Cat with kidney disease has low potassium level under 3.0 mEq/L

[tamu708]

Sandra is going to be started on Aranesp for her anemia.  She is supposed to be getting 1 injection a week until her red blood cell count is up. With the initial Aranesp injection, she will also be given an iron dextran injection. I will have to take her in to the vet's office once a week to have her red blood cell production monitored.  Once the anemia is under control, the injections will be once every 2-3 weeks.  The vet said there is a much less risk of Sandra developing antibodies using Aranesp as compared to the other anemia treatment option, Epogen.  The vet is going to call in her prescription this afternoon.  She said it should be available for pickup tomorrow, and Sandi will be ready for her first treatment Friday. 

I pray that this treatment works for my Sandra.

 

[tamu708]

So I was looking forward to starting Sandra on the Aranesp tomorrow.  Unfortunately that won't be happening.  The Walgreens pharmacist said the vial can only be used one time and would have to be discarded.  She said there is no preservative in the vial so it cannot be used more than once. 

The vial size is 1ml/25mcg.  On the feline crf website it says the Aranesp is sold as a single use human medication but the single use sizes are routinely used for multiple doses in veterinary medicine.  I have been researching and reading online and found many cat owners purchase 1 vial and use it more than once, often for 7 doses. 

So the vet told them to hold off on filing the prescription since it would be too expensive to use it just once and throw away the rest.   And the vet didn't even bother to call me to tell me this.  I had to call Walgreens and check on the status of the prescription to find out.  I'm going to call the vet first thing in the morning.  This is so frustrating.  

 

[pushylady]

Can you not keep it in the fridge to preserve it? I know nothing about this med, but I can feel your frustration!

 

[tamu708]

Can you not keep it in the fridge to preserve it? I know nothing about this med, but I can feel your frustration!

I honestly don't know.  I will ask the vet first thing in the morning.  I told the Walgreens pharmacist many pet owners use this for the cats.  She kept repeating "it absolutely cannot be used more than once."  This just doesn't make sense to me.  I read online so many cat owners use this.  Hopefully the vet can figure out what's going on in the morning.

 

[donutte]

No, there is a way to use it. I would talk with your vet. I had that same frustration when I was looking for Sara. I spent a week just trying to find out prices - geez people, I'm asking about a vial, why do y'all need to know what dose she's on???

I wish I could remember. Let me try to sweep through the cobwebs or go to my CKD group on FB. I remember telling my vet how everyone was saying it was just one-use and he was like, "Oh no, we can use it more than once for cats."

 

[donutte]

Oh, and the people at Walgreens and what-not are used to dealing with people, so don't mind them telling you what you can't do. Your vet knows better. I think that dose is the lowest one a human would take so yes, it's a one-dose only in that case.

 

[donutte]

Asked some of my CKD folks (the cobwebs are pretty dense for me!) and the reason it's considered a "one-dose" is because it's preservative free. You have the vial and not the pre-filled syringe, yes? You can use it multiple times, not a problem. You'll just need to get the syringes (make sure to use a new syringe/needle each time).

Edit: Oops, I missed an entire post of yours apparently! I'm surprised your vet would say to hold off, considering how important this medicine is. The vet should know better! Maybe show them Tanya's page? Everyone I know that uses Aranesp for their kitties has used it multiple times from the same "single-use" vial.

Someone suggested trying Walmart Specialty pharmacy. I've heard from most folks they have the best price, and there is a lot less hassle (maybe they are used to working with pets too?).

 

[Geoffrey]

Sandra is back from the vet. They ran a kidney panel. Her BUN went down to 70. Before it was 83. Creatinine has gone up from 4.4 to 6.2. The vet said she is surprised Sandi isn't very sick already. Phosphorus has gone down from 15.6 to 10.8. But her potassium has also gone down again to 3.2 so the vet said to start her on the potassium supplement again. Also, her calcium has increased. The normal range is 7.8-11.3 mg/dL and Sandra is at 12.9.

They gave me a powder form of phosphorus binder to try, aluminum hydroxide. I'm to give 1/8 teaspoon mixed with food once a day.

The vet techs showed me how sub-Q fluids are given. They told me to think about if this is something I would be willing to do at home and let them know on Monday. It seems scarey. The needle is bigger than the one I use for her Adequan injection. And Sandra was struggling half way through the process. Another vet tech had to hold her. They said I would have to give her fluids 3-4 times a week for about 1 min each time.

When we got home she was very wobbly and shakey. I'm sure from the stress of going to the vet. She ate some of her prescription canned food and is now sleeping. I went and laid down next to her and hugged her and she started purring. So hopefully she is not too upset with me.

The vet wants to look into the Epaktin first and then let me know if it's a good supplement as it contains some phosphorus and calcium.

Does anyone have any suggestions in bringing down the creatinine?

Hello Tamu708,

I am a human specialist physician, not a veterinary surgeon, so please check any advice I give you with your vet, who sounds most competent.

From the history that you give, it appears likely that Sandra was suffering from paralysis of her back legs due to  low potassium, secondary to chronic renal disease.  Your vet was able to correct this paralysis by supplements of electrolytes, but  I believe that her kidney function is now poor as her serum creatinine is so high. 

You have asked for suggestions for bringing down her high creatinine.  I am sorry for the length of this post but the best way that I can answer your question is to describe kidney function, as simply as I can, and the answer will then, I hope, be self-evident (and I apologise if you already know what I am going to describe).

The level of serum creatinine is an index of the degree of kidney function so that any way to reduce her serum creatinine will depend on what caused the loss of the kidney function in the first place.    Loss of kidney function can be temporary or progressive and this latter can be acutely progressive or chronically progressive, with or without temporary deterioration.  Poor Sandra seems to have suffered all of these losses of function with pathological interference of electrolyte regulation causing recent paralysis. 

Basically kidneys act as a blood filter; blood enters the kidney through the renal artery and waste products are filtered out in the urine.  These waste products include nitrogenous substances  and in the presence of kidney damage these nitrogenous substances accumulate in the blood and are measured by estimating the blood urea levels, often described as BUN for Blood Urea Nitrogen.  However a more accurate method of measurement of nitrogenous substances is to assess the serum creatinine.

Other functions of the kidneys include regulation of fluid balance in the body as a whole and regulation of the salts (electrolytes) including the levels of Calcium, Potassium and Phosphorus in the blood .  These functions are regulated by allowing the urine to be concentrated or diluted.  Without going deeply into kidney physiology, a common first sign of kidney damage is usually the loss of the kidney's ability to concentrate the urine.  The BUN and creatinine and the electrolytes can only be kept stable in the blood by drinking a large amount of water thus enabling the passage of a large amount of dilute urine, carrying with it these substances.

My best answer to your question is, therefore, to try and improve Sandra's kidney function.  This is exactly what your vet is doing .

With best wishes,

Geoffrey

 

[tamu708]

Asked some of my CKD folks (the cobwebs are pretty dense for me!) and the reason it's considered a "one-dose" is because it's preservative free. You have the vial and not the pre-filled syringe, yes? You can use it multiple times, not a problem. You'll just need to get the syringes (make sure to use a new syringe/needle each time).

Edit: Oops, I missed an entire post of yours apparently! I'm surprised your vet would say to hold off, considering how important this medicine is. The vet should know better! Maybe show them Tanya's page? Everyone I know that uses Aranesp for their kitties has used it multiple times from the same "single-use" vial.

Someone suggested trying Walmart Specialty pharmacy. I've heard from most folks they have the best price, and there is a lot less hassle (maybe they are used to working with pets too?).

I called the Walmart Specialty Pharmacy.  They are willing to fill the prescription and not give me a hassle.  I just need the vet to call it in.  The did say that since it's a holiday weekend, I won't get it until Wednesday.  I called the vet and the receptionist left her a message to call me back when she gets in at 9.  I will tell her how so many cats are on it.  Maybe she can call a vet teaching school and talk to them.  They should know better.  Now we have to wait until Wednesday.  I just hope Sandi can hold out until then.  She seems ok so far but a little tired.  She's eating small meals.  I am going to call the emergency vet and see if they have some on hand.  I am so mad right now!

 

[donutte]

I can understand being mad. I have to say that week that I was trying to find out prices was literally one of THE most frustrating weeks I had with Sara's illness. Hopefully your vet is open to suggestion, as they just don't make cat-sized doses of this, and no one in their right mind would ever use this stuff if it meant throwing away mostly unused vials of the stuff. The fact is, many people DO use this for their cats, and without incident if they take proper precautions, like using clean (ie new) needles only each dose, etc. And obviously, they are using it as multiple doses (refer back to the "right mind" comment). If he just thinks about it, he'll realize that is the only way people are using it with cats.

Is your vet a new vet? IE just out of school? Or perhaps he's never used Aranesp with anyone before? I think my vet only used it once before with a cat, but that was enough for him to know how the shtick worked. Definitely a learning opportunity for the vet :nod:

 

[mrsgreenjeens]

So Walgreens WON'T fill it?  I got the impression they would fill it, just told you you can't use it for more than one time.  If they would go ahead and fill it, then can't you go ahead and use it the way Donutte said (with the unused syringes), then get any future supply from Walmart.  Wednesday is an awful long ways away. 

I would definitely talk to the Vet and see if he can get Walgreens to fill it first, no matter HOW they do it (one vial), unless it's cost prohibitive

 

[tamu708]

The vet called it into the Walmart Specialty Pharmacy. She said the pharmacist told her there is a very good chance it will be shipped overnight and I can have it tomorrow. I'm not holding my breath on this one. I talked to Specialty pharmacy before the vet called in the prescription and they told me since it's a holiday weekend I wouldn't get it until Wednesday. I just hope by some miracle we get it tomorrow and Sandi can be started on it right away. The vet is younger, maybe early to mid thirties. I believe this is her first time using Aranesp. So yeah, it will definitely be a learning experience for her. The vet has now agreed that the vial can be used more than once.

Sandi had a bowel movement earlier. It was a bit loose and darker colored. I took in a sample to the vets office to have it examined. They are to call me later on with the results. I got a negative vibe from the office when I took it in. I feel like they are getting very annoyed with us. I'm the one that has every right to be annoyed! Had I not called the Walgreens, I wouldn't have known what was going on. Even the Walgreens pharmacist said she was surprised the vet didn't call me to tell me. I'm just trying to help my Sandi. We've had her since she was 3 months old and now she's almost 19. She's a member of the family and means so much to us.

I just hope everything works out. I'm typing this on my iPhone with one hand and Sandi is laying on my other arm purring. She's such a little trooper through all this.

 

[tamu708]

So Walgreens WON'T fill it?  I got the impression they would fill it, just told you you can't use it for more than one time.  If they would go ahead and fill it, then can't you go ahead and use it the way Donutte said (with the unused syringes), then get any future supply from Walmart.  Wednesday is an awful long ways away. 

I would definitely talk to the Vet and see if he can get Walgreens to fill it first, no matter HOW they do it (one vial), unless it's cost prohibitive

They didn't fill it because the vet told them not to. She doesn't have experience using Aranesp. But she has now further looked into it and the prescription has been called into the the Walmart Specialty Pharmacy. I just hope we get it tomorrow.

 

[mrsgreenjeens]

 

 

They didn't fill it because the vet told them not to. She doesn't have experience using Aranesp. But she has now further looked into it and the prescription has been called into the the Walmart Specialty Pharmacy. I just hope we get it tomorrow.

Me too

.  Wednesday was too far away to have to wait, IMHO.  

 

[donutte]

I'm sorry you're having such a bad experience with your vet's office. They definitely shouldn't be annoyed with you, you are a great cat parent and I'm surprised they aren't appreciating that fact. I am glad to hear your vet has come around though regarding the Aranesp. There's a first time for everyone with everything, medicine in general is one big learning curve and lesson after lesson.

 

[tamu708]

The specialty pharmacy called me to verify the order and shipping and payment. Unfortunately the medication won't get here tomorrow. It's scheduled to arrive Wednesday morning. So disappointing. I asked if there is any possible method for it to be shipped overnight and the customer service rep said no; the last shipment had already gone out. I took the day off hoping I can take her to the vet and start the treatment and everything would be good.

I just pray to God Sandi will be ok until Wednesday. The vet seems to think she will be. If something were to happen, I will take her to the emergency vet. There is one less than 15 min from us. She is still eating small meals. I picked her up some Hills Savory Salmon canned food that's pretty low in phosphorus, and she is liking it. I also am giving her baby food which she likes. She has been a little purr monster today and seems to be enjoying the constant attention I'm giving her. But she still seems tired.

The vet did get back to me about the stool sample. She said they didn't find any blood in it. And they checked for parasites and didn't find anything. She said she is not sure why the color is darker.

I plan to keep a very close eye on Sandi. This is going to feel like the longest weekend ever.

 

[donutte]

Oh, I completely remember that feeling regarding the weekends. I called it the great void. They absolutely terrified me, and I felt so alone.

What were her numbers at for her blood levels and when was it done? Sara went a week and a half between the test where it was showing low, and the next one. That's when her numbers actually went up so we decided against the Aranesp at that point. Once I secured which pharmacy I'd go through, my vet actually wanted to check the levels again before we dosed (in case it changed) so I wouldn't be surprised if your vet did the same thing. Not sure if that's something all vets do or not, but mine did.

 

[tamu708]

As of June 25, her BUN is 88 mg/dL, Crea is 7.8 mg/dL, phosphorus is at 10. Potassium is at 4.1 mmol/L and Calcium is 11 mg/dL. HCT is 15.1 percent. The vet said if HCT goes below 15 she will most likely need a transfusion. I'm very worried.

 

[donutte]

I had to go back and look to see what Sara's was, it was 16.8% for the HCT. I'll keep your girl in my thoughts this weekend that things go well. I remember well being in this place and how helpless I felt.

 

[tamu708]

Sandi seems more tired today.  Her appetite, however, is the same.  I noticed that at times she is breathing heavier a bit, not a faster breathing rate but like taking deeper breaths.  I am worried that she is getting more anemic.  I called the emergency vet near us to let them know the situation and her anemia level.  I wanted to see if I were to bring her and she would need a blood transfusion, if it can be done and unfortunately, they are out of cat blood.  I just don't understand how an emergency vet can be out of something that important. They gave me the phone of another emergency vet that is about 20 min from us.  I called them, and they have blood on hand.  I am right now keeping an eye on her.  If she gets bad, I will take her in.  I'd prefer to wait until about 5-6 in the morning.  I figure there is a lot of people out for fireworks so the traffic is going to be pretty bad.  I think it will take a lot longer than 20 min to get there, and I don't want to stress Sandi out.  But if I have to take her sooner, I will.  I just hope she will be ok.