Sorry to just get back to you on the labs. I had a few things come up yesterday/last night and didn’t have a chance to get back on the board.
You asked me this question in yesterday’s condo regarding probiotics:
Side effects of probiotics? I’ve never seen any except if people give high doses of
Saccharomyces boulardi which can cause diarrhea. That would not be the one you’d want to use anyway. You’re just looking for a good quality, human, maintenance probiotic. I do not know what you mean by “eliminate the proteins in his kidneys”. His serum protein levels are fine. You haven’t posted any urine values. Do you have any that show he has protein in his urine or has proteinuria? If a vet has told you to feed a CKD a low protein diet, that is very old school. While at very advanced stages of CKD, we don’t want to feed massive amounts of protein, current research indicates that CKD cats generally need good quality protein (about 35-40% of calories from protein is good).
He’s at the early stages of CKD so at this point, you want to be feeding foods that are lower in P. We look for levels that are less than 200 mgP/100 kcal or less than 1.00%P on a dry matter basis. If you look at the “New to the Group” Sticky, there are food charts linked for low P, low carb diets.
Regarding the hematocrit, anything below 30% is considered anemia but treating it aggressively does not usually occur until it gets below 20%. The reason CKD cats are prone to anemia is because the kidneys produce the hormone erythropoietin which causes the bone marrow to make red blood cells. Kidneys need B vitamins to make erythropoietin. CKD cats pee a lot and excrete a lot of the B vitamins. Therefore, you can usually slow down the process towards anemia and avoid using the heavy guns when it goes below 20% by giving methylcobalamin (B12) and multi B vitamins orally.
Here is an excellent discussion on the B vitamins needed and dosing. I’ve had three cats with CKD and one with PKD (which is a different monster but presents as CKD) and with the three that just had CKD, I was able to keep their hematocrit up around 28%. None of those three passed from CKD and were stable with it for a very long time.
One thing you might consider discussing with the vet and starting him on is
calcitriol (scroll down on the page till you see it). It used to be that calcitriol was used when a CKD cat was diagnosed with secondary hyperparathyroidism (which is not the same as hyperthyroidism). It was given daily at a fairly high dose and blood chemistries had to be monitored closely. Now, the trend is changing and, because this condition is quite common in CKD cats, calcitriol is often given at a small dose, twice a week, or even pulse dosed to prevent the condition and also to help the kitty feel better, in general. While calcitriol given daily at higher doses can potentially increase Ca levels, given twice a week at a low dose does not seem to have an effect on the Ca levels. If your vet is not up on this new trend, you might have a hard time convincing him/her. The link I gave you above has a good discussion and gives links to studies that might help you discuss this better with the vets.
