with some advice on feeding solely wet foods? Do you do it in 2 meals? Leave it out all the time?

I'm extremely cautious about my cats having access to food -- my other cat had hepatic lipidosis ("fatty liver disease") once after she decided to stop eating when we went on vacation. It was touch and go for a while and we had to force feed her every 2-4 hours for 2 weeks (never have I been so surrounded by cat vomit, ugh). So my strong preference is to leave food out.

But can you really leave food out all day? And what about when it's super hot out? In summer it gets 30C+ during the day (86F) and has gotten as hot as 38C (ugh) (100F). Won't the food spoil and make them ill?

Again, thanks for all your expertise and support -- it is much appreciated!
 
I feed Bandit 4 times a day, and many people feed up to 6 times a day. Small, frequent meals work best with diabetics. Plus, if your kitty has CRF that might cause a decrease in appetite, and it's much easier to get them to eat smaller meals in that situation.

I do work two jobs and long days, so when i won't be home for a feeding I freeze portions of Bandit's food and put them in an autofeeder like this one: http://www.amazon.com/Automatic-Fee...DTJA/ref=sr_1_2?ie=UTF8&qid=1314287756&sr=8-2. There are many different brands/prices for auto feeders so a search on amazon will give you many options. I like mine because it's very sturdy and not easy for the cat to break into if your cat is mischievous (Bandit destroyed two other feeders before I found this one), and you can record your voice to play when the food is released. This is great for feeding more than one cat at the same time, because they'll both run their feeders and one cat won't eat the other's food.

If your cat is not a gobbler like my Bandit, you can just freeze the food and leave it out without a feeder. Frozen food left to thaw is good for up to 12 hours. Many people also add water to the food to keep it moise and leave it out without freezing. Non-frozen food is good for up to 6 hours, at normal temperatures. If you house is super hot, I'd knock a couple hours off of that. Those are extremely conservative estimates, though.You could probably double those times and be perfectly fine. Cats are very sensitive to meats that are spoiled, so it's extremely unlikely they would eat the food if it was spoiled. Even if they did, their stomach enzymes and short digestive tracts make them far less sensitive to harmful bacteria than humans, and it's extremely unlikely that any spoilage that could occur in a 12 hour period would affect them.
 
Not on that nutrition list, no. Those are all foods without byproducts, with the exception of Purina DM.

There are low carb/low phosphorus foods on Janet & Binky's list with byproducts. While it's preferable to feed higher quality protein, you do want to feed whatever the cat will eat, so if she refuses the those foods, you might need to go to that list to find other foods as well. Friskies Special Diet has a few low carb, low phosphorus options, I believe.

However, I want to caution that Janet & Binky's list has not been updated in some time, so many of the phosphorus values are no longer correct. EVO and Nature's Variety are two good examples of this--flavors listed as low phosphorus on Janet & Binky's list are now incredibly high in phosphorus and completely inappropriate to fed a CRF cat, if you compare the two charts. So you must cross reference them with Tanya's CRF food list (which is current) if you decide to feed these foods.
 
Just wanted to thank everyone for the encouragement, and especially the additional food tables -- and new perspective on the food tables. Thinking about the percentage of calories from protein/fat/carbs has made a lot of difference.

Brought the vet my most recent BG curve today (she's pretty awesome and sees me quickly between appointments to review the data). She agreed the BG isn't doing well (swinging from 22 down to 5 and back up again, ugh) and that it would be reasonable to try getting B on all wet food, and trying one I found that's fairly low carb, also low phosphorous & sodium, not super high protein, and higher in fat. Now I need to do a slow transition to convince B to eat it!

We're going to do a blood test to get a baseline from the low protein food in a couple days then shift her over and test again once she's settled in the new routine to see the difference. Here's hoping!

Now I just need to figure out how to transition her to free feeding the canned food...oh, and to get the other cat to eat the same food or else separate their food. Julia, the feeder you suggested seems very interesting. However, in the picture it looks pretty deep. Do your cats eat out of it easily? I am definitely considering it.

Other suggestions very welcome. Again, I really appreciate your thoughts and help!
 
It's not super deep--maybe about 2 inches at the deepest part? I make a little bowl out of tin foil and put the food in that so I don't have to take it apart and wash it every time. If you search amazon for auto feeders, there's a bunch of different options at different prices. Just make sure you get one feeder for each cat--otherwise you won't be able to feed both at once.

Depending on the food you pick, you can feed both cats the same food. EVO and Wellness both have flavors fit the nutrition guidelines you're looking for, and they're great to feed a regular kitty, too. I fed my CRI kitty and my diabetic different foods, but when I would be gone and had to set the auto feeder they both got frozen portions of Wellness Turkey because it fit the nutrition requirements for both. So you could either do the same food all the time for both (which is probably easier, plus less expensive because you can get the big cans and save money), or you can feed separate foods and have a common food for when you are gone. As long as all the dry is gone for both, you're good.

I would recommend training the cats for the feeders from the get go. Feed each cat in the same spot for every meal, but separate their feeding spots. Bandit got his food at one end of the kitchen, and Gabby got hers at the other. That way, when the feeders go off they'll automatically run to their designated spots to eat. You'll also want to feed them from the auto feeders a couple times while you're there before you use them alone, so that the cats get used to them and know that whatever noise it makes when it goes off means food. And set them for the same time as their regular meal times. Bandit knows he eats at 7am, 1pm, 7pm, and 1am, so he hangs around in the kitchen at those times whether it's a person or the auto feeder giving him food.
 
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