Diet for CKD stage 2 kitties

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Bandit's Mom

Bandit's Mom

Member Since 2019
So Bandit and my civvie Budge had labs done as part of their pre-dental check-up. They both have BUN and creatinine on the higher side of the "normal" range given by the lab

Bandit: BUN - 28, Creatinine - 1.94
Budge: BUN - 34, Creatinine - 2.17
Normal Ranges: BUN: 16 - 36, Creatinine: 0.80 - 2.40

Per Tanya's website (www.felinecrf.org), they both are CKD stage 2 based on the IRIS staging system. My vet, as expected, is pushing for us to switch them to renal food.

Bandit: Is diabetic and a kibble addict. I have not been able to switch her to wet food at all. And I have tried everything! She is on a combination of Young Again Zero Mature kibble (0.50% phosphorous) and Dr. Elsey's Cleanprotein kibble (1.07% phosphorous) that I get from the US. Funnily, her labs are all over the place - her creatinine was 1.90 when she was diagnosed in Oct 2019, dropped to 1.4 in June 2020 and is now back up to 1.90 in October. Makes me wonder if the labs are messing up.

Budge: Is prone to urinary tract issues. She had a urethral blockage in March 2020 after which I switched her to a LC wet food available here (Whiskas). It has 1.4% phosphorous content. It is not the best brand, but food choices here are practically non-existent. She has also been recently diagnosed with FLUTD - the labs were done when she was having an episode and I am not sure if that affects numbers.

I read-up Dr. Lisa Pierson's as well as Tanya's website (not all of it!), but I am a little confused:
(a) Dr. Lisa is vehemently against renal diets (except for short term use if absolutely essential) while Tanya's website seems to advocate renal diets
(b) Dr. Lisa asks that phosphorous content be lower than 1% while Tanya's website says 0.50%. (I guess the lower the better)

Not sure I have misread the sites but I honestly don't know what to do!

A renal diet is high carb and dry. Wet renal diets are available here but I honestly cannot afford them. Bandit should not have carbs while Budge really needs the water in canned food (Bandit does too, but she won't eat wet!)

How do I manage this balancing act? What should I feed them? Please help?

@Sienne and Gabby (GA)
@Wendy&Neko
@Chris & China (GA)
@Bron and Sheba (GA)
 
Bandit's Mom said:
So Bandit and my civvie Budge had labs done as part of their pre-dental check-up. They both have BUN and creatinine on the higher side of the "normal" range given by the lab

Bandit: BUN - 28, Creatinine - 1.94
Budge: BUN - 34, Creatinine - 2.17
Normal Ranges: BUN: 16 - 36, Creatinine: 0.80 - 2.40

Per Tanya's website (www.felinecrf.org), they both are CKD stage 2 based on the IRIS staging system. My vet, as expected, is pushing for us to switch them to renal food.

Bandit: Is diabetic and a kibble addict. I have not been able to switch her to wet food at all. And I have tried everything! She is on a combination of Young Again Zero Mature kibble (0.50% phosphorous) and Dr. Elsey's Cleanprotein kibble (1.07% phosphorous) that I get from the US. Funnily, her labs are all over the place - her creatinine was 1.90 when she was diagnosed in Oct 2019, dropped to 1.4 in June 2020 and is now back up to 1.90 in October. Makes me wonder if the labs are messing up.

Budge: Is prone to urinary tract issues. She had a urethral blockage in March 2020 after which I switched her to a LC wet food available here (Whiskas). It has 1.4% phosphorous content. It is not the best brand, but food choices here are practically non-existent. She has also been recently diagnosed with FLUTD - the labs were done when she was having an episode and I am not sure if that affects numbers.

I read-up Dr. Lisa Pierson's as well as Tanya's website (not all of it!), but I am a little confused:
(a) Dr. Lisa is vehemently against renal diets (except for short term use if absolutely essential) while Tanya's website seems to advocate renal diets
(b) Dr. Lisa asks that phosphorous content be lower than 1% while Tanya's website says 0.50%. (I guess the lower the better)

Not sure I have misread the sites but I honestly don't know what to do!

A renal diet is high carb and dry. Wet renal diets are available here but I honestly cannot afford them. Bandit should not have carbs while Budge really needs the water in canned food (Bandit does too, but she won't eat wet!)

How do I manage this balancing act? What should I feed them? Please help?

@Sienne and Gabby (GA)
@Wendy&Neko
@Chris & China (GA)
@Bron and Sheba (GA)
Click to expand...
Hi Bhooma

I’m sorry to hear they are both in Stage 2 CKD.

To answer the question about the differences in what you should strive for in P levels in food,

Dr. Lisa is looking at, to me the most important thing: excellent nutrition for a cat with CKD. The better nutrition combined with a lower P level, the better the kitty will do. At some point, if the P rises to 6, binders can be used. This is the approach I took with my CKD cats and once their P levels approached 6, I got them and kept them at 4.5 with P binders

Tanya’s is just stating that a “low” P diet, which is ideal, is less than 0.5% P on a dry matter basis. Because she also provides extensive food lists, she isn’t advocating one way or another. She knows not all cats will eat a renal diet. She states (on the page regarding food tables)

  • In order to keep your cat eating, you may have to have a less ambitious goal, at least to start with, of, say, feeding a food with less than 0.75% or less than 1% phosphorus.
  • But your ultimate goal should be to feed the lowest phosphorus food that your cat will eat.
Click to expand...

Insofar as Bandit and a diet change, it can up to six months to transition a cat’s food. Some are very slow to do so. Patience is the key. I sent you the FoodFurLife link before and she has great tips on transitioning. With Livvie, I was able to use the replacement method but not with Tobey. With him, I put a small amount of the new food on his plate every single meal right next to his regular food. It took two weeks for me to switch him from commercial raw to homemade raw! I was persistent and he finally got used to the smell of the new raw and tried it and then I could start to use the replacement method with him.

You can also try crumbling her dry food and using it as a topper on a small piece of what you want to switch to and leaving it on her plate while she eats. There are all kinds of tricks but the important thing is to switch the diet while she is eating well.
 
Thanks, Marje. I agree that Tanya wasn't advocating renal food, but she seemed to say (or did I get it wrong?) that cats that will eat renal food should be switched to renal food?

Anyway, can I continue to keep Budge on the LC wet food she is on (Whiskas) that has 1.4% phosphorous content? Like I said. I don't have any other LC wet food options here - save a couple of imported brands that I cannot afford.

Bandit has been eating low phosphorous kibble (Young Again) for the last 8 months but it hasn't brought her numbers down (assuming her labs are accurate). I have tried all of Dr. Lisa's tips for transitioning and I continue to try - Bandit will just leave the room if she sees wet food!

I guess my question is - will renal food bring down their values? Do I compromise carb and moisture content and switch them to renal dry food for a few months? Or it doesn't work like that? Values don't come down or they do but they will go right back up once they start eating low phos kibble (YA) or high phos LC wet food? Are they at a stage when they need lower levels of protein?
 
Hi Bhooma,

Bandit's Mom said:
I agree that Tanya wasn't advocating renal food, but she seemed to say (or did I get it wrong?) that cats that will eat renal food should be switched to renal food?
Click to expand...
It depends on the IRIS stage. For cats who have problems with azotaemia (usually the later stages) a reduction in dietary protein is considered beneficial. However, for cats in earlier stage CKD it's better to feed a diet with a regular amount of protein and manage the phosphorus levels to slow progression of the disease. The typical renal therapeutic diets are significantly lower in protein than the typical low carb foods we use for our diabetics, but switching to a renal diet too soon can lead to unnecessary loss of muscle mass in cats at earlier stages.


Mogs
.
 
Red & Rover (GA) said:
The forum has a list of low carb + low phosphorus food, last updated in 2017. Perhaps some of these foods are available to you locally.
Click to expand...

Thanks @Red & Rover (GA). I am in India. None of the foods on the list are available here. The most common brands here are Whiskas and Royal Canin. There are half a dozen other brands that are actually either totally unknown (and provide little to no nutritional info!) or are so expensive (imported) only richie-riches can afford them! :confused:
 
Critter Mom said:
Hi Bhooma,


It depends on the IRIS stage. For cats who have problems with azotaemia (usually the later stages) a reduction in dietary protein is considered beneficial. However, for cats in earlier stage CKD it's better to feed a diet with a regular amount of protein and manage the phosphorus levels to slow progression of the disease. The typical renal therapeutic diets are significantly lower in protein than the typical low carb foods we use for our diabetics, but switching to a renal diet too soon can lead to unnecessary loss of muscle mass in cats at earlier stages.


Mogs
.
Click to expand...

Thanks, Mogs. So for CKD stage II, I continue with low carb, high protein food and manage the phosphorus levels with binders?
I need to get their phosphorus levels checked. I presume they have that blood test here! :(
 
Hi Bhooma, I'm sorry to hear about the CKD diagnosis.
My civie who had kidney disease , Tyler's brother the diabetic ,lived with stage 2 for many many years

The only think he would eat was the Dr Hills K/D chicken or ocean fish flavor
Then eventually he started to need fluids and a phosphate binder

I would put the dry food in a zip lock and add the binder it had no taste
and then shake the bag so it would coat everything.

He then started to eat baby food also and I would add the binder to that

I don't think you cat is at the point of needing fluids or a binder yet
If your vet thinks so I guess she would have told you.

Unfortunately I had to put him to sleep on 10-6 the kidneys started to fail, he was
hiding and would not eat.
I would say he was stage 2 when he was around 4 or 5 years old and passed when he was 12.

I know it must be hard knowing what to feed both of them
I had joined Tanya's site, they are very helpful
Again I'm sorry you and your kitties have to deal with this :bighug:
 
Thank you @Diane Tyler's Mom . I remember your posting about Perry! :-(

Unfortunately, the vets here are pushing renal diets as the only solution! The vet I spoke to last strongly discouraged me from even feeding raw!
Weruva isn't available here - options are very limited.
 
I don't see the phosphorus levels on the Labs tab of the spreadsheet. Do you know what it is? Neko's phosphorus levels were fine for the first while when she was early stage CKD, so I didn't have to do anything other than remove a couple higher phosphorus options from her food rotation. In her case it meant removing the raw with bones and switching to raw with eggshell calcium. You should also note that creatinine/BUN levels can vary based on whether the cat was dehydrated at the time of the test. That might explain some of the variations you are seeing. Has a urinalysis been done on either cat? Specifically you are looking for the USG or urine specific gravity, which tells you how well the cat's kidneys are concentrating their urine. If the vet has a spectrometer (should), you should be able to just collect a sample at home and run it in. Morning sample is best cause that's when it's more likely to be concentrated.
 
Bandit's Mom said:
Thanks, Mogs. So for CKD stage II, I continue with low carb, high protein food and manage the phosphorus levels with binders?
I need to get their phosphorus levels checked. I presume they have that blood test here! :(
Click to expand...

I found this page on Tanya's Site quite helpful on diet:

What to feed - and what to avoid

At the above link, Helen suggests feeding a mix of renal and other foods for cats in early stages. It might give you some ideas on feeding strategy.

WRT phosphorus, once blood work shows that intervention is needed you need to introduce binders and then get follow-up blood tests at the vets to gauge how the dose given affects levels. The phosphorus level test should be part of a standard kidney panel.


Mogs
.
 
First...I know this wasn’t advised and you didn’t say you were going to do it, Bhooma, but I just want to be clear, binders should never be started until the P level is at 6. It is not a good or recommended solution for a kitty with a P level below 6 to feed whatever they will eat and add binders to it.

IMHO, the transitioning methods used on the FFL website are better than Dr. Lisa’s. Again, my opinion.

I looked at Bandits labs tab but don’t see her P level. I could be missing it. I know it might not seem like it but 1.4%P on a DMB is similar to almost 300 mgP/100 kcal so that is really too high. Having said that, you can only do the best you can do given what you have available. What you can do to lower the P in her food a bit is add cooked egg whites,

Bandit's Mom said:
I guess my question is - will renal food bring down their values? Do I compromise carb and moisture content and switch them to renal dry food for a few months? Or it doesn't work like that? Values don't come down or they do but they will go right back up once they start eating low phos kibble (YA) or high phos LC wet food? Are they at a stage when they need lower levels of protein?
Click to expand...
Yes....feeding a renal diet for a few months might get the P down (and likely will) but once you take them off it, it will go back up.

It comes down to dry food with lower P levels vs canned food with higher P levels and what you are able to get. That’s a really hard question to answer because I am not a proponent of any dry food. Having said that, I also know controlling P serum levels is crucial to longevity. I’m not sure any of us can answer that question for you. I can only tell you that P serum levels can get out of control, sometimes quickly, with CKD cats (ECID) and cause a lot of issues like inappetence, ulcers, nausea, etc.

:bighug::bighug::bighug:
 
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@Wendy&Neko @Critter Mom @Marje and Gracie Thank you!

I don't have blood phosphorous levels for either Budge or Bandit. That isn't something they run here in the regular blood work. I will check if they do at all have a blood phosphorus test here for cats and get it done. I am taking Budge for her dental tomorrow morning and will ask the vet about the test and get her to draw a blood sample for it. Are there any other blood tests I should running in addition to blood phosphorous levels? If you could let me know today, I can try to get it done at the vet's tomorrow. She is repeatedly pushing for a renal diet so I am not sure how helpful she will be! :(

On USG, I haven't done a urinalysis on Bandit recently but when she was diagnosed, her USG was 1.015 - on the lower side. She was dehydrated then from the polyuria. I will get one done now. For Budge we did one last week when she looked like she had UTI (peeing repeatedly) and she was 1.015 too - not sure if an episode of UTI/FLUTD would affect USG?

So it looks like I am going to have to check their blood phosphorous levels (and any others that you advise) and then see what to do about their diet, binders etc.

Sigh. I feel as defeated as I did when I got Bandit's diabetes diagnosis. But thanks to FDMB, I've really managed to get a handle on her diabetes. She's back to her pre-diabetes self - even though she's not yet tightly regulated. I'm going to fight this CKD thing too. Its just so hard with ignorant vets and the limited options we have here. Sigh.
 
Bandit's Mom said:
@Wendy&Neko @Critter Mom @Marje and Gracie Thank you!

I don't have blood phosphorous levels for either Budge or Bandit. That isn't something they run here in the regular blood work. I will check if they do at all have a blood phosphorus test here for cats and get it done. I am taking Budge for her dental tomorrow morning and will ask the vet about the test and get her to draw a blood sample for it. Are there any other blood tests I should running in addition to blood phosphorous levels? If you could let me know today, I can try to get it done at the vet's tomorrow. She is repeatedly pushing for a renal diet so I am not sure how helpful she will be! :(

On USG, I haven't done a urinalysis on Bandit recently but when she was diagnosed, her USG was 1.015 - on the lower side. She was dehydrated then from the polyuria. I will get one done now. For Budge we did one last week when she looked like she had UTI (peeing repeatedly) and she was 1.015 too - not sure if an episode of UTI/FLUTD would affect USG?

So it looks like I am going to have to check their blood phosphorous levels (and any others that you advise) and then see what to do about their diet, binders etc.

Sigh. I feel as defeated as I did when I got Bandit's diabetes diagnosis. But thanks to FDMB, I've really managed to get a handle on her diabetes. She's back to her pre-diabetes self - even though she's not yet tightly regulated. I'm going to fight this CKD thing too. Its just so hard with ignorant vets and the limited options we have here. Sigh.
Click to expand...
The tests I look at for CKD are: BUN, creatinine, SDMA if available, phosphorus, calcium, potassium, hematocrit, USG, and protein in urine.

Good luck with the dental!
 
I've attached below a couple of PDFs that I've found really helpful. They're a bit like condensed versions of the main areas covered on Tanya's Site. Though Tanya's Site contains much more comprehensive, nuanced and experience-based information, these documents provide a really good 'bird's eye' overview of the key aspects of managing CKD (and they're good for sticking under your vet's nose if you want something that they haven't yet offered! ;) ).

FYI, Sarah Caney, the author of the first document, is highly respected by UK vets for her CKD expertise.


Mogs
.
 

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Critter Mom said:
Good information on blood tests here:

Tanya's Site - Diagnosis Page

An SDMA test is also a good one to ask about (usually needs to be ordered in addition to standard blood panels). Vets over here now use the SDMA result alongside the creatinine value when staging CKD. Here's a helpful link:

IRIS Staging


Mogs
.
Click to expand...

Thanks Mogs! I did see this page. Thank you also for the other reading material. Will definitely go through them. :-)
 
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