Managing FD with CKD

[Vtambo & Rex]

Well, I finally got Rex's BG regulated after months of trying to figure out which food would be the best for him and that I could get him to eat. We were at the point where on most nights he did not even need his insulin because his numbers were well into the normal range. Even his AM preshot was in the low to mid 200's after having not had a shot for 24 hours. I was so happy, relieved, proud that we were able to achieve this. Felt like we had it dialed. Then we went to the vet for a check up. She called the next day to tell me that he is now has kidney disease and has to go on a prescription diet to slow its progression. I am devastated. Up to now I really hadn't thought that much of CKD (since I was pretty much consumed with FD) but now that I am starting to learn about it - I would take FD in a heartbeat! This is pretty devastating to me. Woke up last night with him curled up next to me and just started crying. What do I do now? How do we manage this?? He was doing so well on the diet I had put together for him. How does one manage both of these illnesses together when the diets required for each is pretty much on the opposite end of the spectrum? Was it the high protein that damaged his kidneys? so many things going through my head. any help would be so appreciated. Thanks All.

 

[Waheeda]

Well, I finally got Rex's BG regulated after months of trying to figure out which food would be the best for him and that I could get him to eat. We were at the point where on most nights he did not even need his insulin because his numbers were well into the normal range. Even his AM preshot was in the low to mid 200's after having not had a shot for 24 hours. I was so happy, relieved, proud that we were able to achieve this. Felt like we had it dialed. Then we went to the vet for a check up. She called the next day to tell me that he is now has kidney disease and has to go on a prescription diet to slow its progression. I am devastated. Up to now I really hadn't thought that much of CKD (since I was pretty much consumed with FD) but now that I am starting to learn about it - I would take FD in a heartbeat! This is pretty devastating to me. Woke up last night with him curled up next to me and just started crying. What do I do now? How do we manage this?? He was doing so well on the diet I had put together for him. How does one manage both of these illnesses together when the diets required for each is pretty much on the opposite end of the spectrum? Was it the high protein that damaged his kidneys? so many things going through my head. any help would be so appreciated. Thanks All.

Sorry to hear about Rex. But don't worry cos there are many members here with experience with cdk cats who can give you good advice. Im tagging @JanetNJ and @Marje and Gracie who have experience.
My cat was diagnosed with cdk just as his diabetes was well controlled. I was devastated just like you. Three weeks later, he's in remission and guess what? He has heart failure. I'm doubly devastated. So many thoughts going through my head these few days that I'm going crazy.

 

[JanetNJ]

Well, I finally got Rex's BG regulated after months of trying to figure out which food would be the best for him and that I could get him to eat. We were at the point where on most nights he did not even need his insulin because his numbers were well into the normal range. Even his AM preshot was in the low to mid 200's after having not had a shot for 24 hours. I was so happy, relieved, proud that we were able to achieve this. Felt like we had it dialed. Then we went to the vet for a check up. She called the next day to tell me that he is now has kidney disease and has to go on a prescription diet to slow its progression. I am devastated. Up to now I really hadn't thought that much of CKD (since I was pretty much consumed with FD) but now that I am starting to learn about it - I would take FD in a heartbeat! This is pretty devastating to me. Woke up last night with him curled up next to me and just started crying. What do I do now? How do we manage this?? He was doing so well on the diet I had put together for him. How does one manage both of these illnesses together when the diets required for each is pretty much on the opposite end of the spectrum? Was it the high protein that damaged his kidneys? so many things going through my head. any help would be so appreciated. Thanks All.

Don't panic! When treated cats can live good quality months to YEARS with kidney disease!!!

Don't switch foods.... But depending on the phosphorus levels you may add aluminum hydroxide phosphorus binder to the food. It's tasteless. Unless your cat is stage 4, there is no reason to go low protien. It's the phosphorus you wanna keep down.

The number one thing you can do to make him feel good and slow the progression is at home sub q fluids!!!! My cat Zimmy loved getting them because he felt lasso good afterwards.
He started getting fluids at stage 2 and the disease didn't progress at all for 18 months until he died of something else.

Can you post a copy of the labs so we can give specific advice? Also there is a great ckd forum on Facebook in on called Cats with Chronic Renal Failure. Very knowledgeable group.

 

[Veronica & Babu-chiri]

Hi I totally understand you, I was still celebrating Babu's OTJ party when the vet told me he had CKD.

First of all don't give him the CKD prescription diets since they all are seriously high in carbs, and you do not want to mess with his diabetes, uncontrolled diabetes will make his CKD worse., but you can look for a low carb low phosphorus food (take a look at Dr. Lisas list you will probably find one ), that by itself will help him. CKD cats do not necessarily need to go on a low protein diet it depends on his stage

It would help to know in what stage is Rex, stage is determined mainly by his Creatinine level and some other factors like his blood pressure your vet can help you determine his stage and that will help you determine what other measures you can take

This is a site with tons of very good information Http://www.felinecrf.org/index.htm

 

[TempestsMum]

God love you, I'm in the same boat, seems this is more common than I thought. Just try to stay positive if you can. I'm doing my best just to get on with 'this hurdle'. All we can do is our best. Nothing more. I don't think it's anything we have done, it's just one of those things.

 

[JanetNJ]

God love you, I'm in the same boat, seems this is more common than I thought. Just try to stay positive if you can. I'm doing my best just to get on with 'this hurdle'. All we can do is our best. Nothing more. I don't think it's anything we have done, it's just one of those things.

Ckd in older cats is very common.

 

[Marje and Gracie]

@Vtambo & Rex

I'm very sorry for the diagnosis but there are many things that can be done to help CKD kitties live a long time with a good QOL. It would be extremely helpful to see his labs so I can get an idea of what stage he is in and what some of the other values are that you need to watch with CKD.

There are other diets you can feed; the prescription diets are too high in carbs for diabetic cats but we have Food lists for foods that are lower carb, lower P that you can choose from.

I want to be sure and stress that phosphorus needs to reach a certain level before you start giving P binders because, if your sweet boy is like my kitties and I hope he is, CKD kitties can live a long time and be very stable and if you start binders before they are warranted, you can potentially end up with some toxicity issues. I would strive for a food that is absolutely lower than 1.00% P in a dry matter basis or less than 200 mg P/100 kcal. The lower you can get on the P, the better.

The number one thing you can do to make him feel good and slow the progression is at home sub q fluids!!!! My cat Zimmy loved getting them because he felt lasso good afterwards.
He started getting fluids at stage 2 and the disease didn't progress at all for 18 months until he died of something else.
.

I've had four CKD cats and the best advice is that, unless there is some crisis management that needs to be done or some other concurrent illness requiring it, you don't start subq fluids on a cat until the creatinine is above 3.5. It's best for CKD cats to get as much fluid as possible through drinking water or having it added to their food until the point where they aren't able to keep up which is generally about 3.5 on the creatinine. Some vets even recommend waiting longer.

It is possible to overhydrate a cat. My best recommendation is to, first, do what I did with all of mine....have an echocardiogram done and be sure the heart is normal. Cats can easily hide heart disease until it's really bad and you don't want to be overloading a compromised heart with fluids.

IF the heart is ok but you start fluids too soon, you risk building scar tissue from the needles even if you use a smaller gauge needle and rotate the site. I've given fluids to a cat every single day for over four years....that's a long time....and was lucky he didn't get scar tissue.

I can give you a lot of tips and info but really need to see the labs first. If you can add them to the lab tab on his SS and then tag me, I'll take a look and give you some advice.

 

[Vtambo & Rex]

Sorry to hear about Rex. But don't worry cos there are many members here with experience with cdk cats who can give you good advice. Im tagging @JanetNJ and @Marje and Gracie who have experience.
My cat was diagnosed with cdk just as his diabetes was well controlled. I was devastated just like you. Three weeks later, he's in remission and guess what? He has heart failure. I'm doubly devastated. So many thoughts going through my head these few days that I'm going crazy.

I am so sorry to hear about your poor baby's heart condition, and all the other stuff. I know how hard all of this is. deep sigh. Thank you for your reply to my post and for getting others involved.

 

[Vtambo & Rex]

thank you to all of you who replied. I am so happy to get advice from people who have had experience with this situation and who have the emotional connection with their animals. I feel like since the vets don't have that connection they just tell what they learned in the books (if that makes sense). My current vet of course right away jumped on the "prescription" food wagon. And she kind of insisted that he "NEEDED" to be on this food and that his diabetes has now become secondary and we would have to manage the diabetes with increased insulin dosages "at some point". Wel, well, well - I of course am freaked out by all of this (again) and don't know what else to do at the time, so BOUGHT the "sample" pack of kidney diet foods (which cost me $40 - I was always under the impression that "sample" meant it was free...... - silly me.) anyway, yesterday was the first day I gave him the "kidney" food. I expected that his BG would go up some, but wow was I surprised last night when I tested him - 429. Holy crap. He has not been that high for MONTHS. I of course freaked out thinking if ONE can of this stuff can do this to him, what the heck is it going to be like feeding this to him on a regular basis??? So last night at bedtime I gave him his regular "diabetes" food, however I put out a bowl of the "kidney" dry food out mixed with a little of his diabetes dry food (I always give him Young Again on the side at night so he does not continually wake me up all night - but usually he only eats a very little bit of it). well apparently the kidney dry food must have smelled REALLY good because he ate pretty much of it. Guess what - this AM when I tested him his BG was 486. that is the highest is has EVER been - EVER! if these numbers are coming after ONE DAY on this stuff, how is this an option?? Ok. now I am upset. We are supposed to be going out of town this weekend. I had arranged for someone to come in to give him his insulin, however I had only been giving him insulin 1x per day on most days because he was so well controlled that his night time shot was almost always not necessary, so I was planning on that person to come only in the AMs. Now I feel like since he is back to being unregulated, I will have to tell her she has to come at night too. and I know I will worry all weekend that something is going on. Ugh. I could "talk" forever here. However, last night I had a bit of time to start doing some research and I think I am realizing once again that there are much better options out there. Unfortunately this time of year is so bad as far as how much time I have to do the research. I have a feeling that much of our weekend away will be spent online trying to do this research.

I guess one question I have is - how fast do I have to move on this?? is this something critical? I don't think I will have time to be able to post the results because I would have to figure out how to do that and that could take a while..., however I can just give you some right here - I will give the ones that say they are high, or that are probably important.

Albumin 4.1 (should be 2.5 - 3.9) I think she said this signifies dehydration.
BUN 59 (should be 14-36)
Creatinine 2.9 (should be 0.6-2.4)
BUN/creatinine ration 20 (this one is not high - should be 4-33 - but thought it might be important)
Phosphorus 5.6 (again not high - should be 2.4-8.2 - but thought might be important)
Glucose 158 (well it WAS good on the day of the visit)!
Sodium 155 (should be 145-158)
Potassium 4.8 (should be 3.4-5.6)
cholesterol, triglyceride and amylase were all high, but he had just eaten before the vet visit - do these make a diff?

Urine -
Ph was 5.5 (i think that is little acidic)
specific gravity 1.022 (should be 1.015-1.060)
Protein in urine - trace
No ketones, or glucose in urine
some blood in urine - not visible - she said he has kidney stones

i have been making every effort to try to get him to drink as much as possible. he loves broth (Wellness Core) so have been putting that on his food (of course i went back to the "diabetes food")

anything i have missed. I will try to get asap.

thank you all again! so much.

 

[JanetNJ]

thank you to all of you who replied. I am so happy to get advice from people who have had experience with this situation and who have the emotional connection with their animals. I feel like since the vets don't have that connection they just tell what they learned in the books (if that makes sense). My current vet of course right away jumped on the "prescription" food wagon. And she kind of insisted that he "NEEDED" to be on this food and that his diabetes has now become secondary and we would have to manage the diabetes with increased insulin dosages "at some point". Wel, well, well - I of course am freaked out by all of this (again) and don't know what else to do at the time, so BOUGHT the "sample" pack of kidney diet foods (which cost me $40 - I was always under the impression that "sample" meant it was free...... - silly me.) anyway, yesterday was the first day I gave him the "kidney" food. I expected that his BG would go up some, but wow was I surprised last night when I tested him - 429. Holy crap. He has not been that high for MONTHS. I of course freaked out thinking if ONE can of this stuff can do this to him, what the heck is it going to be like feeding this to him on a regular basis??? So last night at bedtime I gave him his regular "diabetes" food, however I put out a bowl of the "kidney" dry food out mixed with a little of his diabetes dry food (I always give him Young Again on the side at night so he does not continually wake me up all night - but usually he only eats a very little bit of it). well apparently the kidney dry food must have smelled REALLY good because he ate pretty much of it. Guess what - this AM when I tested him his BG was 486. that is the highest is has EVER been - EVER! if these numbers are coming after ONE DAY on this stuff, how is this an option?? Ok. now I am upset. We are supposed to be going out of town this weekend. I had arranged for someone to come in to give him his insulin, however I had only been giving him insulin 1x per day on most days because he was so well controlled that his night time shot was almost always not necessary, so I was planning on that person to come only in the AMs. Now I feel like since he is back to being unregulated, I will have to tell her she has to come at night too. and I know I will worry all weekend that something is going on. Ugh. I could "talk" forever here. However, last night I had a bit of time to start doing some research and I think I am realizing once again that there are much better options out there. Unfortunately this time of year is so bad as far as how much time I have to do the research. I have a feeling that much of our weekend away will be spent online trying to do this research.

I guess one question I have is - how fast do I have to move on this?? is this something critical? I don't think I will have time to be able to post the results because I would have to figure out how to do that and that could take a while..., however I can just give you some right here - I will give the ones that say they are high, or that are probably important.

Albumin 4.1 (should be 2.5 - 3.9) I think she said this signifies dehydration.
BUN 59 (should be 14-36)
Creatinine 2.9 (should be 0.6-2.4)
BUN/creatinine ration 20 (this one is not high - should be 4-33 - but thought it might be important)
Phosphorus 5.6 (again not high - should be 2.4-8.2 - but thought might be important)
Glucose 158 (well it WAS good on the day of the visit)!
Sodium 155 (should be 145-158)
Potassium 4.8 (should be 3.4-5.6)
cholesterol, triglyceride and amylase were all high, but he had just eaten before the vet visit - do these make a diff?

Urine -
Ph was 5.5 (i think that is little acidic)
specific gravity 1.022 (should be 1.015-1.060)
Protein in urine - trace
No ketones, or glucose in urine
some blood in urine - not visible - she said he has kidney stones

i have been making every effort to try to get him to drink as much as possible. he loves broth (Wellness Core) so have been putting that on his food (of course i went back to the "diabetes food")

anything i have missed. I will try to get asap.

thank you all again! so much.

He needs a phosphorous binder. Aluminum hydroxide powder added to all food. You want to get that phosphorus level down.

 

[Veronica & Babu-chiri]

I hope some of the more experienced in this matters hope in aince I'm just starting to learn but for what I've been learning, Rex numbers do not seem very bad, and if he has kidney stones that may be the reason of this numbers, and I'm guessing that could be treatable.

Your vet is acting on the idea that since you can control the amount of insulin he's getting it doesn't matter if his numbers go high, and well we know high numbers cause a lot of trouble and will damage his kiddneys more.

I think his numbers are not bad enough to start him on prescription CKD diets that would mess with his DB, also I don't think his phosphorus level is high enough to start him on phosphorus binders, I do suggest you take a look at the list that Marge suggested and change him to a low carb low phosphorus diet so that this number doesn't go any higher and hopefully goes down a little controlling phosphorus is important.

For Babu and in my case one of my civies (diagnosed practically at the same time) I m stating to home cook since no commercial options are available down here and that will also allow me to control the protein they are getting not so much less protein but better one

 

[Vtambo & Rex]

He needs a phosphorous binder. Aluminum hydroxide powder added to all food. You want to get that phosphorus level down.

interesting because when I asked the vet about this, she said we don't knee to worry about phosphorus. we need to concentrate on low protein. where do I get a phosphorus binder? and what is the number we are shooting for? can you give me commercial food recommendations? what do I look for on the food label that will tell me about how much phosphorus is in the food?

 

[JanetNJ]

interesting because when I asked the vet about this, she said we don't knee to worry about phosphorus. we need to concentrate on low protein. where do I get a phosphorus binder? and what is the number we are shooting for? can you give me commercial food recommendations? what do I look for on the food label that will tell me about how much phosphorus is in the food?

You don't need low protien until stage 4.... High quality protien, but not low protien. Otherwise you will get muscle wasting. The phosphorus is more important as high phosphorus will progress the disease faster and just generally make them feel icky often leading to a diminished appetite.

 

[JanetNJ]

Here's a link to info about ckd and phosphorus

http://www.felinecrf.org/phosphorus.htm

 

[Marje and Gracie]

If you look above in my post #7, I linked a food list for low P, low carb foods. You can also look at Tanya’s Canned Food list as she also lists carbs. But it’s sorted by P levels.

I always bought my aluminum hydroxide powder at ThrivingPets.com. It goes in the food, not given directly to the cat. The link Janet gave you will talk about dosing based on Stage and P level.

It shouldn’t take you more than 10 mins max to add the labs to his SS. I already have the ranges in there for normal so just check to make sure your lab uses the same or modify them. It’s really important for us to look at the big picture and not just a few numbers here and there. There are other values I’d like to see.

 

[Vtambo & Rex]

If you look above in my post #7, I linked a food list for low P, low carb foods. You can also look at Tanya’s Canned Food list as she also lists carbs. But it’s sorted by P levels.

I always bought my aluminum hydroxide powder at ThrivingPets.com. It goes in the food, not given directly to the cat. The link Janet gave you will talk about dosing based on Stage and P level.

It shouldn’t take you more than 10 mins max to add the labs to his SS. I already have the ranges in there for normal so just check to make sure your lab uses the same or modify them. It’s really important for us to look at the big picture and not just a few numbers here and there. There are other values I’d like to see.

i'll give it a whirl...

 

[Marje and Gracie]

i'll give it a whirl...

Thank you ....it's an excellent way to keep track of his kidney values...as well as others. I keep the same SS for my cats...even the two healthy ones I have now. It just lets me catch any change really fast.

 

[Vtambo & Rex]

I am so sorry. I tried. when I access Rex's spreadsheet from this page, I cannot enter anything. I have to go to my google.docs account and search around on there until I find. I am thinking that is not supposed to work that way. also when I open here there is a tab that says LABS. I don't have that when I go to my google.docs copy of the spreadsheet. I did update his spreadsheet on my google.docs account and the info did transfer over to here. I really don't know what I am doing when it comes to this stuff. I did scan his labs and will attempt to attach a copy here. Again, I am sorry for my ignorance. I really hope you can read it.

 

[Marje and Gracie]

I am so sorry. I tried. when I access Rex's spreadsheet from this page, I cannot enter anything. I have to go to my google.docs account and search around on there until I find. I am thinking that is not supposed to work that way. also when I open here there is a tab that says LABS. I don't have that when I go to my google.docs copy of the spreadsheet. I did update his spreadsheet on my google.docs account and the info did transfer over to here. I really don't know what I am doing when it comes to this stuff. I did scan his labs and will attempt to attach a copy here. Again, I am sorry for my ignorance. I really hope you can read it.

You can’t add anything to the SS from within FDMB....at least, you have it set up right, you should not be able to do that. On google, all spreadsheets are now on google drive. So if you go to your google drive, open it, open his SS, and the lab tab will be there. Promise. Google moved all google sheets from google docs to google drive a couple years ago.

If you aren’t able to do it, I’ll have to come back later to go through that lab report. Generally, my vet has it all concisely printed on one sheet so you don’t have to go back and forth.

 

[Vtambo & Rex]

thank you! I had no idea about Google Drive. I did input all the data in there. the other vet I used to see also had all the info on one page. not sure why this one sent it this way. they are in the same clinic. ???

 

[Vtambo & Rex]

well, here is some good news - I just tested Rex this AM and his BG is down to 149. So glad. I was so afraid that this little bout with the kidney food would take me a while to get regulated again. Now I just have to decide when to give his insulin. We are leaving this morning to go out of town for the weekend. since he had been doing so well up to a few days ago, and I had been giving him usually only one shot a day depending on where he tested, I was going to have someone come just once a day (AM) to give him his shot. I would rather just do the one shot a day than worry that he goes too low and nobody is around to catch it. anyway, I know I need to give him a shot before we leave because he will not get one again until tomorrow AM, but should I wait until the last minute (late AM today)?

 

[Vtambo & Rex]

also had a couple of other thoughts about the CKD. when we were at the vet last week they did an ultrasound prior to collecting urine and the vet said she saw that he had kidney stones. could that be influencing the blood test/urine test results? I read that if you put a little apple cider vinegar in the water or food it can help dissolve the stones. I have been doing that. I did a test strip the other day on his urine and it indicated that the blood in urine was significantly less so not sure if coincidence or if the ACV is helping. also, the last time Rex had this bloodwork done was I believe back in January 2017 when he was initially diagnosed and the vet I was seeing at the time was dragging her feet on treatment for quite some time before I finally just gave up on her and sought out another vet (current one - started seeing her in mid-June) who finally increased his insulin dosage which is what helped him to get regulated. is it possible that during the time when he was so out of regulation and I was consistently getting ever increasing numbers in the high 300's and sometimes 400's that the kidneys could have been compromised at that point and now since he is much better regulated those numbers will come down?

 

[Veronica & Babu-chiri]

I'm not sure anyone can really say what affected Rex's kidneys could had been DB, age, genetics, an infection, the stones, there's really no way of knowing.

Regarding dissolving the stones, some can be disolved but not all of them you will need to determine what kind of stones are before trying anything and check with your vet about it

Here's a link to some very useful information about kidney stones http://www.felinecrf.org/kidney_stones.htm#symptoms

 

[Larry and Kitties]

they did an ultrasound prior to collecting urine and the vet said she saw that he had kidney stones.

Where the stones in the bladder? Or in the kidneys?
Stuvite crystals which can form stones tend to form when the urine is to basic (high pH value). They can be dissolved by acidifying the urine. Frequently just adding an acid like vinegar to the diet does NOT acidify the urine.
Oxalate stones tend to form when the urine is too acidic Making the urine more basic does NOT dissolve oxalate stones.
Stones will have slight effect on blood work results. Frequently stones can cause blood in the urine

 

[Vtambo & Rex]

You can’t add anything to the SS from within FDMB....at least, you have it set up right, you should not be able to do that. On google, all spreadsheets are now on google drive. So if you go to your google drive, open it, open his SS, and the lab tab will be there. Promise. Google moved all google sheets from google docs to google drive a couple years ago.

If you aren’t able to do it, I’ll have to come back later to go through that lab report. Generally, my vet has it all concisely printed on one sheet so you don’t have to go back and forth.

Back from vacation. Have you had any time to take a look at Rex's labs? I was not really able to do any research while away since I did not an internet connection. I did have a book that I was able to take some notes from. Mainly herbal stuff. Not sure that I would be able to get any in him.