CRF/CKD Cat.... food?

pawprints1986

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I just thought i would pop in here to see what you all feed your renal cats?

Ive already found tanyas site, and did some overwhelming reading..... im just curious what you all do re: the protein debate.

my cat was recently diagnosed, and im feeling very overwhelmed with everything.... for now shes on vet diet (royal canin new type, 3 different wet choices and 2 kibble choices), but i also picked up a couple of the science diet to try (lowest phosphorous on tanyas site available in canada), just to try and mix up the flavours a bit, and since those seem lower protien as well. 

bur i was just curious what you all do for your own babies. 
 

mrsgreenjeens

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I feed my kidney cat a smorgasborg of WET food only.  Some are unfortunately very high in phosphorus, some are quite low.  NONE are prescription kidney foods.  I try to buy higher protein as I'm of the belief that low protein is what causes kidney cats to turn into skin and bones.  Our Vet agrees with our protocol and says just get her to eat!  We all figure that with the huge mix of food, probably the phosphorus levels even themselves out, although I DO try to buy low phos food listed on Tanya's site.  Sometimes, though, my girl just won't eat what I want her to eat
 

lisahe

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Our previous cat had mild/moderate kidney disease (among other things) and did pretty well, considering, in her last months eating quite a bit of Weruva food. Many Weruva foods have phosphorous dry matter numbers below or around 1%, plus they have plenty of liquid. Brooksie was very sick but her kidney numbers did improve by eating only foods in that 1% phosphorous range. The vet, who'd wanted us to put her on a low-protein diet, was surprised that she did better on high protein but I wasn't!

If you want to see the phosphorous numbers sorted another way, Dr. Pierson's PDF chart on catinfo.org has a column for dry matter phosphorous. I used that chart more than Tanya's site because it's sorted by brand, which made it easier to shop. Not all the information is up-to-date but it's still very useful! I also liked Dr. Pierson's summary of feeding kidney cats, here; it basically gives background and rationale for what mrsgreenjeens wrote about feeding wet, high-protein diets.

Good luck!
 
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pawprints1986

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She does already like the Merrick various pates (Beef, chicken, turkey, tuna as well but ive heard fish is especially bad with kidney cats? she was never allergic).

i checked out that other catinfo chart, and it has those types listed, but no info filled in as far as the dry matter things, even protien was blank. protien i can find on the label and figure out (i think it worked out around the 40s dry matter), but there is no phosphorous listed on the label. the label itself was printed in 2014... i was going to try calling them tomorrow to see if i can get an answer about the numbers... last i had read online somewhere about it, someone had emailed to check the numbers, and they came back with the formulations were too new so they didnt know. im *hoping* they know now, and i can just keep her on, at least some, of the wet food shes already used to (and wanting! lol). 

im planning on a good vet/commercial mix, just not sure which brands yet.

shes already thinner, so id like to see her beef back up a bit ideally... whcih is why id love to see her do more than just graze.... she always has been a grazer, but if i could get her LOVING something and wanting more of it, it wouldnt hurt my feelings lol. 
 

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She does already like the Merrick various pates (Beef, chicken, turkey, tuna as well but ive heard fish is especially bad with kidney cats? she was never allergic).

i checked out that other catinfo chart, and it has those types listed, but no info filled in as far as the dry matter things, even protien was blank. protien i can find on the label and figure out (i think it worked out around the 40s dry matter), but there is no phosphorous listed on the label. the label itself was printed in 2014... i was going to try calling them tomorrow to see if i can get an answer about the numbers... last i had read online somewhere about it, someone had emailed to check the numbers, and they came back with the formulations were too new so they didnt know. im *hoping* they know now, and i can just keep her on, at least some, of the wet food shes already used to (and wanting! lol). 

im planning on a good vet/commercial mix, just not sure which brands yet.

shes already thinner, so id like to see her beef back up a bit ideally... whcih is why id love to see her do more than just graze.... she always has been a grazer, but if i could get her LOVING something and wanting more of it, it wouldnt hurt my feelings lol. 
Yes, you're right about the Merrick formulas changing. They sure ought to have new numbers (it's been a couple years!) by now so you can calculate the dry matter figures based on their "as fed."

I hear you about grazers! They can be tough to feed, particularly when they have illnesses that decrease their appetite. Have you tried crumbling treats on top of her food? I've started doing that with Pure Bites (chicken or turkey) when our cats get picky, I swear they'd eat just about anything that way. We never used phosphorous binders with Brooksie but they might be worth looking into if your cat just won't eat foods with low phosphorous.
 

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She does already like the Merrick various pates (Beef, chicken, turkey, tuna as well but ive heard fish is especially bad with kidney cats? she was never allergic).

i checked out that other catinfo chart, and it has those types listed, but no info filled in as far as the dry matter things, even protien was blank. protien i can find on the label and figure out (i think it worked out around the 40s dry matter), but there is no phosphorous listed on the label. the label itself was printed in 2014... i was going to try calling them tomorrow to see if i can get an answer about the numbers... last i had read online somewhere about it, someone had emailed to check the numbers, and they came back with the formulations were too new so they didnt know. im *hoping* they know now, and i can just keep her on, at least some, of the wet food shes already used to (and wanting! lol). 

im planning on a good vet/commercial mix, just not sure which brands yet.

shes already thinner, so id like to see her beef back up a bit ideally... whcih is why id love to see her do more than just graze.... she always has been a grazer, but if i could get her LOVING something and wanting more of it, it wouldnt hurt my feelings lol. 
I'm sorry your cat has been diagnosed with renal disease.

We had two cats years ago with CRF, initially we did Hills KD Rx with our first cat, however, that just led to muscle wasting and she didn't like the food much anyway. I ended up putting her on a moderate protein diet (per catinfo.org's chart) and used a phosphorus binder (provided by the vet) mixed in her food to lower the phosphorus.

Cats are obligate carnivores, they must have protein, even sick cats. The idea of restricting protein is usually in end stages of renal failure, or at least according to some vets vs more old school vets who want to restrict protein.

Tanya's site also has a food chart and it may be more current than Dr. Pierson's (2012 but with some updates as of 2014)

Which Merrick pates? There are a few Merrick foods listed on Tanya's chart - not sure if those are the foods your kitty likes, is it Merrick's perfect bistro pate / beef? There are Merrick pates listed toward the bottom of the list, they are higher in phos than some of their other foods:

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

Good luck with this, I know it's challenging but I'm sure you'll get it worked out to find something kitty likes and that will be kind to her kidneys as well.  Talk with your vet about a phos binder. Tanya's is a fantastic site, she is a wealth of useful resources. :)
 
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pawprints1986

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Well, she was diagnosed stage 3, so... im not too too sure regarding low protien, if that stage is "yeah you better stick wth lower" or still "go nuts as long as its lower phosphorous"... both schools of thought seem to go around. 

when she came home... her numbers were, i think creatnine was around 300 (normal is 212 or under i remember), her bun i think it was was 24 (cant remember what normal is), and they did specifically say her phosphorous had come back down to normal range. i did also ask and they said phosphorous is what she would feel the most (upset belly/not hungry/acting depressed/etc)... so id like to keep that as low for as long as possible.

they did a urine test too.. i forget what all they looked at, but besides it being dilute, which they expected with her being on IV fluids, everything else was spot on *touching wood*... 

we have a followup on tuesday with her regular vet... maybe ill ask him about food options.... 

i did just now find her pate that she likes on that list, must have missed it before, but it is even higher than i was thinking..... :/

its all so crazy to think about! 
 

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My kidney cat went crazy for Merrick's Surf and Turf, which,naturally has phosphurus levels WAY too high
.  But I talked to our Vet about it and she said to go ahead and feed it to her, since it's only part of her overall rotation, and in that rotation are others that are under 1% phosphorus.  Luckily, Callie now hates the Surf and Turk .  I guess she overindulged in it
.

I am on my THIRD kidney cat right now, and all I can tell you is that they were all skin and bones towards the end from not eating.  With Callie, I am reversing that by feeding her anything she will eat.  She is actually gaining a little weight now, and I can no longer feel every bump in her spine
.  She seems happier too, which makes ME happier.  I just don't really worry about how much protein is in the food.  I TRY to feed her a good quality, low carb, low phos food, but when it comes down  to it, if I get desperate, I'll feed any wet food I can find, and add filtered water to it to keep her hydrated, in addition to giving her sub-q fluids. 
 
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pawprints1986

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So, does anyone know what phosphorous actuallly does within the body? Like... is it more of a thing where we are ok as long as were adding extra water to it? Or is it still a keep it as low as possible type thing??

im finding a pattern of her enjoying her vet food when its first opened, but not so much warmed up out of the fridge... im not sure what i could mix in to the warmed up portions to get her wanting to eat it. 
 

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My Vet explained whyi it's important to feed low phosphorus foods, but I can't explain it.  Maybe this will help:  http://www.felinecrf.org/phosphorus.htm

It IS important to try to feed as low as you can, BUT, if that refuse to eat those foods, it's more important that they eat.  If they will only eat foods that are high in phosphorus, then you can add phosphorus binders.  Sounds like you are feeding mainly RX foods, which is great.  If you need to mix in a little something else into the refrigerated food to get your little one to finish off a can, I don't really see that as a a problem.   Can't you even take some of the RX dry and crush it and use it as a topper?   That might even work.  If not, and you have to open up another can of something, then won't you have THAT can in the fridge as a leftover?  A catch 22
 
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pawprints1986

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Well, as of now, she doesnt care for the vet diet leftovers, but she will eat the science diet leftovers... today i tried mixing the 2 a bit (some leftover vet diet with some leftover beef, all warmed with added warm water), that went well. the science diet is the same in phosphorous (dry matter) as the vet diet... so i figure im not doing harm...  on the site its a bit different (tanyas foods comparison), but the newer vet diet luckily had the numbers i needed on the label so i figured it out that way, and theyre both 0.7 for phosphorous... protien is aorund the same too, in the 30s... so i figured im hopefully not doing any harm with feeding it. with protien around the same im not even sure why she likes those leftovers better... from what it hear protien is what drives cats to their foods (along with texture, smell). 

fluids went well today too, except it migrated again, to her elbow area. its not bothering her, i just hope its not an issue if that happens on a regular basis... it happened last time too. i freaked a bit and called the 24 hour vets to ask what had happened, explaining she had sat up as her fluids were going in... they sounded like its perfectly fine.... i just hope its ok if it happens regularly :/
 

mrsgreenjeens

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All sounds good
.

It IS curious that the fluid is going to her elbow area on a consistent basis
.  Our last kidney cat would get a "fat leg" once in awhile, but his fluids would gather in different parts of his body just depending on the day.  Now with our current kidney cat, it seems to gather around her neck, so she looks like  little lion afterwards.  I'm guessing it's all in the placement of the needle to begin with, so maybe just angle the needle a little to the left or a little to the right in the scruff, just don't angle it so much that it ends up poking OUT the other side (been there, done that)
 

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Hi pawprints.I'm sorry your baby has CKD.I have lost three to it.you have been given a lot of good replies.One thing I learned(the hard way) that I will never regret is joining a CKD group.their knowledge of CKD is far superior to anyone's in my opinion.Tanyas' site is great.www.feline.crf.org or the group at yahoo.Stage 3 is nothing to laugh about.they will want all bloodwork ,urinalysis tests etc.you are privy to all documents so every test your kitty has had.A non eating kitty is a dead kitty.kitties must eat to live.many will not go the renal formulas.the key being to try lower phosphorus ones' hoping you'll hit on one.The key being that cat eats enough calories per day to sustain life.Average 10lb kitty is around 180-200 calories per day roughly.Then as per bloodwork phos binders may have to be introduced.Actaully depends on where the phos number is now as per if you should be supplementing with a phos binder.these groups will walk you through everything.they are a gift.Have answers to everything & lots of times you will tell you things that you will never hear come from your vet.They have been around for eons and have helped 1000's of kitties all over the world.this is what they do.Stage 3 I would join right away.just my two bits.Ckd being nothing to take lightly and day to day online help  via ckd groups is essential.they read bloodwork like the back of their hand.this is what they do.here is the link to join the yahoo group.Both groups being excellent.But food is life.hydration key etc.They will tell you everything you ever wanted to know about renal disease & how to slow it down.What to watch for etc.Usually with subq with the way is is lying in your kitty change positions.If getting in into the foot/armpit which I have I have been told it is actually very painful for a cat.Happened once or twice with me.Consider the saddle on the cat.That is the subq area.HTH C.Also they will steer you to companies to obtain supplies a lot cheaper.needles,fluids etc.most do not buy from their vets.  https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info
 
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pawprints1986

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So I Brought Boo for her followup yesterday... as of now *touching wood* shes doing really well! 

Her creatnine was originally 1,033, it is now 223 (it says umol/L, not sure what that means), leaving emerg was in the 300's

her BUN was originally 66.7, now 12.2 (thats in mmol/L)

her phosphorous is actually 0.9!! (thats mmol/L as well)... originally that was 6.7... leaving emerg was around 2.6 i want to say

for creatnine my vet was expecting her to stay floating around the 300 area, so suprised in a pleasant way that it went further down, quite closer to normal!! :D

Weve been approved, considering the numbers, to try the fluids down to twice a week from 3, and see how she does. we were also given appetite stimulant to give as needed, if she doesnt seem quite as hungry. she came home with 1 in her yesterday, just because she got SO boney, to try and beef her up a little bit. 

But overall.... *touching wood* he was very happy with her numbers, as am I with the few i understand. 

she is very very slightly anemic, but it sounds like with enough eating again, that should work itself out in the long run. it was so slight he didnt feel the need to supplement. 

her potassium is at the lower range of normal right now too. (before was 6.6, now 3.7 mmol/L). he explained that (i asked why it was added to her fluids to take home), i guess because the IV was such a flush potassium was down, so that bit added to her fluids initially was to bounce it back to the normal range. but he said kidney cats tend to run high for potassium, so no further added potassium should be necessary, and hopefuly we can maintain normal. 

so overall *touching wood* were looking much better than a few weeks ago before any treatment. 

(for anyone who is a member on both, i copy pasted my post from cat forum. just easier that way, but wanted to share the news!)
 

momofmaxwell

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Hi Paw prints.

What you are saying is her USG urine specific Gravity was 1.033 which is good.I;m hoping her creatinine was not in the thousands I have never heard of it every that high in 12 yrs.So maybe a typo..Yes the numbers have come down & that is great!! Her potassium on the lower side just pay attention to unstable walking.Her gait etc.As low potassium can effect their strength in walking,her head,wobbliness etc.The numbers in mmol/L actually need to be converted to reg. US numbers.Mine were measured the same with my CKD kitties and when joining a CKD group they recreated a proper chart of what the real numbers were.Phos levels are usually what you look for as well to rise as with foods and not being on a low phosphorus diet.When I believe the phos gets to 4 and don't quote me on it , i believe that is when phos binders have to be introduced into the diet.Any questions regarding numbers etc you can always go to Tanya's site and read everything there is to know about renal disease & how to prevent things from climbing.You obviously do not belong to a CKD group so you may find help there understanding really what numbers your kitty are at.But very good as per your vet which should well know that baby is on the mend.Here is a snippet of phos levels in CKD cats:

Symptoms of Phosphorus Imbalances                                                          

Since phosphorus control is so important for CKD cats, there is an entire page devoted to the topic, which includes symptoms of imbalances. Briefly, they include:
I'm presuming you were probably given mitrzapine for appetite.Mostly used by vets.You can read about it @ tanays' as well as always addressing nausea first before ever introducing an app.stimulant.Cats are not vomiting to be nauseous.they just don't want to eat that much.Or will walk up to a bowl ,smell & walk away.typical signs of nausea.www.felinecrf.org  Just go into the index or search engine.HTH C.Definitely is not the same IMO to belong to a said group, that,that is all they deal with.A super wealth truly for all of us who have been there........
 

mrsgreenjeens

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Using the calculations on Tanya's website, these are the conversions from mmol to U.S. figures (assuming I used my calculator correctly).  Here's the section of her website where it shows the calculations:  http://www.felinecrf.org/diagnosis_test_ranges_factors.htm

Creatinine is 2.52

Bun is 34.16

Phosphorus is 2.79

Per that page, BUN and Phosphorus are within normal ranges now. 

On the potassium, kidney cats are prone to either high or LOW, depending on what stage they are in.  Based on creatinine of 2.5, it's say she could go either way, so would definitely keep an eye on her gait, as MomofMaxwell pointed out.  But I must say that of all my kidney cats, NONE of them ever had potassium issues, so perhaps it's not all that prevalent? 


Anyway, so glad she's doing well
Keep up the good work
 

momofmaxwell

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Hi Mrs.Green Jeans,

I too with  my 3 Ckd angels never had a problem with low potassium.But belonging to a CKD group & reading daily posts I do see it quite a bit.Some are on huge amounts of fluids.Some had diarrhea etcElder kitts i see more prone.Raw diets without proper addition of crucial additives..Tanya's does talk all about it in Helen's bible.Something always to keep an eye on in regular blood tests and having all your own copies to form a file for your kitty.That way you can on the next panel done compare.I have files for all my late Kitts.Great the babe has great numbers.Here is a link on low or even high potassium which can happen as well levels.Every single kitty responding to treatment differently than the next.:Hypokalemia

https://www.google.ca/url?sa=t&rct=...s.html&usg=AFQjCNFlv-tF7_pgTSBjAi3uQ67JR3-oFA

Hugs to the babe & keep up the Great Work!C.
 

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Hi pawprints1986. One of my cats was also recently diagnosed with CRF/CKD about a month ago and I was and still am overwhelmed by it. My Jumbo first tried the Science Diet Rx wet from the vet. He refused to eat it. He then tried Royal Canine Modified LP from the vet. He nibbled on it a little bit, but then would not eat it. I tried mixing in his old regular wet food or tuna. Three cans were just wasted as my other 2 healthy, senior cats wouldn't even eat it. So I ordered the Iams Rx wet and dry and Hi-Tor Neo wet and Hi-Tor Felo dry from www.chewy.com. I've been alternating the Iams and Hi-Tor wet for the last 3 weeks. He will eat those 2 on his own if I mix in a spoonful of tuna or tuna-mix flavored regular wet cat food. So far I've only fed the Hi-Tor dry. He does graze on that on his own. I don't let it sit for more than a day if he doesn't eat it all. But my other 2 cats like it too apparently and eagerly gobble up his leftovers. I'll give him the Iams dry when he finishes other bag. I know he should be eating wet only, but either he gets tired of wet only or just doesn't love the Rx wet he's supposed to be eating. The regular wet food brands I've been mixing into the Rx are Halo, Soulistic and Best Feline Friend. My other 2 like the Halo and BFF. I would consider just feeding him those and not the Rx, but for now I'm trying to do what the vet wants with his diet.

He hasn't started on fluids yet. He's at about stage 2. Right now we're just seeing how the diet change helps. And I give him 2.5 mg pepcid twice a day per the vet plus some renal support chews (if he will eat them). 
 
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pawprints1986

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So it soudns like youre mixing diets too.... 

im trying to keep some variety, so ive been alternating portions (ive been using smaller portions in an effort to waste less), im using science diet commercial varieties (beef, turkey, chicken), along with the royal canin renal diet. she seems to like the switch up. it means altogether 3 cans of leftovers in fridge at all times (our other cat is still on the merrick for his wet), but we have a container dedicated to them. 

The science diet ones are among the lowest phosphorous for commercial diets, and protien isnt crazy either. 

i alos leave her the royal canin kibble to pick at, which she does do. but luckily she enjoys the wet food and eats probably 95% wet. 

occasionally she does get into our other cats merrick, but i asked the other day, and they said not to worry, as long as its not super often and her regular diet is the renal (or, low phosphorous). 

the alternating seems to have her eating more so, ill definitely keep that up :)

we were given some of the mertazapam, or whatever its called to take home to use as needed for appetite too. 

*keeping paws and fingers crossed that we can maintain wellness on 2x per week and diet changes*
 

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Jumbo is my former street cat and he used to be a gobbler of food, dry or wet, it didn't matter. Food is originally how I got him to trust me when he showed up 4 (almost 5) years ago. Before when I'd feed him wet food, I'd put half a 5.5 oz can in his bowl and he'd eat it quickly. Now if I do that, he'll take a few licks then stop and go sit in his bed or meow at me to pet on him. I guess when his renal disease progressed in the last year or so he became a grazer. So now I give him a quarter of the can watered down and that seems to work better for him. I try to only add a spoonful or 2 of any regular food. I think he has become a tuna addict... that is probably not a good thing. He is mostly kept separate from the other 2 because they fight, while that's a problem on it's own, at least it's easier to monitor his food/water intake. I too currently have 2 cans and a food pouch in the fridge.

I also notice from the food charts that Science Diet has a lot of low phosphorous regular foods. I just wished he liked Science Diet. I had moved all 3 cats to SD senior dry kibble about a year ago. That's about when he stopped eating. A cup of dry would sit in his bowl for several days with him barely touching it. The other 2 didn't mind it at all, they still eat it as their main dry food. He also didn't like the SD Rx wet food from the vet, so I doubt he would like their regular wet food. I think he likes the Iams renal wet more than the Hi-Tor Neo, but I could only get Iams in 12 can case and Hi-Tor comes in a 24 can case. 

When he was first diagnosed last month and wouldn't eat the prescription food, I called the vet's office to ask what to do and the receptionist said, "Well if he's hungry enough he'll eat it. He won't starve to death." That angered me, and still does. That's a common train of thought though. But it's just ignorant and inconsiderate. My cat was already starving himself because he didn't like his regular food (before I put him back on his old food) plus the disease causes appetite loss. Whatever cat food you can get your cat to eat and keep down is the best thing for the cat. Jumbo throws up a lot. He kinda of always did even before the diagnosis. There have been several treats and vitamin chews that I can give my other 2, but Jumbo will throw them up a few minutes later. 
 
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