Yes, I believe you need to get a second opinion. Hallie has a CRITICAL serum phosphorus of 16.1 (normal is below 6.) She needs to be on an effective phosphorus binder (and in my opinion, immediately!) This is a quote from the phosphorus binder page of the CRF supply site. http://members.verizon.net/~vze2r6qt...es/binders.htm
Epakitin/Ipakitine. Ipakitine has been marketed in Europe for awhile and its twin product, Epakitin, is now being heavily marketed in the US as a "nutritional supplement." This product's active binding ingredients are calcium carbonate and chitosan. Tests have shown the calcium carbonate binders are inferior to the aluminum-based products. Several well-known CRF researchers advised that this product should not be used in cats with high normal or elevated calcium due to the risk of throwing such cats into hypercalcemia by adding calcium carbonate to their daily meds. Dr. Larry Nagode of Ohio State University Veterinary College advises that the product should not be used with cats that currently get calcitriol nor cats that may get it in the future, again because of the risk of hypercalcemia. Epatikin is being marketed directly to vets and more as a renal protectorant/preventive than as a treatment for elevated phosphorus. I've received emails from folks in Germany and Switzerland about Ipakitine being prescribed for their early CRF cats - they report it seems to have helped their cats' appetite and energy. None of these cats had elevated phosphorus. Dosage recommendation is based on weight alone (1g/5kg body weight given orally in the morning and the evening mixed with food) without regard to phosphorus levels -- this further suggests that the product is intended for cats in early CRF and/or CRF cats with phosphorus in normal bounds rather than cats with elevated phosphorus where dosage is normally adjusted based on phosphorus values.
*All red highlights are mine.*
It's great that her BUN and Creatinine have come down so well. I do think that she needs to have her electrolytes checked...now especially, since she's on Epakitin. Epakitin can cause an elevation in serum Calcium levels. Her serum Phosphorus level needs to be continually monitored, and as Pat mentioned, you need to stay on top of her serum Potassium level, and supplement when necessary. You might want to call around to other vets in your area, and ask if they are up-to-date with the latest/most current treatment regimens for CRF, and if they are comfortable treating a 'high numbers' CRF cat. Here's a link that may be able to help you find someone in your area. http://members.verizon.net/~vze2r6qt/vets/index.html