Question about Phosphorus and Dr. Pierson's Chart

[Debbie & Mishka]

Hi Everyone,

Mishka is diabetic (of course, otherwise we wouldn't be here ). But he's also been diagnosed with chronic Kidney disease (probably stage 3). His phosphorus levels where 6.0, which on Tanya's CKD site the recommendation is that when I should take action to either (1) intro binders; or (2) lower phosphorus content in food, ideally to less than .5%. I've reviewed Dr. Pierson's food chart and she expresses Phosphorus as "mg Phos/100 kcals." How do you convert that to a percentage? Or, what mg of phosphorus is ideal for a CKD kitty? Yes, I've been to Tanya's CKD site many times, but still confused and overwhelmed. Mishka is not eating tonight and I know that I need to do something to help with the CKD progression and help him feel better. Thanks!!! Debbie

 

[Tanya and Ducia]

Hi Debbie and Mishka,
there are several members on his Board that are currently handling diabetic cats + this or that degree of a kidney "failure. "
All of them, I am confident, will share their opinion on the mater.
I have no personal experience with it but I am going to tag some people to help you out.

he's also been diagnosed with chronic Kidney disease (probably stage 3).

it will be very helpful if yo u can upload/ enter the test results here - in the LAB tab of your SS. Many on here read it like a book!

Mishka is not eating tonight

not eating at all?
or does he eat a little and then walks off?

@LizzieInTexas
@Stacy & Asia

(there are must be others, but I cannot recall the names).

@Debbie & Mishka hang in there!

 

[Stacy & Asia]

Hi Debbie, My Asia has CKD and FD, among some other things.

The kidney stuff is overwhelming. I would definitely ask your vet if they think it’s time to add phosphorous binders. There are many options, but the one that seemed like the best choice for Asia was aluminum hydroxide. I sprinkle a bit in each of her meals and mix it up well. Note, it does not do anything systemically in the cat, it binds to the phosphorous in the food itself, so it’s not dump the whole amount in one meal once a day, you put it in every meal they eat.

I can’t be much help re: calculating low p foods. I feed Asia raw and the brand I buy is particularly low in phosphorous because they use eggshell for calcium instead of bone. But here is a list of low p and low carb foods:

https://docs.google.com/spreadsheets/d/112NvvzgxEBOtkb42rA0XR8GeShw9xXs9kccf9-olK7I/pubhtml

What was his phosphorous value? High phosphorous can make them nauseous. If it’s possible, see if your vet will give you some prescriptions to have on hand in case you need them, like cerenia for nausea.

Add as much water to his food as he will tolerate, I pretty much make Asia’s food a soup. At some point, sub q fluids might enter the picture, but if you get enough water in him orally, you can try to hold that off as long as possible.

Hope he’s feeling better soon.

 

[Debbie & Mishka]

Hi Debbie and Mishka,
there are several members on his Board that are currently handling diabetic cats + this or that degree of a kidney "failure. "
All of them, I am confident, will share their opinion on the mater.
I have no personal experience with it but I am going to tag some people to help you out.

it will be very helpful if yo u can upload/ enter the test results here - in the LAB tab of your SS. Many on here read it like a book!

not eating at all?
or does he eat a little and then walks off?

@LizzieInTexas
@Stacy & Asia

(there are must be others, but I cannot recall the names).

@Debbie & Mishka hang in there!

Thank you Tanya!!! Yes, I will upload the LAB results this weekend. Mishka -- silly boy -- just got up and finished his 1/2 can of FF. I guess that is probably better than nothing!!! I am adding at least two tablespoons of water to each 1/2 can of FF. His phosphorus value was 6 last month and also in January. But in January, I didn't question the vet when he said kidney stuff was "OK." Well, it wasn't OK when Mishka starting throwing up and refusing to eat! I do have Cerenia on hand for nausea and also Entyce (appetite stimulant). But I'd like to get him eating a food that is low carb and low in phosphorus. Again, thank you so much!!!

 

[Debbie & Mishka]

Hi Debbie and Mishka,
there are several members on his Board that are currently handling diabetic cats + this or that degree of a kidney "failure. "
All of them, I am confident, will share their opinion on the mater.
I have no personal experience with it but I am going to tag some people to help you out.

it will be very helpful if yo u can upload/ enter the test results here - in the LAB tab of your SS. Many on here read it like a book!

not eating at all?
or does he eat a little and then walks off?

@LizzieInTexas
@Stacy & Asia

(there are must be others, but I cannot recall the names).

@Debbie & Mishka hang in there!

Hi Stacy -- I just posted a reply to Tanya's message which hopefully answers your questions. Thank you very much for your advice!!! When I asked the vet about phosphorus binders, he said it wasn't time -- and it could have been that was when Mishka hadn't eaten in about three days! But I plan on talking to the vet again!

 

[Tanya and Ducia]

just got up and finished his 1/2 can of FF.

His phosphorus value was 6 last month and also in January.

But I'd like to get him eating a food that is low carb and low in phosphorus.

if you are uncertain about his kidney' s health - try to NOT make the FF Classic your daily choice - it is low in carbs, yes, but also is a Phosphorous Bomb.
The low carbs/ low P could be found HERE (click).

 

[Chris & China (GA)]

Entyce (appetite stimulant)

We've dealt with a LOT of cats here that needed appetite stimulants and I've never heard of this one so I looked it up.

It does say it's for use in dogs only (although I know a lot of drugs are used off-label)

Usually we suggest cyproheptadine or Mirtazapine for kitties that need an appetite stimulant

 

[Debbie & Mishka]

Yes, I know that Entyce is mostly for dogs, but vet said it was ok for cats (off label). It really worked. Just two doses and Mishka was eating again! Vet said that there were studies on use in cats and that it was safe even given Mishka's diabetes and CKD. All I can say is that it worked, with no apparent side effects.

 

[Debbie & Mishka]

if you are uncertain about his kidney' s health - try to NOT make the FF Classic your daily choice - it is low in carbs, yes, but also is a Phosphorous Bomb.
The low carbs/ low P could be found HERE (click).

Yes, I know that FF is BAD, BAD, BAD for CKD. For the time being, I was focusing on getting him to eat, but diligently searching for a better food that he will eat.

 

[Tanya and Ducia]

s, I know that FF is BAD, BAD, BAD for CKD. For the time being, I was focusing on getting him to eat, but diligently searching for a better food that he will eat.

totally understandable!
Check out the 2017 food chart that I linked above - the Soulistic brand, sold at Petco (possible their house brand) - is acceptable - some varieties are both below 10% for low carbs and below 200 mg/ 100Kcal Phosphorous. ETA: So is Tiki Cat - Puka Puka Luau and Koolina Luau for example .
I have very strong feeling that by posting his Blood Work (BW) you might discover that his kidney's condition is not as grieve as the vet told you.. I've seen it before..shall we wait until the actual results are entered and the one to translate in to the common, the lay person English is here?
@LizzieInTexas Lizzie did an extensive and time consuming research on the CKD commercial foods - she'll giveyo u good info.

Do you add extra water to his meals?
If yes - how much a day do you think it is?
Water is very beneficial for cats - diabetic or not. Adding some to their daily meals works miracles.

 

[LizzieInTexas]

Yes, I know that FF is BAD, BAD, BAD for CKD. For the time being, I was focusing on getting him to eat, but diligently searching for a better food that he will eat.

The problem with that "theory" is that high phos can cause nausea . I have tried just about every low phos food - I am now adding phos binder. It is tasteless/odorless and seems to be helping. I am still conscious of amount of phos in the foods I get but gave up on trying the "lowest" - Gizmo just didn't care for a lot of them.

@ 6 phos level you need to strongly consider the binder but as far as foods go you can look at Gizmo's SS under the "Food" tab. I have a small list there and have others that I have bought (some I have tried some yet to try) that are not on the list on the SS yet (I attached the cheat sheet). For Dr. Lisa's list I try and stay ~250 phos and on the list from Tanya's list 1.5 (here). The issue I have is finding the food. I have resorted to ordering a case from Chewy just because it saves me so much time running around to all the pet stores. I have had the most success find the food locally at either specialty pet stores or Petco. Oh, and NO fish based. I only give fishy food when I am trying to get meds into him and then it is only a tiny, tiny amount every once in a while.

You can order the phos binder here but check with vet before giving it and for dosing.

 

[Debbie & Mishka]

The problem with that "theory" is that high phos can cause nausea . I have tried just about every low phos food - I am now adding phos binder. It is tasteless/odorless and seems to be helping. I am still conscious of amount of phos in the foods I get but gave up on trying the "lowest" - Gizmo just didn't care for a lot of them.

@ 6 phos level you need to strongly consider the binder but as far as foods go you can look at Gizmo's SS under the "Food" tab. I have a small list there and have others that I have bought (some I have tried some yet to try) that are not on the list on the SS yet (I attached the cheat sheet). For Dr. Lisa's list I try and stay ~250 phos and on the list from Tanya's list 1.5 (here). The issue I have is finding the food. I have resorted to ordering a case from Chewy just because it saves me so much time running around to all the pet stores. I have had the most success find the food locally at either specialty pet stores or Petco. Oh, and NO fish based. I only give fishy food when I am trying to get meds into him and then it is only a tiny, tiny amount every once in a while.

You can order the phos binder here but check with vet before giving it and for dosing.

Thanks Lizze. Yes, I am checking with the vet about the phosphorus binder. By "checking" I mean I'm going to tell him I want to try a binder NOW . Just kidding, he's a nice guy, but not sure that binders are necessary yet. I just have to persuade him. I'm posting Mishka's labs on the SS tonight

 

[Debbie & Mishka]

@LizzieInTexas @Stacy & Asia

I've updated Mishka's Spreadsheet to include his latest labs! thank you so very much.

 

[Stacy & Asia]

@LizzieInTexas @Stacy & Asia

I've updated Mishka's Spreadsheet to include his latest labs! thank you so very much.

Did they not do a urine specific gravity on the urinalysis? USG, the first value. It’s a useful thing to know for kidney cats how concentrated or dilute their urine is. Asia’s phosphorous was 6.8 when we started p binders, it’s currently 5.7 but I’m still trying to get it down (you can look at her labs on my SS to compare a bit, Asia was stable for a long time but ended up with a kidney infection). I think the 4.5-5 range is the goal. The higher end of the “normal” phosphorous range is only normal for growing kittens.

UTIs are common for diabetic cats, so you’ll want to mindful of that so you can treat them right away and not do further kidney damage.

I’m very glad he is eating again. Keeping his BGs as normal as you can will also go a long way to preserving his kidneys.

 

[Debbie & Mishka]

Did they not do a urine specific gravity on the urinalysis? USG, the first value. It’s a useful thing to know for kidney cats how concentrated or dilute their urine is. Asia’s phosphorous was 6.8 when we started p binders, it’s currently 5.7 but I’m still trying to get it down (you can look at her labs on my SS to compare a bit, Asia was stable for a long time but ended up with a kidney infection). I think the 4.5-5 range is the goal. The higher end of the “normal” phosphorous range is only normal for growing kittens.

UTIs are common for diabetic cats, so you’ll want to mindful of that so you can treat them right away and not do further kidney damage.

I’m very glad he is eating again. Keeping his BGs as normal as you can will also go a long way to preserving his kidneys.

Stacy -- I think his USG is 1.014.

 

[Larry and Kitties]

Stacy -- I think his USG is 1.014.

A USG that low indicates advanced kidney degradation.
Your SS list a HCT of 44% which is high for the kidney values and USG values.

 

[Debbie & Mishka]

A USG that low indicates advanced kidney degradation.
Your SS list a HCT of 44% which is high for the kidney values and USG values.[/QUOT
Thanks Larry. I guess I'm still learning how to read the labs. On Tanya's CRF website, it lists HCT values as:

PCV or HCT Level % Degree of Anaemia

Above 30 (25 at some laboratories) None
20 - 29 (25 at some laboratories) Mild
15 - 19 Severe
11 - 15 Very severe
Below 10 Critical

and the reference range listed on the lab results is 28.2 - 52.7, so I was assuming the HCT was normal. Also I don't really understand the USG value either. But have appointment with Vet on Friday with TONS of questions. thanks again.