CKD Stage 3- newly diagnosed-not doing well

Our kitty had symptoms in March primarily polyuria/polydipsia, muscle twitching, and lethargy. We were told per her labs that she was starting to show signs of early renal failure but not to worry and no treatment was recommended. However we started her on a rx kidney kibble and slowly transitioned her to lower phosphorus canned food until she suddenly wouldn't eat any of it in Aug. Taking her to a new vet in Aug they told us she actually didn't have kidney disease at all just normal aging kidneys and that she was diabetic. But she was severely dehydrated and she received 2weeks of daily SubQ fluids. We were specifically told to not worry about a diet to help her kidneys but to focus only on her diabetes. So we switched to high protein, low carb (and consequently a higher phosphorus) wet food diet and began treating diabetes with lantus. While her blood sugars came down into normal range over the last two months, her symptoms became progressively worse. She is drinking 300-600ml of water per day, has plantigrade stance, walking on front ankles, is tripping, increased lethargy and irritability, constipation, completely uninterested in doing anything but sleeping. She does still groom her face and sometimes her body a little and enjoys petting intermittently. We took her to yet another vet and expressed our concerns that although she displayed symptoms of diabetes, she had these symptoms prior to that diagnosis and that they have continued despite her BG being nearly regulated. We shared that we were worried that she had very little quality of life. The vet reassured us that these symptoms could still be presenting even though her BG had been "normal" for several weeks. We also shared that the last vet said her Blood Pressure was elevated but did not give us the value and requested he repeat it but he didn't have time. So when he called to share her lab value results he like the last vet did not express concern for her kidneys but said he wanted her to come in for a Blood Pressure check and start her on antihypertensive meds. We reviewed her labs ourselves and staged her with IRIS Stage 3 CKD. We called him back and shared this and suddenly he said, that yes she did have severe kidney disease and was close to needing dialysis and that we should consider euthanizing her soon. We are devastated to say the least and so angry/frustrated with this jumble of diagnoses and misinformation/false advice. We could have been addressing her CKD since March but were misinformed. While waiting for those lab results, out of the blue she suddenly refused to eat a few days ago. We have found a couple foods that she will tolerate and having been getting limited calories into her over the last few days. We stopped her insulin since she isn't eating much and are doing spot BG checks which have been 60-80. We also started her on 100mL SubQ LR fluids on Sun. We were about to euthanize her on Monday but the fluids seemed to help a little and she started eating a tiny bit so we are trying to figure out what to do. How likely is it that we will be able to help her have any quality of life or should we just put her off to a peaceful sleep? Our hearts are crushed and we are so torn. We only want what is best for our furbaby, but we ourselves are entirely exhausted from providing such intense care for her and watching her decline over the last 7 months.
With the terrible advice we have been getting from several different vets we feel that we are entirely on our own with determining her treatment if we decide to go that route.
Does anyone have experience with treating a diabetic and CKD cat?
Is it possible to bring them back from looking so ill?
Should we press forward or let her go?

 

I know quite a few members here have had cats with both FD and CKD. I’m not sure who they are so I will tag some more experienced members I can think of and maybe they will get you pointed in the right direction!

I’m sorry you’ve had such a mess getting her the help she needs. Hugs!

@Wendy&Neko @Marje and Gracie I can’t think who else right now.

 

I spoke to you over on the other thread.
A high protein diet can raise the BUN.
I know this happened with Sheba. She also had early CRD
Wait and see what Marje thinks about the labs.
Yes there have been cats here that had FD and CRD. I’m just trying to think of who I could tag for you.

 

Hi, I feel so terrible for you and your sweet kitty as I am in the same boat. My Taqui of 14 years has been in kidney disease stage 4 for a while now and hasn't eaten the kidney diet and miraculously he's done well, UNTIL this week he was diagnosed with diabetes. So I really feel your pain! I'm not sure which disease to address as both are life threatening and he ALSO is anemic and has an infection. I would say his quality of life has been pretty good until now and I'm so torn about what to do because I hate to put him through any more stress. I've been so stressed I'm losing my appetite. He's on daily fluids that I give at home which I know is partly why he's done so well. But the diet is going to be really hard as he ONLY wants the junk Kitty food and doggonit I just want him to eat, and my vet has too up to this point... He's getting ready to start insulin which I dread that whole process, one more thing... Praying for you and your kitty as we know how awful these diseases are!! I'm on the lookout for any and all advice too with CKD/FD cats. I'm getting a lot of information but it's hard to process it all and decide what is best. Following this post.

 

I'm sorry you are going through this too. Our kitty has only wanted to eat the "junk" food too and now all of a sudden she doesn't want that either. I spend all day feeding her tiny portions by hand, taking days off work to stay home to do that. It gives me so much anxiety each day worrying that she won't eat enough. We have had to hold her insulin the last several days since she won't reliably eat.

I don't think she has been terribly dehydrated. She was back in August and I remember how sticky her skin was, not sliding around like normal, and when I tented it -it stayed that way. Her skin moves well now and slips out of the tent easily. Despite wanting her to be on a high protein diet with the diabetes we were not successful in getting her to do so but instead chose moderate protein so that was probably good for her kidneys but all of them were way too high in phosphorus.


Biggest concern right now is that she is refusing to eat most things, and only eating tiny portions when offered them by hand feeding. We have tried a large variety of foods/textures/flavors/brands, all the food toppers to stimulate appetite, heating, adding water, adding gravy etc. She basically sleeps all day or is laying in her water bowl drinking obscene amounts of water. She is avoiding us, and occasionally hiding, does not want us to hold her and only accepts petting for short periods. She has immense difficulty walking. Walking on hocks and front ankles, tripping, slipping, falling and can only make it very short distances. She is grooming less. Regardless of her labs, she looks terribly unhappy and uncomfortable.

 

Are you using cerenia or ondansetron for nausea? It is very possible she is nauseated and cats won’t eat if they are nauseated.
If you don’t have any, ask the vet for some oral anti nausea tablets.

 

Have you tried Tanya’s Comprehensive Guide to Chronic Kidney Disease? It is a website devoted to CKD, and there is a section on “Persuading g your cat to eat.” I apologize if you have already used her site. My cat has early CKD, and Cyproheptadine is one med I have found to help increase appetite.
My heart goes out to you, Butterscotch, and your family.
I’m wondering if there is any other vet in your area, perhaps an Internal Medicine vet, that you could try who might consider hospitalization? Just thinking out loud here, thoughts are with you.

 

Hey, I am so sorry this is happening to you. This story sounds almost identical to what happened with my kitty Bella. She was diagnosed with diabetes, and then eventually CKD. She became lethargic and did not eat just like your kitty. In the end I ended up taking her to an emergency vet nearby just because I was frustrated with the repetitive blood tests with no solution I got from my normal vet.
The emergency vet kind of explained kidney disease to me like this, I don't know how accurate it all might be. She said the kidneys are kind of similar to a sponge, were they can suck up a ton of bad stuff and get damaged, but sometimes if a cat receives enough fluids it can help flush the kidneys out and the cat can continue on. Maybe Butterscotch would benefit from a more intensive round of fluids (Bella had 36 hours straight of fluids) to help her kidneys get a jump start?
Unfortunately Bella didn't get over her last bout of illness and I had to make the decision to put her down, so I truly understand how difficult of a time this can be. I hope that you can find a way to make Butterscotch as comfortable as possible.

 

Your kitties kidneys are not that bad. I have seen so much worst. In fact, her values, except for phosphorus, are better than my CKD cat who lived with CKD for over four years and was stable. He passed from something else.

Her potassium was pretty high in August which could account for some of the symptoms you mentioned. You can read about potassium here. Scroll down to read about hyperkalemia because some of her symptoms are described there.

Her phosphorus needs to come down as fast as you can get it there. You will want to add a phosphors binder like aluminum hydroxide to her food as soon as you can get it and also might consider giving her niacinamide. You can read about P levels here and binders here.

Hospitalization with IV fluids can bring down the creatinine, but honestly, I don’t think this is a kidney crisis that would warrant that and have her be so stressed and not eat. Daily subq fluids are not usually even started until the creatinine is over 3.5.

I wonder if there is some other underlying condition based on other symptoms you list on the SS. For one, she could have diabetic neuropathy even though her BG is normal. I would start methylB12 like Zobaline to see if it helps. It won’t hurt her.

Does her skin seem fragile or tear easily? As suggested by another member, you might want to take her to an IM Specialist and have her assessed for Cushing’s disease (I’m just brainstorming based on some of her symptoms). I also wonder if an abdominal ultrasound might be worthwhile.

sending lots of healing light.

 

Unfortunately we tried both Cerenia and Pepcid and neither seemed to help at all. Pilling her was quite the struggle and adding it to food seemed to cause her even more of an aversion to eating.

We are giving her SubQ fluids daily but I don't think we can afford an emergency stay after all the bills we've already racked up taking her in to so many vets several times. Right now we are so incredibly exhausted with all of the care and emotions we've been through over the last 7 months. We have put our entire lives on hold to be with our kitty, tending to her, and doing research. We are definitely seeing a decline in her and don't want to wait until things are really bad to help her pass away peacefully. Butterscotch still grooms her face after every meal, starting to decrease how often she grooms the rest of her body, enjoys being pet, still uses her scratching post albeit less gracefully than before, she can still walk up the stairs and jump onto low furniture, she is using her litter box, she has very little to no interest in any type of play including not even watching the birds but will sometimes batt at a string a few times, she is stumbling when walking and can only go a short distance before stopping to rest, she sleeps almost the entire day. As you can see she does still exhibit some normal cat qualities but I just worry that she seems so sad all of the time and I don't know if she is in pain but I am sure she is frustrated/confused that her legs don't get her around like they used to. I don't want to prolong any suffering or distress for her but I also can't wrap my head around letting her go. Would feel comfortable sharing with us how you knew it was time for your kitty?

Tanya's site is wonderful, we have been using it since March. Unfortunately we have exhausted all of the persuasive feeding techniques. A technique will work one time but then its as if Butterscotch is too smart and can't be fooled into eating. I don't think her appetite is actually a problem. She sometimes comes looking for the food and acts interested but after she smells it she turns away. If we try 5 different foods, she may decide she likes one and will eat it if hand fed but then if we re-offer that food, she walks away. We did ask for a referral to an Internal Medicine vet and we basically told it takes to long to get in to one and were brushed off and we can't really afford hospitalization. We've already racked up a huge cost on her care. We continue to read every detail on Tanya's site so we can learn whatever treatments we can.

 

I think it would be worth trying ondansetron because it does sound as if she is nauseated it she sniffs then walks away.

Also it’s definitely worth trying the Zobaline (methyl B12) tablets. They ate tasteless and can be put in food. They can be bought from lifelink.
Sheba had very bad neuropathy. She couldn’t jump up at all. Had trouble walking up stairs. Had to stop every few steps for a rest. Was wobbly when walking. I gave her Zobaline and she eventually returned to normal.
Did you see Marjes reply to the lab reports above. ?

 

During our research it seems that her symptoms fall under numerous different conditions including high calcium which she has also had. It is hard to say what the cause is.
We do agree we need to get the phos down and are researching the binders now. It seems the Aluminum ones are the best tolerated and work well?
Our vets also have told us they thought that she has diabetic neuropathy but all of her mobility issues started after her blood glucose levels were in near normal to normal ranges and have progressively gotten worse since. She only gets close to walking on her hocks but more often she slips, stumbles, her legs cross under her, very uncoordinated gate and can only walk short distances or jump to low heights, and now suddenly started walking on her front ankles as well. I'm not convinced it is diabetic neuropathy as she had normal glucose levels in late March and was diagnosed with diabetes in early Aug so she couldn't have been diabetic for more than 5 months and her BG came down to normal in 2 months. It seems unlikely that brief time of elevated BG would cause neuropathy and only after the sugars had come down.

I have researched Cushing's and I don't remember it feeling like a fit for her condition. Her skin has dandruff but has been that way her entire adult life, she has never had a skin tear and it seems a normal thickness to me.

I don't doubt that there is likely some other disease process at work here but I feel it will likely remain a mystery. She has had symptoms of slightly increased water intake and random muscle twitches for several years.

At this point we are kinda financially spent on trying to diagnose her and we have little faith that a new vet will be any different than the 4 others we have worked with. I think we have resolved that we are on our own at this point. If we go with the CKD diagnosis we just want to know what others have found to be the most helpful treatments, any out of the box tricks for helping her eat (we've exhausted all the standard things), and how to know when it is time to let her go.

 

Thank you, we will ask about the Ondansetron and look into the B12 again.

 

Another thing to try is slippery elm bark powder. It is very good for tummy issues. It can also be used as a slurry. I used it for Sheba

Sheba used to slip and slide everywhere too.

 

I'm afraid we've already tried that too

 

Here is a link about food. It may or may not be helpful.
http://www.felinediabetes.com/FDMB/threads/home-prepared-diet-of-crd-cats.150441/

 

Ondansetron can also be given as an injectable, if pilling is really hard. I have used ondansetron on three cats now and found it really works, if you have a good dose.

My Neko had diabetes and CKD stage 2/3 for quite a while. We did start her on fluids when the numbers warranted it. Then she got very inappetant. We started seeing an IM vet, which I highly recommend for multiple conditions. Anyway, turned out Neko had a double whammy of heart condition that was made worse by fluids, and probably small cell lymphoma. Both impacted her appetite. When treated for both, her appetite improved. Treatment included stopping fluids and just trying to get as much fluids in orally as I could. Her food was already low phosphorus raw, but we eventually had to add binder.

 

I don't mind sharing about my cat. At the end of it all she didnt give me much choice in the matter. Looking back on it I knew she was slowly going downhill for probably a couple weeks. Like you, I more or less devoted many of my hours taking care of Bella for about 10 months, constant vet visits, abdominal ultrasound, blood work, frequent UTI's, trying this food vs that food, steroids/blood pressure meds/pain meds. I was at my wits end, and I knew Bella was tired of it all.

But the past few weeks she was alive she just didnt seem "right" she would eat less, wouldn't be bothering me as much as usual, slept downstairs more often instead of in bed with me. She just had this look on her face that she was uncomfortable. And then suddenly she completely stopped eating, I thought maybe she had another UTI so I took her to the emergency vet and thats when they did some tests and told me she was actually a lot worse than she let on. I was kind of taken aback because it was such a sudden decline, 2 days before she was still somewhat acting like herself, and then suddenly she just stopped.

They recommended either intensive fluids or I put her down then. I knew if I decided to put her down then I would always wonder "if I did this last ditch thing would she have lived" so I decided to bit the $1000 bullet and try one last time. After 36 hours her heart rate began slowing down and she want into mutli-organ failure. They gave me a call and told me it wouldn't be long so I rushed over and held her while they put her down so she wouldn't need to suffer anymore.

I completely understand the emotional, and monetary strain of all of this. I think everyone on this site does. It might be worth while to look into something like the care credit card, thats what I put all my vet bills on so I could work on paying them off over time. Otherwise I wouldn't have been able to pay for pretty much any of her vet bills upfront.

In all honesty though, I think I knew she wouldn't be getting better when I visited her at the emergency room. She just had this look in her eyes, like she was tired. I told her if she was tired of it all it was okay to let go. I think there really is just this moment that you will know its time, this moment when Butterscotch is tired and so are you, and that's okay.

I hope this helped you, and I hope even more that Butterscotch pulls through and this information won't be needed. Sending good vibes your way.

 

Hi Liz I just happened to be reading about your sweet Bella. I am so sorry for your loss. . I have tears just reading about her. She looked like such sweet heart. My heart goes out to you.

 

Her calcium is not/has not been that high and they didn’t run an ionized calcium as far as I can tell. When the calcium level goes up over the normal range, they should have run an ionized calcium. I’ve seen higher serum calcium levels and normal ionized calcium.

IMHO, yes, I believe the aluminum hydroxide is the best and most palatable binder when mixed in food. It also seems to work quickly.

It is possible that she has been diabetic longer than you realize. It happens a lot. Once they develop neuropathy, just being in normal numbers doesn’t make it go away. It needs to be treated. Five months is certainly more than enough time to develop neuropathy. In addition, because the BG can vary even in a diabetic cat, it’s still possible she was diabetic when her BG was normal. As an example, my Gracie’s BG on her routine lab tests was normal but her urine had 3+ glucose which indicated she had spiked a BG high enough to spill glucose in her urine. Further monitoring revealed she was, in fact, diabetic.

Insofar as CKD treatments, I would, as others suggested, add ondansetron but I would not stop the cerenia. They work really well together. I would try the niacinamide and definitely the P binder. Keep an eye on her hematocrit and be sure you start B vitamins as it approaches 30%. Monitor her potassium to be sure it stays above 4. Keep an eye on her BP. And don’t neglect urine checks to be sure she doesn’t spill protein into her urine and become proteinuric. Keeping proteinuria at bay also helps with longevity.

 

I was going to suggest many of the same things as Marje... It can't hurt to start the b12 as it also helps with the HCT levels. Your cat's HCT levels are still normal, but have dropped a little... so if her issue is diabetic neuropathy, it will help with that, but it could ALSO help maintain HCT levels so that she doesn't fall anemic (very common for ckd cats). B12 may also help stimulate her appetite. My cat CC is early CKD and we feed her a low carb/low phosphorous diet and half a zobaline a day. She has no neuropathy but we are feeding it to keep up her hct levels and stave off neuropathy. She has acromegly so her diabetes is not well controlled, so we want to try to prevent any neuropathy. Her current favorite food is Tiki Cat, mostly the After Dark line. When I had my cat Zimmy who was CKD he liked Weruva BFF food (cc isn't a fan for the most part, only a few flavors). CC's phosphorous levels are under 6, so we haven't started her on a binder yet. She's do for her next bloodwork this month so we'll see how that is doing. High phosphorous can make cats feel yucky, thus making them not want to eat. Getting your cat's phosphorous under control may be key in helping restore some of her appetite. there's a great group on facebook for ckd cat owners called Cats with Chronic Renal Failure. You should look them up.... very knowledgeble.

Overall your cat's labs really aren't terrible... I mean definitely you want to continue treating with the fluids, find a phosperous binder and/or lower phos food, and some vitamin supplelments... but there's nothing that says to me from the labs it's time to put her to sleep from a clinical stand point. Of course you are the best judge of the quality of her life and are the best one to make that call.

are you giving amlodipine for the high bp? high bp also very common with ckd cats... my zimmy was on amlodipine and benezapril.... doesn't look like your cat has protienuria, so that's good. the vet thought cc had high bp... but when she was in for a few days for a dental and boarding it got down to 130 on it's own without medicine, so she held off on perscribing anything... figured she was just stressed from the vet visit.

 

I think Marje, Janet and the others have already given you some very good suggestions, like they mentioned your cat's labs doesn't look so bad, but you do need to address some issues to help him get back on track and feeling better, specially lowering his phosphorus, and you didn't mentioned if the vet checked his mouth just to make sure he doesn't have some dental issues that could be making him not want to eat.


I just wanted to tell you that having a diabetic cat with CKD is quite manageable, Babu-Chiri, my sugar baby is currently on remission but has had CKD for some years now, he's stage 2 right now, and doing just fine, I'm feeding him a home cooked high quality protein low carb diet to help him plus B vitamins and omegas.

Finding the right food is a very important issue since you need some wet food that is low carb (for his diabetes) and low phosphorus ( for his kidneys) that pretty much rules out most of the renal prescription diets, but there are some comercial brands that do have this characteristic take a look in Dr. Lisa's list, look for the ones that are less than 10% carbs and under 200 in phosphorus in that list (you could go up to 250 but given his phosphorus numbers the lower the better).