Calcitriol and Chronic Renal Failure Experiences/Opinions

Hi all,

I haven't posted here at the forums in awhile, but I'm just wondering what others think about Calcitriol use in CRF kitties.

Blondie was just diagnosed several days ago with "early" CRF. I say early because the vet says his numbers are still low and symptomatically he's showing signs. He's 14 years old. I don't have the numbers in front of me, but I do know his creatinine went from 1.9 to 2.8 in a year, and the vet said his phosphorus is still in the normal to low range but has also gone up in a year.

Anyhoo, the vet's plan is to begin a low phosphorous/lower protein diet which I've already started doing. The vet also suggested Calcitriol. I've done some reading over at Tanya's site for CRF kitties and FelineCRF.com, and it seems like it's yet another one of those treatments that have divided opinions. The vet actually has a CRF kitty that also has thyroid problems, so I'm thinking this could be why she is personally recommending Calcitriol. Makes sense. But still, I'd like to hear from those here who have CRF kitties without thyroid issues who have used Calcitriol. Just wondering how treatment went and if you got good results. Any info will help me in deciding whether or not to start using it. 

Thanks in advance for the help!

Emm

Just bumping this up for you.  I've had 3 CRF cats, but never used it.

Thanks for the bump! I've pored through older posts pertaining to Calcitriol, but haven't found enough info to help me in making a decision. 

It's been a roller coaster during the past week. I've gone from numb, to angry, to depressed, to now feeling like I'm ready to grab this thing by the horns and meet it head on. 

Do you mind sharing some links to your threads here where you've discussed your experiences with your kitties and CRF? I'm not sure exactly how to look up threads by just the username here, so it's not at all because I'm being lazy lol. I'd very much appreciate it; I'm trying to read up about as much as possible, especially about other's experiences. I've already spent about fifteen hours over at Tanya's site and felineCRF.com, but would like to read more. 

Thanks so much,

Emm

It is always shocking to learn of a chronic illness

My last kidney cat passed away in February, so I don't have any recent threads about her, and I honest didn't post many threads about her as I mainly am her in an advisory capacity, so mostly ANSWER threads rather than start them.  To find threads that others have done, however, I can help  you with ( Hopefully) .  Directly under the "search" button above are the words "Advanced Search"  If you want to search by a user's name, before you do anything else, simply click on Advanced Search and a different search page will come up.  You can search by key word(s) or by user name and refine it even further if you want.  I sometimes simply search by user name within the last 2 weeks if I am looking for something specific that I know I read just a couple a little while ago.  Does that help at all?

What specifically are you looking to read about right now, other than knowing much about Calcitriol?  Maybe i can find some threads for you if I know what you're looking for.  It's good you already know about Tanya's site.  That's usually the first thing I do, is refer people over there, although her site can be overwhelming and I sometimes refer people to different pages, simply because it's often hard to find your way around. 

You mentioned Blondie is already symptomatic. What are his symptoms?  Is he having some stomach distress?  If so, how are you treating that?

As far as the Calcitriol, is Blondies ionised calcium high or something?  That's the only reason I can see why your Vet would even be thinking about putting him on it, from what I am reading on Tanya's site.  I guess you saw that on this page:  http://www.felinecrf.org/treatments_regulation_minerals.htm#calcitriol

How is he doing with the new food?  Is he accepting it?  Is it wet or dry?  Honestly, the new way of thinking is that very good quality, HIGH protein, low phosphorus is the way to go until they reach stage 4.  My Vet attended a seminar where nutrition was the topic for CKD cats and she came back finally agreeing with me because I had been saying all along that I felt it was the low protein that was partially causing all the muscle wasting. But the bottom line is, get them to eat, eat, eat

mrsgreenjeens said:

 
You mentioned Blondie is already symptomatic. What are his symptoms?  Is he having some stomach distress?  If so, how are you treating that?

As far as the Calcitriol, is Blondies ionised calcium high or something?  That's the only reason I can see why your Vet would even be thinking about putting him on it, from what I am reading on Tanya's site.  I guess you saw that on this page:  http://www.felinecrf.org/treatments_regulation_minerals.htm#calcitriol

How is he doing with the new food?  Is he accepting it?  Is it wet or dry?  

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I'm sorry for the delay in getting back to you, but thank you so very much for the advice in pulling up posts here. Yes, it does help!

Blondie's symptoms began about six months ago, when I noticed he began drinking more water and the urine chunks in the litter box grew larger, almost double in size. I knew it was a kidney thing because previous imaging had shown one kidney was exceptionally large, the other normal, but I had no idea it could be CRF because I admit my ignorance about it. Other symptoms he has include appetite issues (i.e. "picking" at food, or refusing a favorite flavor) and going into "sick bay," what I call his hiding spot under the bed. He is on Pepcid. He takes the least effective dose, about one sixth of a 10mg tab a day. One curious thing I notice is that he vomits nearly every morning, sometimes undigested food, sometimes just bile, but this only happens after his lion cut has grown out. So, for at least three months after a good shaving, he NEVER vomits. I think his fur intake from grooming affects his system, but one would think it would cause constipation, but alas, he's rarely constipated. I need to start keeping him shaved as much as possible, and maybe consider increasing the Pepcid on an as-needed basis. 

As far as the Calcitriol goes, the vet did say it is optional, but stressed his diet absolutely needs to be altered and that I should start administering a phosphorus binder in low doses, which I just bought today from thrivingpets.com. Two days ago, I received a copy of his labs from the vet. What can you discern from these numbers as far as the Calcitriol goes? Also, what do you think of the numbers overall? If there are other numbers you'd like to see, let me know.

Blood work with high values:

• ALT (SGPT) - 120 
• BUN - 46 
• Creatinine - 2.8
• Phosphorus - 4.3
• Calcium  - 9.8

Low values include:

• Platelet count - 94
• Lymphocytes - 17

Urine values: (vet also mentioned urine was very dilute)

• Creatinine - 1.7
• BUN/Creatinine Ratio - 17
• Phosphorus - 3.8
• Calcium - 9.8

Blondie's food situation is free-choice dry food and one 5.5 oz can of wet food daily. His dry food is currently changing from a mix of Blue Buffalo/Fromm to Petcurean. I chose Petcurean because of the low phosphorus, plus I refuse to feed him Royal Canin or Purina kidney diets due to the ingredients; Blondie has been eating foods free of by-products and other yucky stuff for almost three years, so I do not want to re-introduce it. I give him Weruva, Hound & Gatos, Earthborn, Fromm, Lotus, Nature's Variety and sometimes Wellness, of which I've been making sure he eats low phosphorus varieties (below 1.0 based on dry matter basis). When I get the phos binder, the vet said for now to only use it on days I feed him higher phosphorus food. I've been mixing in about a tablespoon of water into his wet food for about six months now, and he eats small servings spread throughout the day. For treats, he likes Whole Life freeze dried chicken. 

I've also started keeping a food/symptoms journal to document everything. I've already noticed a pattern of about four days of doing well, and the rest of the week, not so well. As I write this, we are in the midst of a bad stretch: He's been picking at his food, and is spending more time in sick bay 

Thanks soooo much for reading, and for your help. I'm pretty sure each time I have posted here for the past several years, you've always been there to respond! You are wonderful!

Hugs to you, Darko and Stinkpot 

Emm

Sounds like you've got a handle on what to do.  Has he taken to the Petcurean, or is he reluctant to eat it?  If he isn't eating it as well, I wonder why not just leave him on his old food and give him Phos Binders every day to offet it?    Now you just need to determine the amount of phos. in all of that canned food.  I know some of the info is on  Tanya's site, but I don't believe all those brands are there.  It's probably simpler to just call each manufacturer and ask them how much there is on a Dry Matter Basis.  What does your Vet consider "higher phos days/"  I, too, tried to keep it under 1%.  Sometimes Callie only wanted foods that were extremely high, like 2.9, but our Vet said since other days she ate foods at less then .8, it all balanced out, and we never gave her phos binder, but she was the kind of cat that knew if anything was added to her food and then normally wouldn't eat it .   I also tried to feed Callie only high quality, low carb foods, but in the end, I tried any and everything I could get my hands on as she got pickier and pickier.  All bets were off.  I even bought Friskies!  She finally decided she liked Iams Purrfect Delights Tunatopia.  Actually, she decided she LOVED it and stopped losing weight because of it.  Whatever worked was our theory.  And luckily, the phos was only .8 ish.

I also fed lots of very small meals throughout the day (and night).  WET meals, also adding 1 T of water to each meal.  At night, I froze 2 bowls of food and then took them out of the freezer when I jumped into bed.  I put one bowl on a towel on my nightstand to start thawing, and the other on an icepak.  (both bowls in individual ziploc bags.  When she came to me a couple hours later to eat, the first bowl had thawed, so all I had to do was reach for it, unbag it and give it to her right in bed.  Then I took the other bowl off the icepak and set in on the towel to start thawing.  Easy Peasy.  I never had to get out of bed!  AND, the boys were trained that if they left Callie alone while she ate, they would get treats that I had in another ziploc bag under my pillow

If Blondie is not throwing up "froth" he  may not need any Pepcid A/C yet.  Or, if he's in sick bay a lot, maybe he needs more.  Hard to know, really.  He may just hurt from too much stomach acid...impossible to know at this point.  You could try giving him the normal dose (1/4 tablet)  for several days in a row and see what happens. 

The only numbers I really know much about are Creatine and Urine Specific Gravity, which you don't have here.  Otherwise I just refer to Tanya's site.  But this shows Stage 2, going on Stage 3 kidney disease if you just look at Creatinine.  Those low values Darko had too recently when he had his dental.  Our Vet said not to worry because other numbers need to be out of whack WITH them in order for there to be a problem that's worrisome. (not related to kidney) 

Did I answer all your questions?  Sorry, I can't find my readers right now so am squinting quite a bit

Thanks for all the info and for sharing your routine with Callie! That makes me feel not as unsure and lost in knowing that I'm following a routine similar to what you did with her. It's comforting knowing that I'm doing something right in all this craziness of the "early" days after getting diagnosed. 

He's actually taking to the Petcurean very well, and I think it's because it smells nearly the same as his Blue Buffalo/Fromm mix and the ingredients are similar, too. He's at about 20% Petcurean so we're almost done with the changeover. I'm also really trying to get him to not eat as much dry food and so far it's working out well. I'd say in the past his diet was about 60% dry to 40% wet and now it's opposite. He's such a dry food junkie, so I figure for now I'll let him have some until the later stages start rolling in. 

Funny that you mention to call the manufacturers about phosphorus levels, because I actually just sent out emails today to three of them inquiring about it. The vet said the same as you did, that anything above one percent is a little iffy. I told her I was thinking of donating some of his cans with higher phosphorus, and that's when she told me about binders. She said hang on to the cans, use them with binders if he's having a fussy day and will only eat a particular can since getting our cats to eat is the most important thing.  

I think I might try and increase the Pepcid AC to the "normal" dose for a bit because now that you mention it, I do in fact notice froth sometimes when I'm able to catch him vomiting. Most times I only see the vomit after the fact, so it could even be there's froth every time. He's been on his low dose routine after we had a gastro scare a couple years ago. He went to a specialist for vomiting and regurgitation issues and the Pepcid AC was prescribed, but as a "lowest effective dose" routine. When I looked at his labs from back then, I noticed his BUN was high, at 37, and creatinine was at 1.9. This now makes me think it was not limited to gastro issues like the specialist thought, but rather because he was in the beginning stages of renal failure. The specialist vet (not our normal vet) never mentioned these values to me. I'm kind of miffed now; I could have started treating Blondie back then! But no sense in fussing about what I can't go back and fix. At least I'm treating him now! 

Oh, before I forget, Blondie's urine specific gravity is 1.019 and by the lab's standards (1.015 to 1.060) he's teetering on the edge. I think I'm going to take him back in a couple weeks to do another panel and also get his blood pressure checked because he's been exhibiting some of the symptoms of hypertension as well. Did Callie have any other secondary issues like hypertension or thyroid problems?

Emm

Yes, if you can eventually wean him completely off the dry food,that would be best, IMHO, although if you cannot feed him those extra meals in the middle of the night, having kibble available might help with the early morning throw-ups.  I used to give Callie some dry treats in the middle of the night until Vet Tech friend  said "too bad you can't get up and feed her a wet meal".    Why didn't I think of that?  It was so easy (for me, because I'm no longer working ) 

Absolutely get his BP checked if he's exhibiting any signs.  Callie never had any issues with BP, or thyroid or IBD or anything other than LIVER, which, of course, is not a good thing to have issues with.  At age 15, though, we decided not to run an ultra sound to try to figure out what was wrong, because, honestly, what were we going to do about it, when she was also in stage 3 - 4 kidney disease?  Her ALT would go pretty high every once in awhile, then she'd get a shot of Convenia and it would go back down for awhile, then it would go up again, and we'd repeat.  Never knew what was causing it, but knew when it was going up again because she's start throwing up bile and just have too many bad days in a row.   And oddly enough, she didn't die from either kidney disease or liver issues. 

I just read your reply; sorry it took a bit to get back to you. As I mentioned before we're in the midst of a bad stretch, as in, he's not eating as much. I admit, I had a bit of a breakdown/crying fit about an hour ago. I've opened 3 cans today, none of which he's really interested in. A couple bites and that's it. I know days like this are common, but when it stretches too long, it's so frustrating and scary. I wish I could just tell him, hey kitty, if you don't eat you're going to get even more sick!  Ugh. I even tried his go-to favorite for when he refuses canned food: I mince no salt boneless/skinless sardines in water. Even that isn't working. This is so tough

Anyhoo, I talked to the vet a couple days ago and she said yes, definitely we can check his BP next time. He's been howling a lot, and also I notice his eyesight has diminished a bit in the past year. And funny you mentioned ultrasound because the vet said she'd like that too. 

As far as the vomiting, I do leave kibble for him over night, but sometimes I noticed he doesn't touch it at all. Another weird thing is he only vomits when he has a full coat of fur. For a few months after a lion cut, he's fine. Even his other symptoms related to CRF go down somewhat! He's like a different cat. His next cut is coming up in two weeks, and I can't wait. The vet said she can't explain this right now (that's why she mentioned ultrasound) so I kind of wonder if he does indeed have some other gastro condition. Hmmm. 

This is all so difficult, but I'm glad I can come here and talk it out. No one else except people like us who been through CRF can understand. Thanks again for reading and listening; I cannot stress enough how helpful and comforting you have been.

Emm

I forget, do you have him on any appetite stimulant?  We gave Callie Mirtazipine every 3 days just to help with her appetite.  We used a transdermal gel to get it in her, and it usually worked quite well.  Not always, if she was feeling particularly bad, but usually.  

The howling in the middle of the night is a little disconcerning.  Be sure to mention that to the Vet.  Did they run a thyroid check on him along with the normal blood test?  Thyroid cats holler a lot, but then again, so do older cats who are beginning to lose their site and/or hearing

.  Kidney disease is definitely an up and down kind of thing and takes it's toll on not on the patient, but also the caregivers. 

Oh, BTW, has your Vet mentioned Azodyl?  Some people seem to think it works well to try to help with the kidneys.  It's a pretty big pill though, and isn't supposed to be split.  Are you any good at pilling?  You can read about it on Tanya's site.  No prescription is required..  Dr. Becker (holistic Vet) recommends Feline Renal Support by Standard Process.  I just read her article yesterday on it.

mrsgreenjeens said:

 
I forget, do you have him on any appetite stimulant?  We gave Callie Mirtazipine every 3 days just to help with her appetite.  We used a transdermal gel to get it in her, and it usually worked quite well.  Not always, if she was feeling particularly bad, but usually.  

The howling in the middle of the night is a little disconcerning.  Be sure to mention that to the Vet.  Did they run a thyroid check on him along with the normal blood test?  Thyroid cats holler a lot, but then again, so do older cats who are beginning to lose their site and/or hearing

.  Kidney disease is definitely an up and down kind of thing and takes it's toll on not on the patient, but also the caregivers. 

Oh, BTW, has your Vet mentioned Azodyl?  Some people seem to think it works well to try to help with the kidneys.  It's a pretty big pill though, and isn't supposed to be split.  Are you any good at pilling?  You can read about it on Tanya's site.  No prescription is required..  Dr. Becker (holistic Vet) recommends Feline Renal Support by Standard Process.  I just read her article yesterday on it.

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I asked the vet about an appetite stimulant, and she said "maybe we're not quite there yet," and went on to basically say it seems like he's okay for now, and let's monitor things. I don't know. Right now we have about 3 "bad" days of the week, the rest good. And on those bad days, he eats half or less than half of what he normally does. The vet seems to think when it gets to the point of more bad days then good, then she will explore stimulants.

They did a thyroid panel and the vet said everything looked okay, except she does want to monitor calcium levels (his were creeping up there a bit, but still normal). She's worried about hypercalcemia and potential thyroid problems. I didn't know that the howling could be associated with sight/hearing issues; I noticed within the past year or so, his eyesight may be diminishing. Hmmm...

Oh yes, Azodyl. I read about that and absolutely LOVE the concept of it; however, pilling is definitely not something I'm good at. And yeah, that pill is HUGE! I thought I read something about giving kitties the human version of Azodyl to get past the pilling problem. The human version has more active bacteria, so essentially more will survive if sprinkled on food. Can't remember where I read this, as I think I've been to hundreds of pages about CRF in the past two weeks!

Thanks for the good vibes  CRF definitely does affect everybody involved. We're back in a "good" stretch, so I am feeling better today, but I know I need to learn to react to the bad stretches better than I do now. It'll take time.