Early CKD likely for Willow - need input, especially about possible diet changes

[FurBabiesMama]

Willow is 17. Her annual exam was due in early August, but we took her early since we noticed her drinking water every day (previously, she only occasionally drank.. as in it could be several days between drinks) and getting bumps on her neck (she has a long history of allergy issues and gets Zyrtec daily). The bumps were cleared up with Temaril P. That was the easy part...

Her test results showed elevated BUN of 55 (Creatinine = 2.4; SDMA = 10). Her urine was diluted and had 1+ protein (Specific Gravity = 1.018). So, a urine culture was done - it was negative. Then, a Urine Protein : Creatinine Ratio was done - it was .6. The lab says that the ratio test needs to be repeated once or twice over the next few weeks to confirm/validate it, but the vet and I are not sure it is worth doing those tests. Taking Willow to the vet causes a lot of stress for her. There were already red flags that prompted doing the ratio test, and the results of the ratio test were another red flag. So, the recommendation is to assume the test is correct which would mean very early kidney issues for which the treatment is special diet. So, I am faced with needing to evaluate her diet and adjust if/where needed. (A follow up urinalysis will be done in a couple of months.)

I worked VERY hard to find a food that I was comfortable with the specs on and that my girls like to eat. They have been eating Weruva Chicken Frick 'A Zee for a long time now. (Nutrition specs: https://weruva.com/nutrition-landing/citk-ni/ Ingredients: https://weruva.com/product/chicken-frick-a-zee-4/) I add home-cooked chicken bone broth and water to their food and sprinkle crumbles of PureBites Freeze Dried Chicken on top. They get home-cooked chicken breast meat as treats. They both eat out of each others bowls, so I really need to be able to feed them the same food as long as at all possible. (The microchip/tag bowls did not work out for us at all; they were too put off by any movement of the lid.)

Willow cannot eat turkey (caused hair loss), and both girls seem to have sensitivities to some ingredients. I try to stay as close to 100% chicken as possible. Obviously, I have to keep carbs low for Mia. I have started reading the recommendations for CKD diet, and it appears that experts used to think low protein was best, but more recently have realized that 'somewhat reduced but not low high-quality protein' is the way to go. I also keep running upon things that warn about reducing the protein too much and not meeting their protein requirements which are pretty high for a cat this old due to muscle wasting concerns. I have started reading through the info on https://www.felinecrf.org/, but it is going to be awhile before I can consume and digest everything.

The vet mentioned Purina Pro N/F, Early; Hill's Science Diet K/D and the Royal Canin renal foods. I looked at those and was not happy with the hodge podge of ingredients or the nutritional specs. (All of them also say for 'intermittent or supplemental feeding' - so they are not intended to be the cat's primary diet???)

I know there are some of you out there who know a lot about CKD and who live and breath it (like we do diabetes). I would so very much appreciate your input/recommendations both on the test results/treatment plan (I can provide any other results that would be helpful) and on what I should do about food. Is the 51% protein in her current food too much? Are there supplements I should be giving like B12, more omega 3, etc.? Please help me. Willow is my 'heart kitty'. I have to do the best I can for her.

 

[Veronica & Babu-chiri]

Hi sorry to hear about Willow.

Given those numbers it is probably a good idea to repeat the tests in a few weeks or a couple of months when she doesn't have any other issues affecting her, because creatinine is sometimes raised by other issues (dehydration or UTI being some of them) but it can go back to normal after the issue is gone.

That being said and since she hates the vet (don't they all?) and given her age, is probably good if you start looking after her kidneys, I wouldn't go right now with a renal diet because those have way to little protein and can cause loss of muscle mass especially on a not so young cat I would consider renal diets just for a very advanced case of CKD which is not your case (stages 3-4), at this point looking for a low phosphorus (to help her kidneys) , low carb ( so that you do not have to worry about Mia getting any contraband) with mid to high protein I think it would be ok, in Dr. Liza's list that would be under 250 phosphorus ( or under 200 if you can convince them to eat it) actually the % of protein is not that important as long as is low phosphorus as you mentioned you can have high protein as long as it is high quality protein

You do not mention her phosphorus level, that is something you will need to monitor, because high phosphorus can make them very unconfortable

I do give my CKD cats B complex and omegas, I add it to the food since I homecook and for one of my civies I did gave her extra B12 but she was far more advanced in her CKD

 

[FurBabiesMama]

Hi sorry to hear about Willow.

Thank you. Me, too. I know she is old and that things like this are inevitable, but I hate to see them actually starting. I know I will lose her one day, and I have already had 'anticipatory grief' for awhile now.

Given those numbers it is probably a good idea to repeat the tests in a few weeks or a couple of months when she doesn't have any other issues affecting her, because creatinine is sometimes raised by other issues (dehydration or UTI being some of them) but it can go back to normal after the issue is gone.

The vet and I discussed doing another regular urinalysis in a month or two. Her creatinine this time was within the normal range (though definitely at the high end and higher than back last August). Other than the bumps from her allergies, she did not have any other issues (no indication of any infections, including UTI, and no dehydration). Can allergies impact this?

That being said and since she hates the vet (don't they all?) and given her age, is probably good if you start looking after her kidneys, I wouldn't go right now with a renal diet because those have way to little protein and can cause loss of muscle mass especially on a not so young cat I would consider renal diets just for a very advanced case of CKD which is not your case (stages 3-4), at this point looking for a low phosphorus (to help her kidneys) , low carb ( so that you do not have to worry about Mia getting any contraband) with mid to high protein I think it would be ok, in Dr. Liza's list that would be under 250 phosphorus ( or under 200 if you can convince them to eat it) actually the % of protein is not that important as long as is low phosphorus as you mentioned you can have high protein as long as it is high quality protein

The poor thing cries the entire way to the vet, in the waiting room, and even a little in the exam room. She starts open-mouth panting with quick breathing. (She has asthma, but it has been doing will. She is not on an inhaler). It breaks my heart. Vet visits have become almost as stressful for me as for them!

Even though neither of my girls had any indications of kidney issues at the time, when I was selecting a food to feed them, I made sure the phosphorous was well below Dr. Lisa's recommended cap of 300 (if it's not good for the kidneys, it made sense to me to watch it whether or not they had issues). Here is the info for Weruva Chicken Frick 'A Zee:
Protein = 50.80%
Fat = 47.20%
Carbs = 2%
Phosphorous = 174 mg per 100 kcal
Magnesium = 15 mg per 100 kcal
Potassium = 193 mg per 100 kcal
Sodium = 44 mg per 100 kcal

Based on what you said, this food should be okay, correct? I feel like I need to do something, though I would much prefer not having to change their food. That is why I am wondering if I could just add some supplements to support her kidneys at this point. I read about B12 helping and omega 3s, even potassium. I just got some krill oil that I ordered hoping it would help with her stiff back legs. I have not started giving it to her yet. I am also thinking about seeing if she will eat cooked egg whites and substituting that for some of the chicken breast she gets now (I read that the protein in the eggs is more easily processed with less waist for the kidneys to deal with).

There is just so much for me to learn before I will feel anywhere near able to make and feel confident about decisions on this. I had to become a diabetes 'expert' under duress from Mia's diagnosis, and I guess that now I have to become a CKD one as well.

You do not mention her phosphorus level, that is something you will need to monitor

In blood chemistry results, phosphorous was 5.1.

 

[Idjit's mom]

I am sorry to hear this news about Willow and I know you are distressed. I don't know very much at all about CKD, but have read that bone broth is high in phosphorus, so I don't offer that to Idjit anymore. Instead he gets the water/broth that I pressure cook boneless, skinless chicken breast (for treats and snacks). I freeze it in ice cube trays and sometimes a thawed cube is a snack too. I thaw cubes to add to his meals.
I still make bone broth, but freeze it in those foil small meatloaf/cake tins, pop them out and transfer to freezer bags. Then I have delicious chicken broth for our meals.
The Chicken Frick 'A Zee at 174 is a whole lot better than many brands, I found Tiki Cat Chicken (no fish) Koolina Luau, and Chicken (no fish) Puka Puka Luau at 149 and 154 respectively on the food chart. I have read about Tiki Cat After Dark, but it's not on the food chart, so I don't know about the phosphorus.
If you like, I can PM you some information I got from the FoodFurLife people about CKD and protein in the diet. That may not be in any direction you want to go, but it was good information about the change about low versus high protein in the renal diets. It might help.

 

[Veronica & Babu-chiri]

Based on what you said, this food should be okay, correct?

Yes in my opinion I think it would be ok.

I read about B12 helping and omega 3s, even potassium.

B complex will help as well as omega 3, those you could start giving to her and they will help as well as the B12 especilly if she has some mobility issues

But I would NOT give extra potassium unless her potassium levels in the blood chemistry came back low, and even then it has to be done with extreme caution and under vet supervision, because to much potassium is dangerous.

I am also thinking about seeing if she will eat cooked egg whites and substituting that for some of the chicken breast she gets now (I read that the protein in the eggs is more easily processed with less waist for the kidneys to deal with).

Egg whites are really a very good addition of good quality protein with very very little phosphorus so it would be great if she would eat it (not all cats like it) you could start adding just very little to her food and see if she would take it, but it has to be cooked is not good for cats raw egg white, regarding the chicken you can consider giving her chicken thighs instead of chicken breast they have less phosphorus and certainly without any bone or bone broth ( bone has a lot of phosphorus)

There is just so much for me to learn before I will feel anywhere near able to make and feel confident about decisions on this. I had to become a diabetes 'expert' under duress from Mia's diagnosis, and I guess that now I have to become a CKD one as well.

I totally get it one is never prepared when this things happen and most of us had to learn a lot really fast but like diabetes eventually one gets the hang of it even if it is with less hope than diabetes ( in my case I got a CKD diagnose for 3 of my cats with less than a month between them long story best left for another threat)

In blood chemistry results, phosphorous was 5.1.

It's ok but a bit on the high side considering she's already on a low phosphorus diet, so you will have to monitor it closely, and will probably have to consider phosphorus binders mixed with her food(I would do that rather than change her to a renal diet before it's time, I've seen those can cause them to become less active and weaker)

 

[FurBabiesMama]

have read that bone broth is high in phosphorus

certainly without any bone or bone broth ( bone has a lot of phosphorus)

Yikes! I had read that plain bone broth does not really have very much phosphorous in it. (Here is one article: https://vinccitsui.com/blog/2015/01/bone-broth-myth/#.XRFLoY9Ok-U) I give them an ice cube of bone broth in every meal, so I may need to rethink that. (Here is what made me first start making it for them: https://healthypets.mercola.com/sites/healthypets/archive/2013/12/02/pet-bone-broth.aspx) Even if it is not that high in phosphorous, it certainly has some, and because they get it so often, I can see that definitely being bad.

I would NOT give extra potassium unless her potassium levels in the blood chemistry came back low, and even then it has to be done with extreme caution and under vet supervision, because to much potassium is dangerous.

Okay, got it! Potassium was 4.2, so within normal range (3.7 is shown as the bottom of normal range).

will probably have to consider phosphorus binders mixed with her food

I'll keep a watch for hitting the point that these are needed. I saw here https://felinecrf.org/phosphorus_binders.htm that they should be used when phosphorous is over 6 or phosphorus multiplied by total calcium is higher than 70. (Currently, Willow's is 5.1 phos x 9.1 cal = 46.41.)

B complex will help as well as omega 3, those you could start giving to her and they will help as well as the B12 especilly if she has some mobility issues

Any recommendations for a B complex to give? For B12, would Zobaline (that I hear so many people talk about for neuropathy) be good? For omega3, I'm going to try the krill oil I just got.

Thank you so much for taking the time to give me your advice. It really means a lot.

 

[FurBabiesMama]

If you like, I can PM you some information I got from the FoodFurLife people about CKD and protein in the diet. That may not be in any direction you want to go, but it was good information about the change about low versus high protein in the renal diets. It might help.

Sure, I am not turning away any info that could help!

Thanks for your support.

 

[MeganEvans]

I dealt with kidney issues with another one of my cats a number of years ago. Like I'm learning with diabetes (another cat was just diagnosed this month)...it's all a dance and can take a little bit of learning and adjustment, but it is possible. My kitty was probably worse off because we didn't catch it till he crashed the first time. The vet basically gave him fluids over night and sent him home the next day & I was in a panic. Obviously I loved my Sidney (he was my very first fur baby) and wanted to do my best for him but felt like I had no real guidance or support. I found the website you mentioned.....and I can't tell you how grateful I was for it. There was so much information on there that at least gave me options. We fed him a kidney specific diet and I added binders to his food & he never seemed to mind them one bit and I feel like it made a big difference. I believe what we used was Aluminum Hydroxide---it really had no side effects and the cats can't taste it. He was also a very laid back boy so we were able to give him sub-q fluids at home on a daily basis. Yes, I was one of those pet parents who had an IV pole in my living room! We never had to fight him to give them and my husband doesn't mind needles so that was his job. I felt like it was a very careful balance of getting everything right so that he felt good, but once we had it down he had so many good days. Controlling the phosphorus levels seemed to be key for us. Another tip that I can make....Sid also had low potassium and the easiest way to get that regulated was to just have them add it to his fluid (ringer) bag. There was another way to give him potassium but it wasn't pleasant for him. Adding it to his fluids was so much less stressful for us and him since we were already poking him for that. Hopefully you won't have to deal with nuance with your Willow, but I wanted to mention it just in case. I feel like I'm kind of the mirror opposite to you. I had to get good at dealing with the kidney issues first and now I'm struggling to find my way with a diabetes diagnosis for another dear pet. They sure know how to stress us out!! I hate going to the vet because I feel like I'm more anxious than my poor pets -- I just want to make the best decisions for them & I don't like it when they aren't feeling 100%. Hang in there.....your love will see them through!!!

 

[FurBabiesMama]

I'm considering this: https://shop.mercola.com/product/2104/vitamin-b-complex-for-pets-2-1-oz-per-container-1-container
I'm scared she won't eat her food if I mix anything in though. I have never had success going that route. It looks like the dose is pretty large so I doubt I could get it in a gel cap. I wish everything fit in her size 4 gel caps! Maybe it would fit in two.

 

[Veronica & Babu-chiri]

Yikes! I had read that plain bone broth does not really have very much phosphorous in it. (Here is one article: https://vinccitsui.com/blog/2015/01/bone-broth-myth/#.XRFLoY9Ok-U) I give them an ice cube of bone broth in every meal, so I may need to rethink that. (Here is what made me first start making it for them: https://healthypets.mercola.com/sites/healthypets/archive/2013/12/02/pet-bone-broth.aspx) Even if it is not that high in phosphorous, it certainly has some, and because they get it so often, I can see that definitely being bad.

I think that for a non eating sick cat, whatever he eats is good regardless of the phosphorus or anything else it may have ,so bone broth is very good in this cases, plus is true it has very good nutrients, and for a healthy cat even Dr. Lisa's recipe includes bone (ideally) but for cats with kidney problems that is a whole other story since they do not process the phosphorus and calcium as the healthy ones

I'll keep a watch for hitting the point that these are needed. I saw here https://felinecrf.org/phosphorus_binders.htm that they should be used when phosphorous is over 6 or phosphorus multiplied by total calcium is higher than 70. (Currently, Willow's is 5.1 phos x 9.1 cal = 46.41.)

Yes she's ok for now but a bit high already for a cat eating low phosphorus diet (the bone broth may be having an influence here ) so you do have to keep a close look on it so that you can catch it early if it goes a bit higher since is usually recommended to try and keep it under 5 (ideally)

Any recommendations for a B complex to give? For B12, would Zobaline (that I hear so many people talk about for neuropathy) be good? For omega3, I'm going to try the krill oil I just got.

I've heard very good things here about Zobaline, it is not available where I live so I personaly do not have any experience with it, as for the B complex the one I use is this https://mx.iherb.com/pr/Source-Naturals-B-50-Complex-50-mg-100-Tablets/973 but I mix it with the food I prepare at home and I make big batches which makes dosing easy I think it may be tricky to dose maybe some others can give recomendatios for this

 

[Georgiana & Perlutz]

How exactly do we know how much phosphorus is in a certain food? None of the brands my kitty eats has it listed and I can't find anything about it anywhere My lil guy is also in early CKD so I'm trying to figure out what would be a good diet for him now.

 

[Veronica & Babu-chiri]

How exactly do we know how much phosphorus is in a certain food? None of the brands my kitty eats has it listed and I can't find anything about it anywhere My lil guy is also in early CKD so I'm trying to figure out what would be a good diet for him now.

If they are not in Dr. Lisa's list or Tanya's list you will probably need to contact the manufacturer and ask him directly to give you the phosphorus content % in as fed values, not the guaranteed analysis because that one usually is min, sometimes if chewee.com sells the food they can get the values for you (they have excelent service)

 

[FurBabiesMama]

How exactly do we know how much phosphorus is in a certain food?

Dr Pierson says to ask the manufacturer, "How many milligrams of phosphorus are in the food per 100 kcal?”

I assume the foods you are feeding are not on the cat food list? You would be able to get the phos there.

 

[Georgiana & Perlutz]

Dr Pierson says to ask the manufacturer, "How many milligrams of phosphorus are in the food per 100 kcal?”

I assume the foods you are feeding are not on the cat food list? You would be able to get the phos there.

No, some of his food is not on Dr Lisa’s or Helen’s (felinecrf.org) lists of foods. I guess we’re at the mercy or food manufacturers and will have to start emailing them

 

[AmandaE]

I'm not 100% sure, but I think someone on here has mentioned phosphorous binders before... I think it was @Sienne and Gabby (GA). I think they basically work by preventing the body absorb the phosphorous... Maybe you could ask your vet about it?

 

[Veronica & Babu-chiri]

I'm not 100% sure, but I think someone on here has mentioned phosphorous binders before... I think it was @Sienne and Gabby (GA). I think they basically work by preventing the body absorb the phosphorous... Maybe you could ask your vet about it?

Yes what phosphorus binders do is "bind" to the phosphorus in food so that it gets thrown away instead of absorbed, but is always better to try and control phosphorus with low phosphorus food specially if the cat is in early stages of CKD and his phosphorus levels ain't to high, if all this fails then you consider the phosphorus binders