rapidly decreasing appetite in older cat

buttonsmom

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Hi everyone,

I'm new to this forum, so I hope everything in this post is as it should be.

I have a 14-year-old cat with kidney disease. 

He was diagnosed with kidney disease a little over a year ago, in February of 2015. His creatinine was 2.9 I followed the advice of one board-certified vet that I spoke to, as well as of the holistic nutritionist: I fed him a high-protein diet, which I realize is contrary to the mainstream opinion. Since his diagnosis his creatinine has risen steadily, but nothing else seemed to be affected. He continued to have a healthy appetite, gain weight, etc. And yes, of course he is on subcutaneous fluids. His phosphorus has been well-managed, as I put a phosphorus binder (aluminum hydroxide) into his food.

In March of this year, his creatinine hit 4.2 and the vet he sees insisted that we lower protein. So I did that via a vegetable pre-mix (Dr. Harvey's Veg-to-Bowl). Everything went well at first. He didn't even notice the veggies, and gobbled them up with the rest of his food. His creatinine went back down to 2.9 !

Then suddenly around mid-May, his appetite started decreasing. It is the rate at which this happened and continues to happen that I find astonishing. First, it was worse every 2-3 days. Then it was worse every day. Now it's every meal.

There is no: vomiting, teeth grinding, pawing at the mouth, playing with water, etc.

In fact, he tells me he's hungry. Then I bring him food and he won't eat it. He sniffs at it and then walks away.

This not eating food is across the board. He won't eat food with the vegetable premix, he won't eat food mixed with rice, he won't eat a low-protein diet, and he now won't eat plain cat food or raw meat either.

The vet says it is not excess stomach acid, nor is it metabolic acidosis. He is not anaemic, and he is not dehydrated.

Moreover, my understanding is that cats with a creatinine of 2.9 (and a BUN of 35) are not uraemic. If they're not uraemic, their sense of smell/taste should not be impaired, should it?

I'm going to pick up an appetite stimulant tomorrow. But does anybody have any idea if this appetite loss happens in kidney disease with these numbers? Or maybe his appetite loss is not even kidney disease-related?

Thank you so so much. 
 

donutte

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Hello there! I'm sorry to hear your kitty isn't doing too well. First off, is your kitty on subqs (subcutaneous fluids)? I didn't see that but it's possible I missed it. Dehydration can cause a kitty to feel yucky, can cause creatinine levels to be up, and overall isn't a good thing.

Out of curiosity, how does the vet know it's not stomach acid? That's the first thing I'd suspect if a cat isn't eating, since high levels of creatinine can cause increased stomach acid. In fact, I'd treat for that and/or any nausea (possibly with something like Cerenia) before trying to use an appetite stimulant.

Do you happen to have all of the blood work that you can post? We can get a better overall picture there, since there are so many other things that need to be considered (especially phosphorus).

High protein diets in early stages is definitely not a bad thing. It's the phosphorus you need to worry about though. You should aim for high protein/ low phos if you wanted to go that route. I wouldn't feed the veggies, that doesn't really help much with cats. Is he on a phos binder?

Right now, in the mean time, offer him anything you have to see what he will like. Kidney cats are extremely finicky, and what they liked yesterday or even earlier today, they won't like now. But they'll like something they snubbed the other day.
 

donutte

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Actually, in re-reading what you said, it definitely sounds like nausea. The whole being interested in food but then not eating it. Does he hover over the water bowl by any chance? Usually the protocol for nausea with kidney cats is something for acid like Pepcid. If that doesn't work, onto the anti-nausea drugs like Cerenia. And if that doesn't work, THEN appetite stimulant. So I would definitely have a talk with your vet about giving Pepcid or another acid reducer, and possibly Cerenia.
 
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buttonsmom

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Thank you so much!

His creatinine is currently 2.9, his BUN 35, and his phosphorus is 3.7 

His phosphorus has been well-managed for a while (not higher than 4.2), because I do put a phosphorus binder (aluminum hydroxide in his food).

There is no vomiting. We don't really know, of course, if there is any nausea.

It doesn't seem to be a question of being finicky, as he likes fewer and fewer thing each day. First he rejected the veggies, then canned cat food, then raw food, then his favorite treats.... He absolutely won't eat ANYTHING now.

Yes, he is on subQs. He gets them every 3 days. Actually sometimes we go to the vet on the day of the subQs, before he has gotten them. She gives him that skin test, and he is never dehydrated.  According to that skin-snapping-back test anyway.
 
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buttonsmom

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Oh  really you think so? So a cat with 2.9 creatinine can have nausea? I thought that usually happened to cats with higher numbers.

No, absolutely no hovering over the water bowl. His drinking is normal, as far as I can tell. Although of course he is drinking less since he's eating less.
 

donutte

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My vet has a saying - treat the cat, not the numbers. Sara was on Pepcid when her numbers were lower than that because she was symptomatic. That's good if he's not hovering over the water bowl. That seems to be more common when the nausea is extreme. Sara didn't have that so much but my poor Lucky did. But, each cat is different.

It may be a good idea to ask if he needs to be on low-dose regular subqs. Or at least have them give him some in the office and see how he gets. It's amazing how they can bounce back after getting some fluids. The last thing you need is a dehydrated kidney cat.
 
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buttonsmom

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Ohhhh interesting.          

Thank you so much!

So maybe before the appetite stimulant I should try both of those things....

Thanks a million! !! !!
 

donutte

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Yes, would definitely try the appetite stimulant AFTER the other stuff. But please talk with your vet first about it to make sure they are on board, and express your concerns.

And again, I'd ask about the fluids. Those are SO important in treating kidney cats.

Edit: Sorry, just saw your other post. How much do you give him every three days for subqs?
 
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buttonsmom

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150 mLs every 3 days.
 

donutte

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I would definitely ask if it would be better to give less, more frequently. Maybe 50 ml a day. I know a lot of vets (LOTS) say to give more less frequently, for reasons I can only guess are around the comfort level of the owner poking their cats (or their perception of it). But, as someone said, you don't drink 24 glasses of water in one day and then not drink any the next two.

It's just a thought though. It will hydrate him more evenly though.
 
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buttonsmom

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Hmmm I suppose I could ask that, and I did read that on Tanya's website - but he hates the subQs.

Do you think being hydrated unevenly could have affected his appetite?
 
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