? What do I feed when one is diabetic and one has CKD?

[Daddy Jack's Mommy (GA)]

My oldest fur baby (Celie, my 14 year old calico) was just diagnosed with CKD. I have no idea what I should feed her. My vet recommended rx canned food. I said no. I told her that I now feed Fancy Feast (and Dave's canned food), and she said to keep doing that. I'll also be giving her sub-q fluids 3x a week. Although I have given fluids to my dog many years ago, my experience with CKD is zero. I want to make the right choices for her health and well being. I also want her to continue being the happy little girl that she is, so I wonn't sacrifice quality of life to keep her alive.
I was seriously considering making my own cat food, and then yesterday I learned about Celie. Now I'm unsure of what to do next. Homemade food is high in protein, and Celie needs lower protein. But I'm not convinced that it has to be as low as those rx foods (at roughly 20% protein). I read an article (an interview) with Dr Pierson yesterday, and she said she is appalled at how low the protein is in CKD diets. She stated that 40% protein is sufficient, as compared to the 60% and higher that they eat in the wild. Fancy Feast is 40% protein, so I lucked out with that one. Or have I? I have found some recipes for homemade cat food for those with CKD, but all of them are high in carbs, and Jack can't do carbs. None of them should do carbs.
I don't know where to go from here. Have any of you made homemade food for a cat with CKD? Did your other cats eat that as well? I need to find a diet that all 5 can eat, as my life style and circumstances would not lend themselves to feeding them different foods. They won't even use their own bowls, for crying out loud! They walk around and take turns eating from all of them.
I would love any information, suggestions, or ideas on how to best manage her diet and how I can make her life easier for her.
Thank you.
~ Carolyn

 

[Sharon14]

Did your vet say what stage she is in? A cat with CKD needs a low phosphorus food. Fancy Feast is very high in phosphorus so I wouldn’t use that for Celie. Making your own food would be a good idea. Just be sure the supplement you use gets calcium from eggshells rather than bone, which would be too high in phosphorus. @Idjit's mom can give you some info on homemade. If you decide instead on canned for all, look for low carb, low phosphorus (under 200 on Dr Lisa’s chart). If you have her bloodwork results, you can post them here for more info. Here’s a great site on CKD
https://www.felinecrf.org/

 

[Idjit's mom]

Did your vet say what stage she is in? A cat with CKD needs a low phosphorus food. Fancy Feast is very high in phosphorus so I wouldn’t use that for Celie. Making your own food would be a good idea. Just be sure the supplement you use gets calcium from eggshells rather than bone, which would be too high in phosphorus. @Idjit's mom can give you some info on homemade. If you decide instead on canned for all, look for low carb, low phosphorus (under 200 on Dr Lisa’s chart). If you have her bloodwork results, you can post them here for more info. Here’s a great site on CKD
https://www.felinecrf.org/

Hi Sharon, I have already told Carolyn about the FoodFurLife product I use. But she is concerned about the protein %, since her vet recommends low protein. I remember reading something about that being a more outdated approach, but I can't seem to find just where. I think I would be concerned with a low protein diet, since just to my thinking, if there isn't enough protein then would the body begin to break itself down to get enough? I just don't know enough about CKD at this point.
Oh, I just remembered where, it was an email from the FFL folks. I will try to get that info to Carolyn for her consideration.

 

[Idjit's mom]

Carolyn, this is the response I got when I contacted FoodFurLife about my concerns with phosphorus and preventing kidney disease.

Regarding your question about phosphorus, the typical guidance for phosphorus in earlier stages of CKD is to feed a food that is less than 1% phosphorus on a dry matter basis, or less than 250mg phosphorus per 1,000kcal. EZComplete is both.

The Veterinary / Rx renal diets typically have phosphorus at lower than AAFCO (which minimum is 0.5% on a dry matter basis). But they achieve this by trading protein for carbohydrates.

If you want to feed a low carb diet, then yes, raw is your best option. In a traditional raw diet with bone, the phosphorus is over 2% on a dry matter basis. This is because bone is used as the source of calcium - but it is also the largest repository of phosphorus in the body. By removing the bone and replacing it with an alternate source of calcium like eggshell (which is what EZComplete premix powder uses), this alone reduces the food to less than 1% phosphorus on a dry matter basis, typically to 0.8% - 0.9% DMB if using very lean meats. You can lower the phosphorus further by using fattier cuts of meat.

That said, Laurie has had 5 CKD cats since she transitioned her cats to raw 7 years ago (half of her crew were seniors when they transitioned), and she now has 2 and Carolina has 1. We've both tried feeding low protein in order to lower phosphorus further (because outside of bone, the organs and meat are the source of phosphorus, which is why the Veterinary / Rx renal diets replace meat with carbs). Lowering phosphorus further in a homemade diet is actually quite easy to do with food made with EZComplete by adding fattier cuts of meat, as mentioned above. If you target 15% fat as fed, the food will have about has much phosphorus as the Rx diets (below the AAFCO minimum), and protein will be around 40% on a dry matter basis - not quite as low as the Rx foods, which are around 30%. At about 10% fat as fed (with food made with EZComplete), the protein will be just about 50% on a dry matter basis. BUT. But it turns out that - in our experience - phosphorus really isn't the only consideration in an ideal CKD food, unless your kitty is late stage 4 or in kidney failure. Again, based on our experience.

We went back to feeding mostly lean meats. Doing extensive research, we learned why our cats do better on the higher protein diet: senior cats need MORE protein, not less. Over time, on the higher fat diet, our cats got weaker in the back end. That's muscle wasting. In a referenced piece by Dr. Mark Peterson, one of the most widely recognized small animal endocrine specialists in the world, he walks through the known needs of senior cats from published studies. It turns out, based on that info, senior cats need a minimum of 53% protein (dry matter basis) to prevent muscle wasting. So we weren't imagining it when our observation was our cats did better on a high protein diet. https://endocrinevet.blogspot.com/2011/11/optimal-protein-requirements-for-older.html

Dr. Becker has a referenced article on a study conducted in cats, designed to determine if low protein made a difference in CKD. It turns out, protein control does not impact CKD, where phosphorus control does: https://healthypets.mercola.com/sites/healthypets/archive/2018/02/13/feeding-senior-cats.aspx

So we both feed food made with EZComplete to our cats, using a rotation of chicken breast (lean), chicken thigh (fattier than breast), pork loin (lean), pork shoulder (very fatty), turkey breast (lean) or thigh (fattier), and Laurie uses fatty cuts of beef (chuck beef) and very lean cuts of beef (like top round), and each of us typically feed 2 of 3 meals a day to our cats that are lean, and one that is made with fattier meat.

What we do is control phosphorus by using a specific form of vitamin B3, niacinamide. Laurie lost her 3 prior CKD cats to problems unrelated to the CKD, and the current two have been completely stable for 1.5 years since diagnosis with this approach. Carolina's CKD cat also has hyper-T, IBD, megacolon and a hiatal hernia, and he's been completely stable for two years. Totally stable! Some of it luck-of-the-draw genetically. But this approach has been serving our kitties well.

We hope this helps, please let us know if you have any further questions.

Best Regards,

Laurie & Carolina

 

[Sharon14]

concerned about the protein %,

That’s why I asked what stage CKD. Early stages you don’t restrict protein, but I’m not sure what stage you start. I’m sure the link to Tanya site will have that info.

 

[Chris & China (GA)]

If you post your lab results, we can help determine the stage of CKD. My vet told me similar stuff to what your vet told you but when I posted the lab results I got, @Marje and Gracie (who is a WHIZ at reading test results) assured me that China did not need sub-q fluids yet and she wasn't as "sick" as the vet would have had me believe.

 

[Daddy Jack's Mommy (GA)]

@Sharon14 @Idjit's mom @Chris & China (GA)
I so appreciate that all of you have responded. I'm overwhelmed. I'm going to attempt to upload pictures of the test results. I hope this works...
The vet said that the elevated EOS indicates allergies, which may explain why she scratches her ears and nose to the point of hurting herself sometimes. I took her to the vet because she has been vomiting, she has lost some weight, and I also wanted to see what was going on with her ears. I don't have a copy of the urinalysis, but the vet said that it indicated there is no protein in her urine and nothing of concern in that test. I'll get a copy next time I see her.

 

[Daddy Jack's Mommy (GA)]

@Idjit's mom
Thank you for putting my mind at ease, and for taking the time to give me such a detailed explanation. I had sent FoodFurLife a request through their contact tab (on the website) to inquire about using this product for cats with CKD. I have not yet checked my email to see if they responded. But your email gives me my answer. I am so relieved to know that I can prepare food for all of them this way, and that it will benefit all 5 of my cats. There's no doubt in my mind that this is the best option and that this is what I will do. Thanks also for explaining what meats you use, as I was curious to know how to proceed first and worried about getting meats that were harder to find or more expensive. Chicken, turkey, and pork... it's all easy.
And I greatly appreciate the links to the studies.

What we do is control phosphorus by using a specific form of vitamin B3, niacinamide.

Do you include this vitamin in their food?

Best Regards,

Laurie & Carolina

And now I will ask you the silliest questions of all (and I feel a bit embarrassed to ask)...
Who are Laurie and Caroline? I thought your name was Lou. Am I mistaken? There are soooo many names of humans and cats, and I'm beyond terrible with names to begin with.

 

[Chris & China (GA)]

Who are Laurie and Caroline?

They're the makers of the FoodFurLife product.

They are also the ones that "control phosphorus by using a specific form of vitamin B3, niacinamide." (that's all part of their reply to her original email)

 

[Daddy Jack's Mommy (GA)]

They're the makers of the FoodFurLife product.

They are also the ones that "control phosphorus by using a specific form of vitamin B3, niacinamide." (that's all part of their reply to her original email)

Ha ha ha ha ha ha ha ha!!!!!! I had, at one point, thought that it switched to Lou's story. Thank you for explaining that!

 

[Idjit's mom]

@Chris & China (GA) thank you for making that clear.
@Daddy Jack's Mommy sorry, I guess I should have formatted the response in Italics. I was just so proud of myself for remembering where that info was and then locating it. But you never know, I might have a secret alternate identity or two! (Chris does)
I also use beef chuck. It's not Idjit's favorite and so I mix the chicken breast and beef half and half per serving. He has refused the pork by itself so far, I'm glad I only made a very small amount. I had to use it up by sneaking in very small amounts into his chicken dishes.

 

[Daddy Jack's Mommy (GA)]

I was just so proud of myself for remembering where that info was and then locating it.

To be honest, I was impressed with that myself!

But you never know, I might have a secret alternate identity or two! (Chris does)

 

[Marje and Gracie]

I’m not able to look at the labs and post tonight but I will in the morning if that’s ok. My apologies and thanks for your patience.

 

[Daddy Jack's Mommy (GA)]

I’m not able to look at the labs and post tonight but I will in the morning if that’s ok. My apologies and thanks for your patience.

That's absolutely fine! I appreciate

I’m not able to look at the labs and post tonight but I will in the morning if that’s ok. My apologies and thanks for your patience.

No worries! I appreciate your help, and had no expectation of the time frame.

 

[Marje and Gracie]

@Daddy Jack's Mommy

I’ve had three cats with CKD and one with polycystic kidney disease which presents as CKD but it is quickly fatal once the numbers start to rise. The other three cats with CKD all passed from something else and were stable with CKD for a very long period of time.

Lou posted some great info from Laurie and Carolina who are friends of mine and very knowledgeable about CKD.

Celie appears to be in Stage 2. Was a urine test done? I’d be interested in seeing her urine specific gravity. I agree totally with what has been posted on RX diets for CKD. They are way too low in protein. Yes, their benefit is being lower in phosphorus than you can generally get to with other foods but then ingredients are also terrible. With a cat with CKD, you want a really good quality diet with excellent protein and lower in P. I totally agree that, if you can get your kitties to eat raw with EZ Complete, you’ll be giving excellent protein and lower P.

However, when the P gets to be over 6 like Celie’s is, you have to be more proactive. It’s odd to see a cat in Stage 2 with such a high P level. She needs to have a binder on her food now. The best one, IMHO, is aluminum hydroxide. It’s a tasteless powder and you mix a bit of it in with each serving of food to bind the P in the food. Even with the lower P level of EZC, you can’t usually get the P level to drop significantly without a binder and her P level should be more around 4-4.5. The other concern is that when Ca x P is approaching 70, then we worry about tissue calcification so it’s really important to get the P down.

Here’s a great discussion on Phosphorus control. Here’s what you need to know about phosphorus binders and how to dose them. I always used the aluminum hydroxide from Thriving Pets.

Subq fluids are not usually started until the creatinine is 3.5 and, some vets specializing in CKD, believe even higher. Celie should get as much water from drinking and from what you add to her food. Once the creatinine gets above 3.5, it’s a signal that she can’t keep up with hydration but she’s not there yet. One main reason to not start subq fluids too early is that some cats are stable with CKD for many, many years and starting fluids too early can risk building scar tissue from the larger gauge needles needed (even if you use 21g as opposed to the harpoon-sized 18g). Also, you can overhydrate a cat and it’s just not necessary to start fluids as soon as your vet is suggesting. You can read more about hydration also on Tanya’s.

Besides P control, the other parameter that has a lot to do with longevity and how the kitty feels is preventing anemia. Celie is not anemic yet but once the hematocrit (HCT) reaches 30%, you’ll want to start giving B vitamins as indicated in the anemia discussion.

The other two things are, as Lou said, adding niacinamide to the diet and potentially using calcitriol. When I had my CKD kitties, calcitriol was not used unless the kitties had secondary hyperparathyrodism but more people are now using it to prevent that condition. You’ll need to read the discussion on calcitriol and talk to your vet.

That’s probably more than enough to get you started. Tanya’s is the gold standard for treating CKD so I’d read as much as you are able starting with phosphorus control as that is what really needs to be addressed now.

Let me know if you have questions.

Also...her ALT is mildly elevated. I’d keep an eye on it but it is a very mild elevation.

 

[Daddy Jack's Mommy (GA)]

Marje, thank you so much for looking over her blood work. I have zero experience with CKD, and I really felt overwhelmed. I'm feeling calmer now, knowing that there are things I can do to help Celie to feel better. She's such a sweet little girl, but very feisty! These last few days of being sick have made her pretty grumpy. It's sad...
When I took her to the vets on Tuesday, it was not her usual vet who saw her. Today, I took her to see the vet that I like the best in that practice, and let him know that I want him to treat Celie from here on out. I took her today because she didn't eat or drink one single thing all day yesterday, and most of today. I believe, and Dr G agrees with me, that she reacted to the cerenia that I gave her Wednesday night. About 3 hours after I gave it, she became lethargic and is slowly coming out of that state today. She has finally eaten a little, and drank a good amount of water. And Dr G gave her some fluids this afternoon. It's so nice to see the light back in her eyes tonight. I was so worried about her yesterday and earlier today. As far as a urine test... I thought one was done, as the vet took urine and told me it all looked good. But Dr G said the first thing he's going to do is a complete urinalysis. So, the vet on Tuesday wasn't very thorough. I'm taking Celie in on Wed morning for a urinalysis and an X-ray. Dr. G said he wants more blood work, but we can wait a little on that. My finances are not good, and he understands that.

Thank you for the links to Tanya's site. There is a wealth of information there.

I'll get her started on a phosphorous binder right away. My only concern is that all of the cats eat from each other's dishes, and there are no rooms in my micro small dwelling to separate them. So it's going to be challenging to completely keep her from eating food that doesn't include a pho binder. I just briefly looked up some stuff on pho binders, and I gather that it's not good to include it in the diets of cats who have healthy kidneys.

I'm also going to order EZ Complete.

And I'm leaving you with a picture of my girl Celie.

 

[Daddy Jack's Mommy (GA)]

Did your vet say what stage she is in? A cat with CKD needs a low phosphorus food. Fancy Feast is very high in phosphorus so I wouldn’t use that for Celie. Making your own food would be a good idea. Just be sure the supplement you use gets calcium from eggshells rather than bone, which would be too high in phosphorus. @Idjit's mom can give you some info on homemade. If you decide instead on canned for all, look for low carb, low phosphorus (under 200 on Dr Lisa’s chart). If you have her bloodwork results, you can post them here for more info. Here’s a great site on CKD
https://www.felinecrf.org/

I'm sorry that I didn't respond directly to you on Wednesday. I was so overwhelmed for a few days, trying to decide what I should do to help Celie and trying to learn as much as I could about chronic kidney disease. Thanks for the good information you shared, and for giving me the link to Tanya's website. I really didn't mean to overlook your response to my questions. Thank you, Sharon, for taking the time to answer me. I really appreciate the help that I'm getting in this group with my sugar baby Jack, and now with Celie. And I hope to pay it forward, as soon as I calm down!

 

[Daddy Jack's Mommy (GA)]

Was a urine test done? I’d be interested in seeing her urine specific gravity.

When I had Celie to the vet on Tuesday, urine was collected and tested. I was told that everything looked good. However, the vet who saw her on Tuesday wasn't my usual vet. It was the same practice, but a different vet. Celie has been very lethargic and not eating since Wednesday night. Yesterday I took her to see Dr. G, who is my usual vet and the one that I really love. He immediately noted that there wasn't a complete urinalysis done on Celie, and he's going to do that on Wednesday along with an x-ray. When I get the results of that urine test, I'll post it here. He didn't do that work last night because I came in at the end of the day as a sick visit. He did, however, give her fluids.

On a very positive note, there is a marked improvement in Celie today. She was purring so loud that I could hear her all the way down the hall when I first got up. And she's been eating wonderfully and so far has held it down. It seems to me that she reacted to the Cerenia tab that I gave her Wednesday night, as those symptoms started a couple of hours after I gave her that tab. Dr. G agrees with me, that it could have been a reaction to the medication.
Thanks Marje for all of your help. I hope that you're enjoying your weekend.

 

[Sharon14]

there is a marked improvement in Celie today.

Great news!

 

[Larry and Kitties]

and I gather that it's not good to include it in the diets of cats who have healthy kidneys.

That is correct. Cats with health kidneys should not be feed exclusively food with phosphorus binders. A little of such food is fine.

 

[Marje and Gracie]

When I had Celie to the vet on Tuesday, urine was collected and tested. I was told that everything looked good. However, the vet who saw her on Tuesday wasn't my usual vet. It was the same practice, but a different vet. Celie has been very lethargic and not eating since Wednesday night. Yesterday I took her to see Dr. G, who is my usual vet and the one that I really love. He immediately noted that there wasn't a complete urinalysis done on Celie, and he's going to do that on Wednesday along with an x-ray. When I get the results of that urine test, I'll post it here. He didn't do that work last night because I came in at the end of the day as a sick visit. He did, however, give her fluids.

On a very positive note, there is a marked improvement in Celie today. She was purring so loud that I could hear her all the way down the hall when I first got up. And she's been eating wonderfully and so far has held it down. It seems to me that she reacted to the Cerenia tab that I gave her Wednesday night, as those symptoms started a couple of hours after I gave her that tab. Dr. G agrees with me, that it could have been a reaction to the medication.
Thanks Marje for all of your help. I hope that you're enjoying your weekend.

You’re welcome! Please tag me when you get the results.

I’m glad she’s feeling better.

 

[Daddy Jack's Mommy (GA)]

@Marje and Gracie
I wanted to post the results of Celie's urine tests. Also, would you know if the following numbers appear to be high for her blood pressure? The doctor took it four times in a row and it was 169/100, 169/69, 176/134, and 171/95. Her vet said she is only borderline high and doesn't need to be medicated. However, everything I read seems to contradict that. I'm concerned that I need to find another vet because I don't think he's giving me good advice. He also said she doesn't need a pho binder, and it seems like he's wrong there as well.

She is continuing to do well, and has a great appetite! I have started transitioning her to raw chicken with EZ Complete, and she absolutely loves it!
Thank you,
Carolyn

 

[Idjit's mom]

I have started transitioning her to raw chicken with EZ Complete, and she absolutely loves it!

That's super, I'm so glad to read this!

 

[Daddy Jack's Mommy (GA)]

That's super, I'm so glad to read this!

Out of all five cats, she's the one who loves it the most, followed by 12 year old Marley who has no teeth! The youngest, at six years old, seems to enjoy it enough. My other Calico, soon-to-be 14 also, literally runs out of the room when I serve it. She wants no parts of it! Jack, my sugar baby, takes a few bites and walks away. Then he comes back and takes a few more bites and walks away. It's pretty comical to see their distinct reactions. I used my Vitamix, and I couldn't get it to be completely consistent in texture. I think Jack has somewhat of a sensory issue, and can't tolerate the different textures in what he's eating. So, I ordered a cheap grinder and it should be here by tomorrow. I'm not going to give up on transitioning all five of them. Thank you for turning me on to this Ez Complete stuff!

 

[Idjit's mom]

Out of all five cats, she's the one who loves it the most, followed by 12 year old Marley who has no teeth! The youngest, at six years old, seems to enjoy it enough. My other Calico, soon-to-be 14 also, literally runs out of the room when I serve it. She wants no parts of it! Jack, my sugar baby, takes a few bites and walks away. Then he comes back and takes a few more bites and walks away. It's pretty comical to see their distinct reactions. I used my Vitamix, and I couldn't get it to be completely consistent in texture. I think Jack has somewhat of a sensory issue, and can't tolerate the different textures in what he's eating. So, I ordered a cheap grinder and it should be here by tomorrow. I'm not going to give up on transitioning all five of them. Thank you for turning me on to this Ez Complete stuff!

It is funny to read about the different reactions in your household! I'm so glad it's working out for you. It's not for everybody, but it works well at this house, and for most at least at your house. These cats, they crack me up!

 

[Djamila]

Carolyn, I'm so glad to read that you've been using EZComplete. I'm a huge fan. It is the only thing outside of his old kibble (which he hasn't had in years now!) that Sam really likes eating. Every week when I'm making up the batch he is walking all around my legs and purring up a storm. And he is not a cat who purrs! My other cat though, won't touch it. And he's been on raw food exclusively every since he came to live with us, so it's not an aversion to raw. He just doesn't like that one. I think sometimes they do it just to be difficult. It would be too easy on us if they all liked the same food!

 

[Daddy Jack's Mommy (GA)]

I'm making up the batch he is walking all around my legs and purring up a storm.

That's adorable.

I'm hoping that they'll all like it better once I get the consistency more...consistent! But I'm not banking on it.

 

[Djamila]

I had to play around with the texture for a few batches. First I made it too chunky, then I made it too smooth, then I got it just right! (our own little goldilocks story here!). It took more than three tries though to figure out exactly which texture Sam preferred. So it's also possible that your kitties might have slight differences in how much they want to chew their food. Because cats.

 

[Daddy Jack's Mommy (GA)]

our own little goldilocks story here

 

[Veronica & Babu-chiri]

What we do is control phosphorus by using a specific form of vitamin B3, niacinamide.

How do you give the B3?
I do apologize if I'm hijacking the thread a bit but I've been looking for alternative options to control phosphorus for one of my cyvies since she's already getting a low phosphorus ( fairly high protein ) diet but her phosphorus is still a bit high and using the phosphorus binder that is available where we live has given us a bunch of problems

 

[Marje and Gracie]

@Marje and Gracie
I wanted to post the results of Celie's urine tests. Also, would you know if the following numbers appear to be high for her blood pressure? The doctor took it four times in a row and it was 169/100, 169/69, 176/134, and 171/95. Her vet said she is only borderline high and doesn't need to be medicated. However, everything I read seems to contradict that. I'm concerned that I need to find another vet because I don't think he's giving me good advice. He also said she doesn't need a pho binder, and it seems like he's wrong there as well.

She is continuing to do well, and has a great appetite! I have started transitioning her to raw chicken with EZ Complete, and she absolutely loves it!
Thank you,
Carolyn

View attachment 44684 View attachment 44685

Sorry to just get to this...we are in NYC for a fun little trip

Her urine specific gravity is not as low as I’ve seen but she certainly isn’t concentrating her urine in this sample. It should be above 1.040. However, I’m also not real trustworthy of in-house testing because they have to keep their equipment calibrated and not all do. But, we will have to assume they did.

My vet treated my CKD kitty that had high BP when his BP got over 160 as an average and that’s pretty standard.

I will say that when I took my young cat,Tobey, in one day to have his BP checked because he has a left bundle branch block, it averaged over 200 but he was super stressed. My vet had me bring him back in two days, late in the day when it was quiet, and we sat for ten minutes in a semi dark room with zen music and his BP averaged about 120. My board certified anesthesiologist told me that a really accurate BP is hard to get without shaving. I know my regular vet doesn’t usually shave but her tech also has a hard time sometimes getting the reading.

If you are going to try a new vet, I’d do it soon and have them check the BP. If it still averages over 160, I’d get meds started. I wouldn’t wait but a few days on this.

 

[Larry and Kitties]

Her urine specific gravity is not as low as I’ve seen but she certainly isn’t concentrating her urine in this sample. It should be above 1.040. However, I’m also not real trustworthy of in-house testing because they have to keep their equipment calibrated and not all do. But, we will have to assume they did.

The sheet said the USG was read using a refractometer. Those are very reliable devices (I have one myself) and really do not read incorrectly. If they do then it is only by a little like 0.001. They are easily checked using distilled water. On the other hand if the reading was from a pad on the urine test strip then the strip USG reading are not accurate at all.

 

[Marje and Gracie]

The sheet said the USG was read using a refractometer. Those are very reliable devices (I have one myself) and really do not read incorrectly. If they do then it is only by a little like 0.001. They are easily checked using distilled water. On the other hand if the reading was from a pad on the urine test strip then the strip USG reading are not accurate at all.

I also have a refractometer at home, I’m also a biologist and accustomed to dealing with this kind of equipment, and agree with my vet who has said even they are only as reliable as the calibration. Just like a weight scale...it can be very reliable as long as it’s calibrated. And, yes, calibration is quick and easy as long as you use distilled water, as stated.

 

[Daddy Jack's Mommy (GA)]

Sorry to just get to this...we are in NYC for a fun little trip

Her urine specific gravity is not as low as I’ve seen but she certainly isn’t concentrating her urine in this sample. It should be above 1.040. However, I’m also not real trustworthy of in-house testing because they have to keep their equipment calibrated and not all do. But, we will have to assume they did.

My vet treated my CKD kitty that had high BP when his BP got over 160 as an average and that’s pretty standard.

I will say that when I took my young cat,Tobey, in one day to have his BP checked because he has a left bundle branch block, it averaged over 200 but he was super stressed. My vet had me bring him back in two days, late in the day when it was quiet, and we sat for ten minutes in a semi dark room with zen music and his BP averaged about 120. My board certified anesthesiologist told me that a really accurate BP is hard to get without shaving. I know my regular vet doesn’t usually shave but her tech also has a hard time sometimes getting the reading.

If you are going to try a new vet, I’d do it soon and have them check the BP. If it still averages over 160, I’d get meds started. I wouldn’t wait but a few days on this.

@Marje and Gracie Again, thank you for reviewing this and giving me some feedback. I hope you enjoyed your NYC trip! I'm going to bring Celie in to see my vet on Wed, just to have her BP checked again. This time, there will be no other tests. And hopefully, if I remain with her and she is calmer in general, it won't be as high. If it is, I'm going to ask that he medicate her now. I'm hoping that he will agree, and even if he doesn't , I'm hoping that he allows me to make that judgement call. If not, I'll have to find another vet. I've made some calls to other vets in the area, and it's reinforced the reasons why I love my current vet. I never have to wait long for an app't, they always fit in a sick visit at the end of the day (without charging an emergency fee), they don't over charge, they're a 4 minute ride from my house, they have great hours (7 days a week), and absolutely everyone is courteous. And I'm struggling financially. Their willingness to keep my cost down can make the difference between my being able to afford a vet visit, and my not being able to afford a vet visit. So... I'm hoping that my vet will work with me, and allow me to do my own research. I'm really hoping that this works, and that he will prescribe what's needed and support my decision to have started her on pho binders, which he doesn't yet feel the need for.

 

[Daddy Jack's Mommy (GA)]

How do you give the B3?
I do apologize if I'm hijacking the thread a bit but I've been looking for alternative options to control phosphorus for one of my cyvies since she's already getting a low phosphorus ( fairly high protein ) diet but her phosphorus is still a bit high and using the phosphorus binder that is available where we live has given us a bunch of problems

No worries (about hijacking the post). I do it too!
I would love to learn more about alternatives to using pho binder. I'm worried about side effects. May I ask what problems you had while using them for your civvie? (Celie is a civvie too, by the way.) I found a wonderful Facebook support group for CKD. If you're interested, the name is Feline Chronic Kidney Disease: https://www.facebook.com/groups/felinecrf/

 

[Daddy Jack's Mommy (GA)]

@Idjit's mom and @Veronica & Babu-chiri
I just found this response from Laurie and Caroline (FoodFurLife) in response to my inquiry about EZ complete and low phosphorus. It was sent on April 19th, but I just today realized that it was there. It ends with a link about how to use vitamin B3 (niacinamide) to lower phosphorus.
Here is a copy of the response:

Hi Carolyn,

We're sorry to hear of the diagnosis. We're the owners of Food Fur Life, and each of us has a cat (or cats) with CKD, and our cats are thriving on food made with EZComplete.

Compared to prescription foods, this does have higher protein, and thus a bit more phosphorus than a prescription diet. Of course, when feeding a CKD food that isn't the Rx food, the general guideline is to find a food that is less than 1% phosphorus on a dry matter basis. EZComplete will have about 0.8% when using lean meats. But as a human grade food with only species-appropriate ingredients, it is less work on the kidneys and less stress on their system. Please be aware that prescription diets are very low protein: Hill's k/d is just 29% protein on a dry matter basis. But that's why cats on k/d or other Rx renal diets experience muscle wasting, because it isn't enough meat-based protein for a cat, let alone a senior cat.

Regarding phosphorus, as mentioned, food made with lean, boneless meat and EZComplete premix will have phosphorus of about 0.8% on a dry matter basis. The minimum AAFCO requirement for an adult cat is 0.5%, and Hill's has about 4%, so less than AAFCO minimum requirement. They lower the phosphorus by replacing protein with carbohydrates. This is one of the many reasons many people choose to transition to a raw diet for their cats with CKD, because their cats do better on a human grade, meat-based diet that isn't low protein.

The concept of feeding cats lower protein diets as seniors has become controversial within the veterinary community. Here is a section from an article published in a veterinary journal, Veterinary Practice News. Dr. Norsworthy is a leading and well known GI specialist. The title of the article is "Feline Kidney Insufficiency is Still Tricky to Treat:"

"A changing view of the best diet is a key development in the treatment of chronic kidney insufficiency, Nortsworthy said.

In the past, the approach was a low-protein diet. Now the practice is to put such a cat on a high-protein diet, he said.

There are several reasons for this switch in thinking, particularly to keep the cat from losing too much weight and muscle. Muscle wasting is a common problem in senior cats, Norsworthy noted. Their spines and hips become very prominent because they have lost muscle mass. This occurs due to protein deprivation.

“The low-protein diet really hasn’t done the good that we thought it was doing,” Norsworthy said, adding that its benefits to kidney function “are minimal to nil” and that many older cats on a low-protein diet will begin to lose muscle and get thin.

Despite this change in thinking, many manufacturers continue to make low-protein diets that are officially labeled for the kidney disease, he said.

“I don’t even use those official kidney diets anymore,” Norsworthy said. Instead he recommends foods made for diabetes patients because they are low in carbohydrates, which is in excess amounts in many cat foods, and the food makers have replaced the carbs with mostly proteins."

...High protein diets will elevate the BUN measurement, but that doesn’t mean the kidney function is down, he said. “It just means the cat’s on a high-protein diet.”

The link: https://www.veterinarypracticenews.com/why-feline-kidney-insufficiency-is-still-tricky-to-treat/

Phosphorus is the only thing that has been scientifically shown to impact kidney health / longevity in feline CKD. The meat, of course, contains phosphorus: that is part of the theory behind a low protein food: reduced protein = reduced phosphorus. This is a theory applied to humans, and it seems was just transferred to cats with disregard for their protein needs as obligate carnivores and their increasing need for protein as seniors.

In a referenced piece written by Dr. Mark Peterson, one of the most widely recognized small animal endocrine specialists in the world, he walks through the known needs of senior cats from published studies. It turns out, based on that information, senior cats need what works out to a minimum of 53% protein (dry matter basis) to prevent muscle wasting. https://endocrinevet.blogspot.com/2011/11/optimal-protein-requirements-for-older.html

What we do for our CKD cats is control phosphorus by using a specific form of vitamin B3, niacinamide. Most vets are not familiar with this role of B3, though many are familiar with it and its safety, as they use it for a nail fungus in dogs. There is information here: http://www.rawfeedingforibdcats.org/feline-ckd-niacinamide-in-phosphorus-control.html

Hope this helps!

Laurie & Carolina

 

[Idjit's mom]

@Idjit's mom and @Veronica & Babu-chiri
I just found this response from Laurie and Caroline (FoodFurLife) in response to my inquiry about EZ complete and low phosphorus. It was sent on April 19th, but I just today realized that it was there. It ends with a link about how to use vitamin B3 (niacinamide) to lower phosphorus.
Here is a copy of the response:

Hi Carolyn,

We're sorry to hear of the diagnosis. We're the owners of Food Fur Life, and each of us has a cat (or cats) with CKD, and our cats are thriving on food made with EZComplete.

Compared to prescription foods, this does have higher protein, and thus a bit more phosphorus than a prescription diet. Of course, when feeding a CKD food that isn't the Rx food, the general guideline is to find a food that is less than 1% phosphorus on a dry matter basis. EZComplete will have about 0.8% when using lean meats. But as a human grade food with only species-appropriate ingredients, it is less work on the kidneys and less stress on their system. Please be aware that prescription diets are very low protein: Hill's k/d is just 29% protein on a dry matter basis. But that's why cats on k/d or other Rx renal diets experience muscle wasting, because it isn't enough meat-based protein for a cat, let alone a senior cat.

Regarding phosphorus, as mentioned, food made with lean, boneless meat and EZComplete premix will have phosphorus of about 0.8% on a dry matter basis. The minimum AAFCO requirement for an adult cat is 0.5%, and Hill's has about 4%, so less than AAFCO minimum requirement. They lower the phosphorus by replacing protein with carbohydrates. This is one of the many reasons many people choose to transition to a raw diet for their cats with CKD, because their cats do better on a human grade, meat-based diet that isn't low protein.

The concept of feeding cats lower protein diets as seniors has become controversial within the veterinary community. Here is a section from an article published in a veterinary journal, Veterinary Practice News. Dr. Norsworthy is a leading and well known GI specialist. The title of the article is "Feline Kidney Insufficiency is Still Tricky to Treat:"

"A changing view of the best diet is a key development in the treatment of chronic kidney insufficiency, Nortsworthy said.

In the past, the approach was a low-protein diet. Now the practice is to put such a cat on a high-protein diet, he said.

There are several reasons for this switch in thinking, particularly to keep the cat from losing too much weight and muscle. Muscle wasting is a common problem in senior cats, Norsworthy noted. Their spines and hips become very prominent because they have lost muscle mass. This occurs due to protein deprivation.

“The low-protein diet really hasn’t done the good that we thought it was doing,” Norsworthy said, adding that its benefits to kidney function “are minimal to nil” and that many older cats on a low-protein diet will begin to lose muscle and get thin.

Despite this change in thinking, many manufacturers continue to make low-protein diets that are officially labeled for the kidney disease, he said.

“I don’t even use those official kidney diets anymore,” Norsworthy said. Instead he recommends foods made for diabetes patients because they are low in carbohydrates, which is in excess amounts in many cat foods, and the food makers have replaced the carbs with mostly proteins."

...High protein diets will elevate the BUN measurement, but that doesn’t mean the kidney function is down, he said. “It just means the cat’s on a high-protein diet.”

The link: https://www.veterinarypracticenews.com/why-feline-kidney-insufficiency-is-still-tricky-to-treat/

Phosphorus is the only thing that has been scientifically shown to impact kidney health / longevity in feline CKD. The meat, of course, contains phosphorus: that is part of the theory behind a low protein food: reduced protein = reduced phosphorus. This is a theory applied to humans, and it seems was just transferred to cats with disregard for their protein needs as obligate carnivores and their increasing need for protein as seniors.

In a referenced piece written by Dr. Mark Peterson, one of the most widely recognized small animal endocrine specialists in the world, he walks through the known needs of senior cats from published studies. It turns out, based on that information, senior cats need what works out to a minimum of 53% protein (dry matter basis) to prevent muscle wasting. https://endocrinevet.blogspot.com/2011/11/optimal-protein-requirements-for-older.html

What we do for our CKD cats is control phosphorus by using a specific form of vitamin B3, niacinamide. Most vets are not familiar with this role of B3, though many are familiar with it and its safety, as they use it for a nail fungus in dogs. There is information here: http://www.rawfeedingforibdcats.org/feline-ckd-niacinamide-in-phosphorus-control.html

Hope this helps!

Laurie & Carolina

Carolyn, thank you very much for sharing this response. I copied it to my personal files for review and so that I can pass on the information when needed. Kisses for Daddy Jack.

 

[Daddy Jack's Mommy (GA)]

Kisses for Daddy Jack.

 

[Veronica & Babu-chiri]

No worries (about hijacking the post). I do it too!
I would love to learn more about alternatives to using pho binder. I'm worried about side effects. May I ask what problems you had while using them for your civvie? (Celie is a civvie too, by the way.) I found a wonderful Facebook support group for CKD. If you're interested, the name is Feline Chronic Kidney Disease: https://www.facebook.com/groups/felinecrf/

Thank you very much your information is very good, I've already downloded it and I'm showing it to my vet

We do not have ALOH here so my choices are e-pakatine and renvela, my cyvie es already on the high end of the calcium range (also no ionised calcium test available), so we decided to go for the option of renvela, which is not working as effectively as we would have liked and is causing her some mayor problems with constipation, even with contumax (magrogol 3350 - Miralax) I'm having a lot of problems so an other alternative is seriously welcome thank you very much again.

By the way I started Babu also on renvela because his phosphorus levels were a bit high too and it worked a lot better than with my cyvie and with not much of an impact he did had a bit (but I really mean a bit) of constipation too though