Home cooked for CRF kitty

[peaches08]

What phosphorus amount are we shooting for?  The phosphorus in the beef recipe Laurie mentioned is quite a bit higher than that in Dr. Pitcairns recipes.

I was wondering about that. At one point before binders my Grey ran into problems. Blood work might help. Also, we tell our CKD patients on binders to increase the amount of binders when having a steak dinner. But I am not a nutritionist!!! Just throwing stuff out there that might help the lurkers find their way too.

 

[ldg]

What phosphorus amount are we shooting for?  The phosphorus in the beef recipe Laurie mentioned is quite a bit higher than that in Dr. Pitcairns recipes.

Yes, when I was working with CatScratch, she (at least originally) wanted 1% or less DMB. The beef recipe is 0.58% (0.6%).

Peaches, that's interesting about the steak dinner and binders... I wonder what happens to the recipe if chicken or turkey is used. Maybe substituting 10% of the meat with egg white....

 

[mschauer]

mschauer, a question for you (you can answer tonight!): When using Dr. Strombecks' renal recipes, would it be safe to substitute eggshell powder for calcium carbonate, based on the knowledge that eggshell powder is 97% calcium carbonate? e.g. if his recipe calls for 600mg of calcium carbonate, can we use 618mg (or 620mg) of eggshell powder?

I don't know of any reason eggshell couldn't be used. 

 

[ldg]

Just checking.

 

[mschauer]

 

[mschauer]

Oh, and removing the heart from the beef recipe didn't have a significant impact on the phosphorus level.

Given what I've posted so far what else would you (as in anyone 

) like to see???

I'm going to have to sign off for the night but I can post more tomorrow. 

 

[ldg]

mschauer, this is wonderful, thank you!

I wasn't thinking about the impact on phosphorus (with removal of the beef heart) - just impact in general, really. I know they're nutritious and packed with taurine (but USDA doesn't track taurine, so... :dk: ).

Using the potassium instead of table salt would bump the potassium number (obviously). Might want to use some iodine...

 

[mschauer]

For what it's worth here is my reworking of Dr. Pitcairns recipe. I've replaced the rice with egg white, added more taurine used the Jarrow brand of vit B-Complex.  The Jarrow B-Complex provides enough B vitamins to allow for there to be quite a bit left to meet AAFCO recommendations even after cooking and storage loses. And if the recipe ingredients are cooked all cooking liquids should be retained and added to the final food to recover vital minerals that leach into the liquid during cooking.

LowPhosphorusChicken.png

• mschauer
• Oct 26, 2013

And the same recipe with liver:

LowPhosphorusChicken(2).png

• mschauer
• Oct 26, 2013

 

[peaches08]

Do cats need vitamin D replacement in advanced kidney disease?

 

[ninemilecountry]

 I am the one who asked for Laurie's assistance with my cat.  Feeling overwhelmed and want to do what is best for her.  She has a UTI and is anemic so I have antibiotics and vitamins to boost her RBC.  They gave me Epakitan as a phosphorus binder to add to her food.  Her phosphorus numbers from her blood were in the high normal range and some have mentioned these binders can cause problems so just feeling confused what is best.  I got some "better quality" canned cat food last night without and grains and have been feeding it to her with added water multiple times during the day and evening.  Is making a homemade renal friendly recipe something I should try?  I have three other cats aged 10, 6, and 2, would it be okay for them to eat it also?

 

[mschauer]

If you want to try a more natural way than using a binder to get her phosphorus levels down then a homemade diet might do the trick.  I would talk to my vet and ask if she is OK with trying a homemade diet. If you like I can email you a printable pdf of whatever recipe you want to try. Making a cooked food and having a nutrient analysis to show your vet might make her more willing to approve of you going that route. She might not like the high protein content of the recipe with egg white rather than white rice though.

I don't know of any reason why a low phosphorus diet wouldn't be acceptable for your other cats. You could check with your vet on that.

Eating iron rich liver, especially raw  should help with anemia.

Edit: Backpedaled on "especially raw".  Cooked liver is just as good an iron source as raw.

 

[mrsgreenjeens]

 
 I am the one who asked for Laurie's assistance with my cat.  Feeling overwhelmed and want to do what is best for her.  She has a UTI and is anemic so I have antibiotics and vitamins to boost her RBC.  They gave me Epakitan as a phosphorus binder to add to her food.  Her phosphorus numbers from her blood were in the high normal range and some have mentioned these binders can cause problems so just feeling confused what is best.  I got some "better quality" canned cat food last night without and grains and have been feeding it to her with added water multiple times during the day and evening.  Is making a homemade renal friendly recipe something I should try?  I have three other cats aged 10, 6, and 2, would it be okay for them to eat it also?

I'm so sorry about you little girl

.  Other than the highish phosphorus numbers, are her BUN and Creatinine on the highish side too?  But at the moment, I would think the Anemia is the main issue!  In the meantime, grain free canned is good, but did you check the phosphorus level already in them, or are you automatically adding the Epakitan to them, no  matter what.  Some canned food already has a phos level of around .20%!  I'm talking about foods like By Nature Organix or Natural Planet.  Have you seen this food chart which lists the protein, fats, carbs AND phos in canned foods?  I refer to this every time I go food shopping for my kidney girl:  http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

Here's another webpage you might find helpful, about phos binders.  I'm the one whose Vet doesn't like to use them unless absolutely necessary.  BTW, this webpage is just one page among hundreds within that website pertaining to kidney disease, so while you're there, look all around.  http://www.felinecrf.org/phosphorus.htm

As to our question about it being ok for healthy cats to eat the homemade renal food, as long as they are adults, which I see they are, then it IS ok, although it would be best to not offer it exclusively.  And I would most definitely try making her food, that way you know exactly what is in it, because even high quality grain free foods usually still have icky ingredients, like carrageenan.  I was feeding my girl raw, then she decided she didn't like it anymore, so I tried a homeCOOKED food, and she didn't even want that

.  Her brothers loved it, but not her

, so I have no choice but to give her grain free canned.  And on those days where she will only eat ones with higher than I like phosphorus, I cook up some egg whites and blend them in, as my way of lowering the phos by increasing the "mass" and protein. I figure in total that's got to lower the phos, if only by a little bit.  Not very mathmatical, but better than nothing.

for your little one

 

[ninemilecountry]

I had her in Monday and since we could not get a urine sample from her he decided to wait and do any tests. By Wed AM she was acting like she had a UTI so I dropped her off for the day and that is when they ran all the tests and gave me the news.  Her BUN was 82 and her Creatine was 4.6.  Her HCT was 21.4 and HGB was 7.2.  She had no other symptoms except excessive thirst and urination.  So when I heard how bad her numbers were I just felt awful.  Antibiotics twice a day for 10 days.  Hi-Vite vitamins with liver and iron twice a day for 6 weeks then recheck her RBC and Epakitin twice a day.  He said even though her phosphorus levels were normal Epakitan helps the kidneys process the food and waste better.  What brands of grain free canned do you recommend?  There are so many out there and it was a guessing game for me to pick a few yesterday.  I picked up "dave's Naturally Healthy Cat Food" and phosphorus content is not listed like many of the cans I looked at.  I feel like I have so many unanswered questions and feeling overwhelmed.  I bought her a heating pad and have it user a fleece blanket and she is in the bathroom next to the hot water radiators and seems very content.  She is not constantly at the sink or in the tub drinking from the faucet.  I have been trying to feed her small portions with added water throughout the day and night.

 

[ldg]

I know it's confusing.

I think one of the main considerations here is that this was caught early, and the disease is not advanced. But from what I've been able to find, it seems it is best to start with diet, especially when the disease isn't advanced - and then proceed to binders, if necessary.

From the World Small Animal Veterinary Association: http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2008&Category=3868&PID=23977&O=Generic

"When to Intervene and What to Use"

.... Dietary Phosphorus Restriction

Hyperphosphataemia has been found in around 60% of cats with CRD and has been correlated with the progression of renal failure, hence dietary phosphate restriction is crucial in the management of CRD (Figure 2). Additional phosphate restriction has been shown to blunt renal secondary hyperparathyroidism and reduce the level of PTH (implicated as an important uraemic toxin). Studies in both dogs and cats have suggested definite benefits from phosphate restriction, reducing mortality and improving well being. During the early stages of CRD low phosphate diets may be sufficient to control hyperphosphataemia. If, however, hyperphosphataemia persists in the face of dietary restriction, oral phosphate binders should be administered with food, aiming to maintain serum phosphate levels between 1.0-2.0 mmol/l (blood samples should be taken after a 12 hour starve to avoid post-prandial rises).

Protein Restriction

Dietary protein restriction is associated with a fall in serum urea levels. This does not represent improved renal function but is a reflection of the change in nitrogen balance. Clinical observations suggest that in many cats CRD is slowly progressive and in some cases, renal function appears to remain stable for many months or years. In cats, when renal mass was reduced (sufficient to induce azotaemia), progressive decline in renal function was not observed, but feeding a protein restricted diet led to reduced glomerular hyperfiltration (reduced solute load), decreased proteinuria, and decreased histological glomerular damage compared to a group fed a high protein diet. From studies performed in dogs and cats, it can be concluded that there is no evidence in these species to suggest feeding high protein diets to normal animals is harmful. Even when azotaemia is established, evidence that protein restriction will benefit renal function is equivocal; nevertheless, studies have shown that protein restriction in the face of azotaemia results in amelioration of clinical signs of renal failure. It is generally recommended that protein should be restricted to approximately 20% of the total calories in CRD diets for cats but the optimum protein intake has not been established.

This is saying that it still isn't really known whether or not protein restriction helps, but there are there are studies that have shown it helps. Of course, there are studies that have shown it doesn't help. This is the most referenced study as re: no need for protein restriction:

Protein and calorie effects on progression of induced chronic renal failure in cats.

Diets replete in protein were not associated with increased severity of glomerular or nonglomerular renal lesions, increased proteinuria, or decreased GFR. Diets replete in calories were not associated with increased severity of glomerular lesions, but were associated with mild increase of nonglomerular lesions. Factors other than protein and calorie intake must be considered potential causes of progression of renal failure in cats. Results raise questions about the practice of restricting quantity of protein in the diet of cats with chronic renal failure, with the intention of ameliorating development of further renal damage.

Link: http://www.ncbi.nlm.nih.gov/pubmed/9582959?dopt=Abstract



The bottom line is that there are still a lot of unknowns: but lower phosphorus has definite benefits, and the WSAVA recommends dietary management first, then use of phosphorus binders if the diet doesn't properly manage phosphate levels.

The dietary recommendations are to lower protein by increasing fat, not carbohydrates.

The B-vitamin supplementation is recommended (but already included in the menu): the vitamin C suggestion is 70mg daily per kg of body weight.

mschauer, I know the program you've designed doesn't analyze vitamin C.... since the diet probably doesn't contain much (?) as cats synthesize it and have no need (normally) for vitamin C supplementation.... since you're good with the nutrition math, can you figure out how much to add to the food to get to the target? (Or would it be easier just to supplement it separately? :dk: )

There's also discussion of potassium, so it might better to use the salt substitute (potassium chloride) as suggested in Dr. Strombeck's menu vs the salt in Dr. Pitcairn's menu.


*******************************************************

And then just for consideration, two articles by vets:

2) A guest post on The Conscious Cat blog by Darren Hawks, DVM. "Darren Hawks, DVM graduated from the UC Davis School of Veterinary Medicine in 1988. She is a board certified specialist in internal medicine. She offers a variety of alternative therapies including chiropractic, other manual therapies (myofascial release, Integrative Manual Therapy, Reiki), herbs, homeopathy, flower essences and nutrition. Her goal is to guide owners towards a total health program including diet, exercise, improved energy flow via body/energy work, removal of stress and toxins, as well as addressing emotions and stress. For more information about Dr. Hawks, please visit her website." (She was paid to plug Ziwipeak in the article). Link: http://consciouscat.net/2011/10/17/...ign=Feed:+TheConsciousCat+(The+Conscious+Cat)


3) "Diet, Kidney Disease and the Urinary Tract," Written by Elisa Katz, DVM CVA Elisa Katz, DVM CVA is a graduate of Ohio State University and practices in Windsor, Connecticut.
Link: http://feline-nutrition.org/health/diet-kidney-disease-and-the-urinary-tract


Personally, rather than use phosphorus binders, I'd want to try diet first. Depending on her blood work and the stage of the disease, I don't know that I'd want to use restricted protein, but I'd definitely want a low phosphorus diet.

With the anemia, I'd want to use a diet with liver. If you want to use commercial foods, Dr. Pierson's food list is a great place to start. OK... I just went through it. I found basically one food: Purina Pro Plan, Urinary Tract Health Chicken in Garvy Entree: 57% protein, 20% fat, 15% carbs, and 0.58% phosphorus.

...and this just illustrates why a homemade diet might be the best option to pursue.

What is her hematocrit? Was there any discussion of why she's anemic?

 

[ldg]

Oh, I had that reply window open for so long, you posted her numbers.

ETA: question? Is she prone to UTIs? Are these actual infections? The urine is cultured, and infection found?

 

[mschauer]

mschauer, I know the program you've designed doesn't analyze vitamin C.... since the diet probably doesn't contain much (?) as cats synthesize it and have no need (normally) for vitamin C supplementation.... since you're good with the nutrition math, can you figure out how much to add to the food to get to the target? (Or would it be easier just to supplement it separately?

)
 

After a quick look at the USDA database of the animal based sources it seems only liver contains any vit C. I'd just add the full 70 mg/kg BW daily.

 

[ldg]

Thank you.

 

[mrsgreenjeens]

Daves is a very good cat food, IMHO.  Phos levels around 1% on a dry matter basis, if I am calculating correctly (for most flavors

. )  It's one I have bought for my princess.  Naturally, she doesn't like it, since it's fairly good for her 

Also, on that Purina Pro Plan, I'd try to add in a little fat, maybe just some oil.  My Vet said it was ok to add in veg oil, although I haven't done it since my girl is so picky.  I figure she'll reject anything added like that.  She doesn't even like butter!

 

[ninemilecountry]

I am not sure how they found the infection.  I am assuming from the urine sample they got from her but I do not think they cultured it.  I knew from her actions that morning of going to the litterbox and straining and nothing happening that I suspected a UTI.  She has never had one before.  My mom had long term kidney disease from high blood pressure so I know how failing kidneys affects the whole body.  The vet today told me her urine was so dilute it was jut about like water and because it is so dilute the normal PH is not there to ward off bacteria.  I had been giving her Cosequin because she has a paralyzed tail from in injury she sustained before we found her.  Cosequin is also good for the bladder because it makes the lining slippery.  Do you think that I have caught this early, I am hoping so.  I told the vet today when I went to pick up some meds for our 12 year old dog who has beginning renal issues that Zoe would not eat the canned renal food and I bought some grain free canned and I add water to it.  He told me that she needs to eat because if she does not get enough protein se will lose it from her body which is not good.  He suggested giving her chicken and also cottage cheese but not the low fat version because it is high in protein and some cats like it.  I have an appointment to have her RBC checked in six weeks.  

Thank you to everyone who has responded I can't tell you how much I appreciate it and all of the suggestions for Zoe's health!  This pic was just taken a few weeks ago.

IMG_0332.jpg

• ninemilecountry
• Oct 26, 2013

 

[easybee]

In order to follow the recipes..how to you translate the g....into amounts to be used??

Also..

have you ever made this ..but not cooked the meats and liver??

 That was really great that you shared with us all your calculating for this recipe...how is your cat doing on it and how long

have you been using it??

I assume you are still giving fluids ...and have you had to add any other supplements??

Like Azodyl?....or what about Renalfood..by stand process I read about this too.

I have fed my cats a raw diet all their lives and never had any problems that the vets seem to be so

concerned about...

but..I always grind bones into the mixture..and I know that will be too much phosphuros...

Thank you so much.

bev