Kidney Disease and Protein Controversy

the3rdname said:

 
Rory's internal med vet gave Epakitin the thumbs up when her calcium fell back into the normal range (she's been on Epakitin since beginning treatment, even when cal was high- an oversight on regular vet's part!), so I think it could be worth considering if a cat has normal calcium levels.  It's highly palatable and doesn't have the same toxicity risks that come with AH use.  Binders are a PITA...seems like they've all got pros and cons.

A newer one that looks interesting is Lanthanum Carbonate.  Here's a page all about binders for the OP: http://www.felinecrf.org/phosphorus_binders.htm

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They can feel so crappy with high calcium and high phosphorus we avoid it. High Ca cascades to multiple organ/glandular involvement, tight spasming muscles, as Ca triggers muscle contraction, and leads to higher pain.

Aluminum hydroxide, while administering a metal and hydrogen/oxygen is introducing something foreign systemically, is better long term for all my renal patients. They didn't die of aluminum hydroxide; most didn't even die of renal failure. They died of cancer, or introducing a new contraindicated drug at home, a toxicity due to dietary indiscretion, or stopping a medication accidentally, during a stressful event or boarding/petsitting.

I'll look up lanthanum carbonate, but we have stuck to AlHO, despite Vetoquinol producing Epakitin, what would be a great product if the insect exoskeletons, chitin, was combined with aluminum hydroxide powder rather than calcium carbonate.  Many internists, oncologists, and AAFP's with which I've worked and utilized for my own are pro-AlHO. Especially if the patient has a history of ever having or currently having elevated ionized calcium. No calcitriol, no calcium carbonate.

I've pulled Vetoquinol sales reps and vets that come to cater to my clinics, providing Lunch and Learns, to tease them into lobbying for manufacturing a non-calcium product. They just nod a lot, yeah, I know what you mean, just clinically with what you see and biochemically with the blood evidence, we're working on that.  Kind of like when I bugged Merial about when they were gonna invest in the studies and titers to prove their canarypox live vector rabies vaccination lasts at least 3 years, if not 5, in the domestic cat immune system. They pushed that and sold more vaccines for at least 10 years after initial FDA approval for the 1 year Purevax. Booger. Bugger. Ah, hell, both ;]

puck said:

 
OMG, he's flame point AND polydactyl! What a stud muffin!

He looks my dad's old cat Leo, crotchety old flame point siamese, abandoned at one of my clinics at 14 for pooping outside the box after the baby started walking :[ Man, was that old man happy livin' with an old man ;] 

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Ha ha, stud muffin. I'll have to tell him that.   Yeah, I love the older cats; there's just something about them that draws me. Max is still super active, to the point of tearing through the apartment somewhere between 6 to 8 am like a tiny, crazy horse.

I'd heard elsewhere about Omega 3's too. I've got Lifeline's Salmon Oil already, and it would be about 325.5 mg of Omega 3 daily based on their dosing instruction. DHA would be 116.25 mg, DPA is 29 mg, and EPA is 104.5 mg.... I'll check how that stacks up to Welactin.    I'm curious if you need to worry about the additional EPA and DHA in VetriScience if you're already supplementing? 

I talked with my vet today over the phone, and I think it went well. Basically, she told me that she recommends starting early on the renal diets because statistically, they see longevity with lower protein. But she's open to care-givers making their own decisions and recognizes that there's different schools of thought on management. Because he's only in Stage 1, she thought using a commercial diet with lower phosphorus than I was feeding before would be fine for Max, of course with re-evaluation down the road and adjustments as necessary. She agreed that because  he's still a skinny boy and is trying to grow fur back from an allergy, that sticking with a higher protein would be okay at this point. However, she did say she usually prefers to try changing diet before adding the phosphorus binders because those can throw the cat off as well, and sometimes medicating them with it daily can be more stressful. (Note that this is all my interpretation of what she said.) So, I'm still looking at raw diets and commercial diets with lower phosphorus content and that's going to be my focus for now...

Also: is anyone else able to get on Tanya's Comprehensive Guide to Feline Chronic Kidney Disease? I keep getting error messages or "service unavailable" and can't tell if it's me or the site's down...

The EPA and DHA in Renal Essentials is similar to the low concentrations in pet diets. Too inconsequential to make a difference. A cat can have upwards of 40mg/kg EPA to effectively help organs beyond skin. Orthopedic surgeons put all their cats and dogs on 40mg/kg EPA. I stick to a 20-25mg/kg EPA range with good results for internal organ health, including cardiac, renal, GI, pancreas, spleen, and liver, when actively treating conditions that affect these organs and the clinical improvement on long-term supplementation.

The diets aren't a wrong answer. For my current kidney cat and kidney dog, they get a rotation of renal diets daily with added high quality meat/egg sourced protein, psyllium husk to bind any excess, and currently both their phos have gone down without needing to continue AlHO. Many patients do well on Rx diet only, until variety is needed as the late stage inappetance kicks in. Many do well on OTC with binders, or homemade with low phos/Ca and high potassium ingredients. Fingers crossed.

K was thinking about dropping, then changed its mind with diet for both. Hypertension controlled medicinally, as renal leads to hypertension and heart disease, and visa versa. PCV holding around 30%, excellent for renal patients with diminishing erythropoetin.

Cat 14 yo foster, Dog 16yo cocker, who has coinciding arrhythmia, hypothyroidism, liver disease, anemia, likely brain and/or bone marrow cancer (no MRI or marrow FNAs, not at this stage). Doing hella great. Supplements include Dog: VetriLiver (liver disease worse than mod stage renal now), Denosyl, Welactin, proviable and Probios, tumeric, frankincense, myrrh, Pet Tinic, B Complex. Same for cat except Renal Essentials rather than VetriLiver, no tumeric, frankincense, or myrrh, as these are for the dog's severe IVDD, which the cat doesn't have. Cat also on Cosequin and Adequan monthly (old boy elbows and held urination too long when stress came to home, helps with both), Viralys (no URI in 2 yrs), currently marbofloxacin, just finished tapered prednisolone for separate issue, and Buspar, as he's a nut ;]

I am able to get on Tanya's website every single day, multiple times.  I have THIS page saved as a favorite, since I need to copy and paste it so many times:  I just opened it again to paste it for you:    http://www.felinecrf.org/canned_food_usa.htm#canned_usa

If you can't open it up, try a different servier (ie, firefox versus Internet Explorer) or try rebooting our computer or something like that.  I'm not too computer savvy, but doing stuff like that usually works for me.

Puck: Glad to hear your dog and cat are doing well. I wasn't meaning to discount renal diets completely, and also, I know I'm not a vet. I am just hesitant to put Max on a low protein food at this point, because from what I've read elsewhere, he could start catabolizing his muscles if he's not getting his protein needs met. He's already kind of bony...

Msgreenjeans: That worked! Thank you! If it happens again, I'll restart my computer. That usually works when I have other issues.

To skip right through to my questions go to the lines that have **

My cat turned 10 the end of May. The beginning of June he seemed ill, lethargic and some vomiting and I took a urine free catch sample to the vet where I am currently staying. He had a wellness blood panel in March and the urine was included in the cost but they forgot to give me the special sand for his litter box and told me bring the sample whenever. There was no bacteria (June 1) but they found blood in the urine at 1+ and put him on Clavamox. He previously had a UTI in November 2013 and the amoxicillin didn't do it and he had Corvenia to knock it out. He had dermatitis in December 2014 treated with Megase (a prednisone) and Corvenia and again in Feb treated the same way. I didn't want him having more prednisone and read disturbing information on Corvenia and when he had dermatitis in April I used coconut oil topically and an Elizabethan collar. The vet here also said, based on the urinalysis of June 1, that he was "going into stage 1 of kidney disease" and I should increase his wet food and totally discontinue the dry (grain free Blue Buffalo). I did that making his diet all wet food.     

He was back to his old self after two days of Clavamox but when the symptoms returned early July, just 2 wks off the antibiotic he was put back on Clavamox and my regular vet, back home, said that he thought my baby had stones. Kidney or bladder, oxalate or strevite that was causing irritation in the lining of the bladder or the kidneys, causing blood in the urine and infection. He suggested that when we return home I schedule an ultrasound but suggested that I wait until my boy was feeling good to drive the 20 hours with him. I decided I would find another vet where I am staying and have x-rays to see if the stones were in the kidneys or bladder and what kind they were. The new vet suggested labs again instead saying some stones didn't show on x-rays and since I was going to have an ultrasound labs would be the way to go.

The labs on July 17th results were an unpleasant surprise. The blood in urine was 3+, no crystals leading to the possibility of oxalate stones if any but he was on the border of stage 1/stage 2 kidney disease. 

I tried the K/D and he would not eat it. I have read so much on the internet my eyes get blurry. I want a commercial food that is 1) low in phosphorus 2) moderately high to high in protein 3) low in carbs and grain free (I'm not crazy about potato, peas or cranberry now with the CDK either but will take these over grains) 4) Carageenan free (after trying at least 30 foods a year ago when I was trying to introduce him to wet food I had settled on Blue Buffalo Healthy Gourmet pate from Pet Supermarket and Newman's Own Organic from the grocery store when I couldn't get to the pet store but found that they reformulated within the past year to include carageenan and switched him to Nutro grain free pate and from the grocery store Sheba pate)

He won't eat the homemade chicken and basmati rice or ground beef and rice and the vet said that baby food and adding taurine would due until I can find a low phosphorus food he will eat. Baby food apparently is high in protein and lower in phosphorus than some of the Rx foods but it is lacking in feline nutrition.

Currently he is on Pepcid AC 1/4 tablet once a day, Epakitin 1 scoop 2x a day, Taurine 1000 mg a day, Clavamox 62.5 mg every 12 hours, Normosol-R 200 ml every other day. 

**Does anyone have a moderately high to high protein recipe that is low in phosphorus? (I have looked for ones using egg shells instead of bone as well as cooking the meat without the bone and boiling the bones separately to reduce phosphorus).

**Alternatively has anyone found a commercial food that is  1) low in phosphorus 2) moderately high to high in protein 3) low in carbs and grain free (I'm not crazy about potato, peas or cranberry now with the CDK either but will take these over grains) 4) Carageenan free?

**Besides the Epakitin (I tried Azodyl twice but he regurgitated) has anyone found a product that will help with the BUN creatinine and phosphorus levels?

**What supplements should I give besides Taurine that are beneficial and safe for cats? He won't touch food with Kids Complete multivitamins crushed and too big to pill pocket. He won't always eat pill pockets anyway. I wanted to try slippery elm instead of Pepcid AC but can't find any without alcohol or other additives. I ordered Ubiquinol liquid for pets from Mercola.com but it has silica in it and I'm leery of that with CKD. Other brands contained other assorted ingredients that I was unsure of for felines with CKD from the start. I asked the vet about Mannitol to replace the Clavamox but she said "no". I had an ultrasound following the bad labs and one kidney is small which could be congenital, the other kidney is large and has the beginnings of oxalate not yet formed into stones but scarring that is from previous stones or more likely previous infection. 

I have researched stem cell therapy and found a DVM in East Louisville that had success as far back as 2009. I was told that it cost $2,000-2,500 and my pet insurance will only pay "if medically necessary" which is a decision that the insurance company makes themselves. I lost my cat's brother just a year ago (8/9/14) to what turned out to be superative lung infection. I spent $2,400, in six weeks, that I couldn't afford (went late on my bills) and ruined my credit so I purchased pet insurance and would prefer to spend the money up front if there is a reasonably good chance our lives could go back to normal. I haven't had a full nights sleep since the diagnosis and my fur baby and I are both stressed. 

@Seven, I think you will find Weruva fits all the categories you are looking for in canned food, high protein, low carb, low phos (most are under 1% on a dry matter basis), NO carrageenan.   They have many flavors to choose from, and some of them do have potatoes and peas. You just have to look select ones that don't.  My only issue with Weruva and their sister companies is that they are very low calorie as well, and I am trying to get my kidney cat to gin weight, so I try not to feed this food.  I'm going to refer you to the same food chart mentioned above:  http://www.felinecrf.org/canned_food_usa.htm#canned_usa , which lists canned food in  order of the least amount of phosphorus, but also lists the amount of protein, fats, carbs and calories.  If you find something that interests you, then simply look it up on the internet for ingredients to see if it contains carrageenen.  

As far as a homemade recipe that is high protein, etc, you might want to ask that question over in our Raw and Homecooked Cat Food Forum, a sub-forum in the Nutrition Forum.  Or possibly just browse this thread:  http://www.thecatsite.com/t/263751/cooked-recipes-thread

Here is another section of the above referenced webpage that discusses treatments, which you might find helpful:  http://www.felinecrf.org/treatments_essential.htm.  Your Epakitin as a replacement of Azodyl is probably good (I can't get my furbaby to take ANY supplements ).  If you can give him some Vitamin B, that would be good too.   BTW, this section also discusses Stem Cell therapy

What helps us the most with the BUN and Creatinine is giving Sub-Q fluids, but our cat is further along with her kidney disease than yours.  She gets fluids twice a week, along with the antacid AND an appetite stimulant.  Plus I add water to her canned food.  

Oh yes, on my Callie, one kidney is now so small our Vet can barely find it anymore.  I think it may be something common in kidney disease. As they get worse, the kidneys possibly start shriveling up . 

Hey Seven: really sorry to hear about your kitty. That's really hard and my heart goes out to you...

The canned food link MrsGreenJeens provided is a good one, as is this: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf. I've used both to try and find foods for my cat. (Note that the one I've posted is from 2012, so some of the data may have changed... case in point is RadCat Raw Lamb, which now has a DM phosphorus of .456 which is incredibly low and seems comparative to some prescription diets.) Again, like MrsGreenJeans suggested, you could try some of the Weruva. My kidney boy is allergic to chicken, which a lot of their formulas have, and I don't like menadione bisulfite in the seafood formulas so that eliminates a lot of their options for me, unfortunately. But I would just try to get your guy to eat ANYTHING formulated for cats.

The food I'm currently using is Lotus Just Juicy (shredded)... a couple of veggies and potato starch but grain and carageenan free. They have another line too, just basic Lotus (pate), but chicken liver flavor in all those formulas means, again, I can't use it. Lotus is not on either of the food links above, but you can do some quick calculating to get % DM Phos: [(% Phos as fed) / (100% - % moisture)].  For the pate/basic turkey, the DM Phos is .67%, as compared to Just Juicy Turkey, which is .94%... Turkey is the lowest DM per line, I believe, with chicken in the pate line is .82% and salmon is 1.1%... In Just Juicy chicken is about .93%. So to reiterate, best overall is the Turkey and Vegtable from their basic pate line...

I also feed RadCat Turkey... Raw diet with the eggshell rather than bone. Here are their values, already in DM! http://www.radfood.com/products/nutritional_analysis My goal is to get Max to eat the lamb because it's by far the lowest in phosphorus, but after a promising start he threw it up then didn't want it. So I've got him on the turkey and hope to wean him to that. (Though I don't know how comfortable you are about feeding raw?) 

The only other thing I do for mine is a salmon oil additive, but I wouldn't add until he's probably stable on a cat food. I have no idea about your other questions. 

These are just things I've found and my opinions; I'm not anywhere close to a vet. There's some great members with a lot of good advice on here. Best of luck with your boy, and keep us updated!

I have been not paying attention to protein, but only phosphorous for my cat that has CKD.  She was first diagnosed in stage 3.  That was a year ago.  She is on subcutaneous fluids at home and I give her science diet minced.  I am not a fan of science diet because of all the fillers, carbs, etc, but is the only food she would eat that was low enough in phosphorous.  Believe me I tried every single high quality brand out there for several months and she absolutely would not eat it.  Anyway, it's a year later and she is doing much better now than she was at that time, so it must be fine.

There is a store within 25 miles that has the Weruva but nowhere within 50 miles for Lotus or RadCat. I had tried him on a raw frozen I think Natures Variety but it was when he had the UTI in June and he didn't want any part of it even when I tried to slightly cook it as recommended for transition. 

I have been on many if not all of Tanya and felinecrf pages and others that have contradictory advice and I'm trying to boil all the information down to things that most agree on. 

Here is a sight that I didn't see mentioned http://www.shirleys-wellness-cafe.com/AnimalWellness/RenalFailure.

I also purchased Ubiquinol for pets by Dr. Mercola after researching Ubiquinol (a better variety of CoQ10 for kidney failure in people) and now haven't used it because it contains .5% silica which I'm concerned about.

I don't think my vet here is very knowledgeable about feline nutrition. She is a standard Hills KD fan. He is still on the Clavamox and I asked about mannisol to replace the antibiotic and she said no but couldn't say why.

I would like to get him back north to my regular vet but am leery, no frightened, to take him until he is stable and I don't have anyone there to help with the Sub Q. In fact I only have two people here that can help and neither are especially reliable. I do the injection and hold and squeeze the bag to make it go faster and all any assistant has to do is hold him but apparently that is too difficult for most people I have asked.   

There is a store within 25 miles that has the Weruva and I will see if he will eat something from that brand. He likes pate but before he was diagnosed with CKD they gave me free samples of A/D at the vet and if I blended it to mush he ate some of it. 

I have been on many if not all of Tanya and felinecrf pages and others that have contradictory advice and I'm trying to boil all the information down to things that most agree on. 

Here is a sight that I didn't see mentioned http://www.shirleys-wellness-cafe.com/AnimalWellness/RenalFailure.

I also purchased Ubiquinol for pets by Dr. Mercola after researching Ubiquinol (a better variety of CoQ10 for kidney failure in people) and now haven't used it because it contains .5% silica which I'm concerned about.

I don't think my vet here is very knowledgeable about feline nutrition. She is a standard Hills KD fan. He is still on the Clavamox and I asked about mannisol to replace the antibiotic and she said no but couldn't say why. 

I would like to get him back north to my regular vet but am leery, no frightened, to take him until he is stable and I don't have anyone there to help with the Sub Q. In fact I only have two people here that can help and neither are especially reliable. I do the injection and hold and squeeze the bag to make it go faster and all any assistant has to do is hold him but apparently that is too difficult for most people I have asked.   

Hi there,

I do my cat's fluids by myself (I live alone). The way that I found it to be easiest was to put her on my bed, up towards the pillows.  I make the pillows into a barrier on one side and then use my arm on the other side just to sort of hold her in place.  I have a ceiling fan and I hang the fluids (with a hanger) on that.  That way I still have a free hand to hold her from the front for the times when she tries to escape from that angle.  This has worked well for a year.  Also, I give her her favorite treats right afterwards to reward her.  Since I started doing that, it has made it easier and she tries to run away less since she knows she'll be getting the treats.  Also, the terumo thin wall needles really do speed up the process.  If you use a good needle you won't have to squeeze the bag because it will come out quickly on its own.  

Don't drive yourself crazy with all of the advice that you'll find on the different websites.  The bottom line is you have to do what works best for your cat.  

Lulu: I'm glad your cat's doing better. And I've heard the prescription diets are probably the most beneficial in later stages, so that's great your cat took to it. I've been lucky enough with mine that he's taken to the high protein, relatively-low phosphorus food...

Seven: Good luck with getting him to eat the Weruva! I wish I could offer more advice. Sounds like you are sort of stuck between a rock and a hard place right now... Hopefully you'll find something he likes and then can move him if that's what you decide. Any other vets in your area that might give you a second opinion so that you don't have to go so far?

I *may* have a more than cursory interest in this topic; Ritz' protein levels have been high over several repeat tests. The lab is further analyzing her urine for (some technical name) to see if it's something "we really have to worry about". Ritz is showing NO signs of kidney issues; she is six years old.
I have been feeding Ritz Raw (prey model) for about three or four years (using bone).
But I am also relieved that should the need arise, there is a holistic vet at the group practice that I take Ritz to who 100% supports raw feeding. Point being: you might try to find a holistic vet in your area.

Lost my little Luckman a few weeks ago to acute on chronic, which was so aggressive that he was stage IV when diagnosed, and stage V when we put him to sleep just sixteen days later, despite treatment. In his case, we were already at the point of "feed him whatever he'll eat". Human food - any food - was a go.

I know this is six months after the OP made her post, and some things have probably been clarified since then, even for vets. My vet, which he does prescribe k/d, definitely doesn't seem to be anti-protein when it comes to CKD. k/d is the easier way to go obviously, but not the only way. 

Now my Sara has very early stage CKD herself. She's not been on a high-protein diet, so I'm not gonna switch her to one when she changes to a kidney diet (don't want to thoroughly disrupt her diet). Although, she'd happily eat turkey every day for the rest of her life I think so there is that possibility. I am keeping on top of the whole "high protein/low grain" idea though for the sheer fact I have three young cats - a three year old girl that I just adopted and two 6-month-old boys. I want to do right by them as early as possible. 

Ritz: Good luck with your girl! I hope it's nothing; she's still so young... I tried to do a little searching online for holistic vets and came up blank... maybe I'm not doing it right. My boy is doing good right now, though we haven't done another blood test yet (my vet said we'd retest in six months, so we're about due). He's on Rad Cat turkey -he's got an allergy to chicken, and intolerance to beef and lamb, which is too bad because Rad Cat lamb is so LOW in phosphorus- and an okay couple of canned foods.

Donutte: I'm so sorry about Luckman. That must have been (and I'm sure still is) so difficult;  my heart goes out to you. It's such a devastating disease. I looked at Luckman's page and I love that first picture of him on the counter. 

I've talked with two vets at different practices, and my regular is of the opinion that while high protein is good for non-CKD cats, historically she (or the vet community as a whole, not sure which) has seen better results with limited protein but she had no problem with me just doing commercial canned at first. The other vet was a bit noncomittal, saying that their practice does prescribe the k/d but when I brought up my concerns with low protein, she agreed that it was an issue and said that every case was different....

Sigh. I like both the vets I've talked with, but I think Ritz is right and I should at least find and consult with a holistic vet and see how they compare. I used to be pretty trusting of "conventional" medicine and a little skeptical of less conventional treatments just because of my experiences growing up. But that is something that's slowly changing (not saying traditional vet medicine is wrong AT ALL, just that it seems there's enough disagreement on CKD management that it warrants a much closer look than some vets may be giving it, IMO.)

Coneja said:

 
Sigh. I like both the vets I've talked with, but I think Ritz is right and I should at least find and consult with a holistic vet and see how they compare. I used to be pretty trusting of "conventional" medicine and a little skeptical of less conventional treatments just because of my experiences growing up. But that is something that's slowly changing (not saying traditional vet medicine is wrong AT ALL, just that it seems there's enough disagreement on CKD management that it warrants a much closer look than some vets may be giving it, IMO.)

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Well, if you think about it, CKD is something that really is treated more holistically. Using nutrition as a method of treatment isn't exactly "traditional" medicine, but with CKD, there isn't really anything traditional available, at least not yet. It's all about hydration, nutrition, and palliative care. Some of the aspects of palliative care don't fall under holistic, granted.

I don't know where in Washington State you live, but I searched and found 38 holistic vets in Washington . Do read their bios/expertise carefully; some vets may be experts at acupuncture but have limited nutritional knowledge about raw feeding for cats. (Raw feeding for dogs is a little more accepted.)

Ritz’ "microalbuminuria" is low so I don’t need to worry about kidney problems. The vet suspects the reason her protein reading was high was due to the concentration of Ritz’ urine (dehydrated). She recommended increasing water intake, perhaps by a water fountain. Water fountain might be the way to go; Dahalia (rescued her from under a car in July) is fascinated by dripping water. But, she's a nine-month old kitten and everything fascinates her!

Good luck--I know it's hard to know what to do when your vet says one thing, another vet says something else, but your heart/gut tells you something else.