? CKD/FD Diet

[Bibi and Kira]

Bibi now has a CKD stage 2-3 (closer to 3 according to her Creatinine value) diagnosis along with her diabetes (OTJ since last fall, BG controlled with combination DM/TikiCat After Dark wet food diet). Does anyone have current recommendations of commercial diets for cats with dual diagnosis? I'm hoping to avoid the Rx renal diets as they all seem to have "byproducts" and /or "meal" as top ingredients (the DM does too, which I hate, but her current diet has kept her in remission thus far). Also they are very expensive. Unfortunately a raw diet is not an option for us. I've read the felinecrf.org pages at length and find it all a bit overwhelming in terms of the arguments for and against lower protein. My vet is fairly insistent we must lower her protein to help her kidney function. I'm okay with trying moderately lowered protein to see if it slows the progression of renal disease, but I don't want to lower her protein so much it causes muscle wasting or kicks her out of remission. Weruva Cats in the Kitchen seems to have a few moderate protein/low phosphorus/low carb varieties. Anyone tried it with dual diagnosis cat?

 

[Bron and Sheba (GA)]

Yes the Weruva brand has some suitable foods. Have you seen their website?
Sheba was only early stages CRD but I fed Weruva as well as home made and she maintained her numbers well.

 

[Bibi and Kira]

Yes the Weruva brand has some suitable foods. Have you seen their website?
Sheba was only early stages CRD but I fed Weruva as well as home made and she maintained her numbers well.

Yes, I've looked at their nutrition info. page. Several of their Cats in the Kitchen cans have phosphorus which is nice and low, well below 200, good for CKD. However the recommended protein As Fed is 28%-35% for CKD cats and all these Weruva cans have well over 50%. I find this totally confusing as I thought protein and phosphorus levels were directly correlated, i.e. low phosphorus would necessarily mean lower protein. Hmmm...

 

[Veronica & Babu-chiri]

Yes, I've looked at their nutrition info. page. Several of their Cats in the Kitchen cans have phosphorus which is nice and low, well below 200, good for CKD. However the recommended protein As Fed is 28%-35% for CKD cats and all these Weruva cans have well over 50%. I find this totally confusing as I thought protein and phosphorus levels were directly correlated, i.e. low phosphorus would necessarily mean lower protein. Hmmm...

Actually the recommended protein is usually given in order to try and have the lowest possible phosphorus content, but if you can find a high protein low phosphorus food (like in the case of Weruva) is even better because that way you can help avoid muscle loss which happens a lot with CKD cats because of the low protein in some CKD food.

And even though more protein can mean more phosphorus that is not always the case there are good quality proteins that have a low phosphorus content, egg whites for example have a very high protein content and almost no phosphorus and in chicken for example thighs have a lot less phosphorus than breast so the phosphorus content of the food will depend not only in the amount of protein but also in the type of protein they are using

Regarding the renal diets I think you should try to avoid them as much as possible because they all are very very high in carbs and that could get him out of remission, even consider using phosphorus binders before a renal diet, although that may not be possible once he's in a very advanced CKD stage (which fortunately is not your case )

 

[Bibi and Kira]

Actually the recommended protein is usually given in order to try and have the lowest possible phosphorus content, but if you can find a high protein low phosphorus food (like in the case of Weruva) is even better because that way you can help avoid muscle loss which happens a lot with CKD cats because of the low protein in some CKD food.

And even though more protein can mean more phosphorus that is not always the case there are good quality proteins that have a low phosphorus content, egg whites for example have a very high protein content and almost no phosphorus and in chicken for example thighs have a lot less phosphorus than breast so the phosphorus content of the food will depend not only in the amount of protein but also in the type of protein they are using

Regarding the renal diets I think you should try to avoid them as much as possible because they all are very very high in carbs and that could get him out of remission, even consider using phosphorus binders before a renal diet, although that may not be possible once he's in a very advanced CKD stage (which fortunately is not your case )

My vet seems stuck on the notion that a reduction in protein content is necessary, but maybe I'll try one of the Weruva varieties that are low phosphorus, low carb and see if a) she likes them b) her BG stays low and c) if her kidney values improve in a couple of months, and then take it from there. Thanks.

 

[Deb & Wink]

Does her lab work show proteinurea? Excess protein showing up in the urine?
How is her blood pressure?
You said stage 2 possibly stage 3 CKD.
Was she sub-staged by your vet according to the I.R.I.S guidelines?

I.R.I.S Guidelines are here http://www.iris-kidney.com/guidelines/staging.html
http://www.iris-kidney.com/pdf/IRIS_Staging_of_CKD_modified_2019.pdf
Updated in 2019. So pretty current information.

 

[Veronica & Babu-chiri]

My vet seems stuck on the notion that a reduction in protein content is necessary, but maybe I'll try one of the Weruva varieties that are low phosphorus, low carb and see if a) she likes them b) her BG stays low and c) if her kidney values improve in a couple of months, and then take it from there. Thanks.

Do you have the blood tests ? Could you post her results?

Keeping her BG levels under control is important not only so that she feels ok (and you don't have to stress about controlling BG) but also because uncontrolled diabetes can actually on the long run worsen her kidney problem, vets sometimes disregard this thinking that if BG raises you just give more insulin but it may not be that simple,

You have to consider that with CKD her kidney values may not improve sometimes the goal is for them not to get worse although with proper control phosphorus levels and some other parameters may get better

 

[Bibi and Kira]

Does her lab work show proteinurea? Excess protein showing up in the urine?
How is her blood pressure?
You said stage 2 possibly stage 3 CKD.
Was she sub-staged by your vet according to the I.R.I.S guidelines?

I.R.I.S Guidelines are here http://www.iris-kidney.com/guidelines/staging.html
http://www.iris-kidney.com/pdf/IRIS_Staging_of_CKD_modified_2019.pdf
Updated in 2019. So pretty current information.

Her urinalysis shows Negative for protein, and the vet said her BP was normal. I don't know if she was sub-staged, will try to find out. Thanks.

 

[Bibi and Kira]

Do you have the blood tests ? Could you post her results?

Keeping her BG levels under control is important not only so that she feels ok (and you don't have to stress about controlling BG) but also because uncontrolled diabetes can actually on the long run worsen her kidney problem, vets sometimes disregard this thinking that if BG raises you just give more insulin but it may not be that simple,

You have to consider that with CKD her kidney values may not improve sometimes the goal is for them not to get worse although with proper control phosphorus levels and some other parameters may get better

I will try to figure out how to post the lab results. Yes, very good point that a diabetic relapse could also worsen her kidney disease, and also that the realistic goal is to slow the progression of renal disease. Thanks.

 

[Deb & Wink]

Her urinalysis shows Negative for protein, and the vet said her BP was normal. I don't know if she was sub-staged, will try to find out. Thanks.

Sub-staging for CKD involves taking into account the protein levels in the urine and the blood pressure.

Negative for protein (UP/C <0.2) in the urine means "Non-proteinuric", which is good for stage 2 (proteinuria can disappear in stage 3). Normal systolic blood pressure (BP) <140 mmHg means "Normotensive" or normal blood pressure and risk of "future target organ damage" is minimal. So some positive signs there.

I will try to figure out how to post the lab results.

There is a tab on the spreadsheet where you can enter the lab results. You need to add columns to the "Lab" tab on the SS first. Then you have to enter the reference ranges, next to the column that has all the names for the lab tests. Then you add a column to enter the lab results for a specific date, and enter the values you have for any of those labs. You are unlikely to have test results for all the lab tests listed.