CKD test results

Discussion in 'Feline Health - (The Main Forum)' started by TempestsMum, Sep 26, 2017.

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  1. TempestsMum

    TempestsMum Well-Known Member

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    ok so Tempest has had a second lot of bloods done. Comparing them to the first there is a rise in a few areas, my vet seems to think these are not significant yet and to continue doing nothing but wait and watch and bring her back in November for another panel.

    I did ask about CBC and she suggested it wasn't necessary at this point. Phos binders weren't offered. Is this something I need to ask about?

    At the moment Tempest is eating normally, behaving normally and there's no change in her habits or demeanour. You really wouldn't know there was anything going on in there. And her FD so far remains in remission. Thank goodness.

    Here's the original and the new test if someone would be kind enough to give me their opinion I'd be very thankful.
    The only person I know who can read is @Marje and Gracie (thank you for your help previously)

    New Test results

    FullSizeRender.jpg

    Original test from July

    IMG_1338.PNG
     
  2. JanetNJ

    JanetNJ Well-Known Member

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    Have you joined the Facebook group Cats with Chronic Renal Failure?

    She's pretty much in the middle of stage 2. At this point I started doing sub q 1-2 times a week although some choose to wait on that until stage 3. My vet felt she saw prolonged life the earlier it was started.

    http://www.felinecrf.org/how_bad_is_it.htm#meaning_practical_terms


    Tanya's site recommends the goal of 1.49 or less phosphorus at this stage your cat is in.... Are you feeding foods low in phosphorus now?

    http://www.felinecrf.org/phosphorus.htm
     
  3. TempestsMum

    TempestsMum Well-Known Member

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    Hi Janet, yes I'm on there and another group.
    I've read and re-read Tanya's site which has been very usedful. :)

    I cannot find any foods here that she will eat that are less phos than her normal foods.. it's so frustrating. I'm now actually thinking I might ask a friend or two in Canada/USA to try posting me weruva or something to try. She eats well but only if she likes it..

    My vet said that at this point nothing needs done but I'm seeing progression here which is scary in the matter of a couple of months those seem like a big jump.
     
  4. Waheeda

    Waheeda Member

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    My civvie crea and phos looks similar to Tempest. The vet also did not mention using binder of subq. She only pestered me to give prescription food. But I'm not going to listen to the vet and do nothing. Have started on binder and subq.
    @JanetNJ
     
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  5. Waheeda

    Waheeda Member

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    Sorry accidentally pressed post.

    @JanetNJ do u think daily subq for crea of 2.9 is too much? His bun is also high but it's due to high protein food. Leslie of cdk Fb group don't think subq is needed now.
     
  6. TempestsMum

    TempestsMum Well-Known Member

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    Waheeda, the prescription food seems high in carbs to me, I also discussed this with my vet, it's catch 22 and so many foods available to me the little minx won't eat. And she lets me know. Lol
     
  7. Waheeda

    Waheeda Member

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    This cat of mine is not diabetic. He's also very picky. Licked the gravy of the prescription food and walked away!
    The diabetic one is on fortekor for his heart and amazingly his creatinine has dropped from 2.8 to 2.4. So perhaps vets should give fortekor to kidney cats?
     
  8. JanetNJ

    JanetNJ Well-Known Member

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    Well it depends. How high is the bun? Daily may not be necessary. When Zim hit 2.9 I think we did 3 x a week. Like I said some wait until stage 3 and just add extra water in the meantime, but for us I feel like it helped him feel better, his fur improved, and he had no constipation. I was following my vets advice.

    I bought phosphorus binder but never used it because diet was enough to lower his.
     
  9. Waheeda

    Waheeda Member

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    His bun is 50. It was in normal range 3 months ago. Vet is blaming it on his high protein diet. He's eating his usual wet food and YA. The YA is meant for my diabetic cat but this boy likes it too.
    I'm going to buy Weruva BFF on Amazon tonight. Shipping will be twice the price of the food but I'm at wits end getting suitable food here.
     
  10. tiffmaxee

    tiffmaxee Well-Known Member

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    Fluids in my opinion are not needed unless your cat is in any way dehydrated. I would add SH binder to regular food and as much water to the food as possible. I'd well hydrated fluids just add unneeded sodium.
     
  11. Waheeda

    Waheeda Member

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    At what point should fluid be given? I have 2 different vets practising different thgs.

    @TempestsMum did your vet ask you to do the SDMA test?
     
  12. tiffmaxee

    tiffmaxee Well-Known Member

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    There are different philosophies on fluids. I believe they are needed when a cat can't get enough water via drinking and/or adding it to the food to avoid dehydration. Fluids don't slow down progression of CKD. Staying adequately hydrated does that. Dehydration causes the kidneys to deteriorate. That's when fluids help. If pancreatitis or going under anesthesia causes the kidneys to take a temporary hit, then fluids are needed at that time. When starting fluids it's important to be sure there isn't heart disease. Any murmur should be checked out via an echo to make sure its benign. Max had one and it was benign. Two years later it wasn't. I think fluids given at tge vet's office led to his quick passing. Others think fluids are magical. Keeping a cat adequately hydrated by whatever means necessary is what is important. I believe less is more. JMHO.
     
  13. TempestsMum

    TempestsMum Well-Known Member

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    No they didn't. They just did an inhouse panel.
     
  14. Waheeda

    Waheeda Member

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    Wow this is something new! I thought the purpose of fluids is to ensure cats are sufficiently hydrated. Especially since cats do not usually drink much. Going by your philosophy, then I would presume cats on mostly canned food would have sufficient hydration. Doesn't the extra fluid help to get rid of excess toxins since the kidneys are compromised?
     
  15. Waheeda

    Waheeda Member

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    From what I read, sdma will be able to detect kidney failure much earlier than the kidney panel test. So if the panel test already shows high crea value, why the need for sdma? I really couldn't connect with the vet yesterday. She seriously wasn't listening to my reasoning.
     
  16. TempestsMum

    TempestsMum Well-Known Member

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    I
    I think the sdma test is more accurate and gives a better impression as to where kitty falls on the scale (i.e. Which stage the ckd is at) they don't tend to offer a lot of 'unnecessary' tests at my vets, although I can ask for them and they are happy to do them.

    When I use the term unnecessary I mean they offer the tests they believe are needed at that time to determine what course of action to take rather than a lot of in depth ones that may not change the treatment plan.
     
  17. Waheeda

    Waheeda Member

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    Yes that's exactly how I feel too. I don't think sdma is necessary for my cat as we have established that he has cdk. The vet also made me buy a renal supplement. I didn't want to argue with her.
     
  18. TempestsMum

    TempestsMum Well-Known Member

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    I have to laugh,my vets know me so well, I'm such a fussy customer. My wee lad (dog) had to go in for a minor anal op and dental last week, and to stop the issue they recommend a fibre supplement to add to his food. And described the one they had. Then asked if I'd prefer to research my own first, bless! And the vet went and got me their food book (prescription one) to look at as well. They are so good! :)
     
  19. Waheeda

    Waheeda Member

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    I don't usually go to this vet. Went to her for dental works and that's when we discovered my boy has cdk. My diabetic cat has a different vet, an internal med specialist and she will listen. She knows I read a lot and I usually will ask whatever I learnt from members here and from Fb grp and she will offer her point of view.
    I'm definitely changing vet. Will get appt with the specialist for this boy too.
     
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  20. TempestsMum

    TempestsMum Well-Known Member

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    Funny it was going for the dental/yearly check up too that caught the ckd for us as well. :confused:
     
  21. Waheeda

    Waheeda Member

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    He had blood works done last Sept and all was good. 9 months later and he has cdk. So fast it happened.
     
  22. TempestsMum

    TempestsMum Well-Known Member

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    I know, but a human year is approx 4 years to a cat - 3 months = 1 kitty year so it works out a yearly blood test is actually 4 cat years... scary..
     
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  23. tiffmaxee

    tiffmaxee Well-Known Member

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    Yes the purpose of fluids is to keep them hydrated and if your can do that with canned food and adding water it's better. A drinking fountain my help as well. When one of mine got CKD she would drink from the bathroom faucet. If you can't get them well hydrated then you move to fluids but that's usually with a creatinine of 3.5+. I say usually because ECID.
     
  24. Waheeda

    Waheeda Member

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    Thanks!
    Yes I do have a drinking fountain and a bowl for 3 of them. He doesn't like me putting water into his food.
    Do you switch to prescription diet? Vet was adamant I switch and she indirectly implied that his crea and bun values increased cos I did not stick to prescription food. It's not for lack of trying. He rejected k/d wet and will only lick the gravy of royal canin pouch. I think the vet is being idealistic here!
    I do hope I don't see 3.5 for a long long time. If doing subq few times a week will help, I would do that. Vet checked that she didn't hear any heart murmurs.
     
  25. Myrtlesmum

    Myrtlesmum Member

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    I've had 2 cats with chronic renal failure. The first cat was diagnosed when she was borderline stage 2/3 - I started her on Fortekor immediately and she lived for another 4.5 years. I only did subq a few times when she was end stage and that seemed to perk her up for a few days but she hated it and I thought quality of life was far more important and in the end had her PTS at the age of 17.5 years. I changed vets half way through her treatment and he wasn't convinced Fortekor did much but we left her on it as she seemed to be doing so well. Myrtle is currently bordeline renal failure stage 1 and the vet has suggested that if with the next blood test she is getting worse that we start her on Semintra (telmisartan) but I'm not sure how that will affect her diabetes as I really don't want her knocked out of remission.
     
  26. Myrtlesmum

    Myrtlesmum Member

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    Myrtle would only lick the gravy off Royal Canin (ultra light) for the longest time. I finally figured out that if I chop it up into smaller pieces and mix some tuna with it, she'll it eat. I gradually reduced the amount of tuna and now she will pretty much eat the RC on it's own - I only mix in some tuna now as a treat or if her appetite is a bit down.
     
  27. Marje and Gracie

    Marje and Gracie Well-Known Member

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    I've had four CKD cats and I, personally, would not start them on fluids, for CKD, until the creatinine is 3.5 or higher. Cats can live a long time and be stable with CKD and if you start giving fluids too early, you risk building scar tissue even if you move the needle around. Cats should get their fluid through oral intake for as long as they can keep up.

    Two of my CKD cats lived a very long time and I did not start fluids until creat of 3.5. Neither died of CKD. One of the others was 21 and stable with CKD but passed suddenly from a heart issue. The other actually had PKD which is very, very often fatal at 2-3 years of age and he lived to be 13.
    Just seeing this now and it's late here. I will try to look at it in the morning and send you some thoughts. Thanks for your Patience!
     
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  28. Waheeda

    Waheeda Member

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    Good that u mentioned fortekor. My diabetic cat has both kidney and heart failures. He's on fortekor plus diuretic and anti coagulant. Amazingly his crea has dropped from 2.8 to 2.4 in 2 weeks! I'm pretty sure it's cos of fortekor.
    So I'm really thinking of giving fortekor to the civvie. But it doesn't seem to be standard treatment for cdk here.
     
  29. Waheeda

    Waheeda Member

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    Thanks @Marje and Gracie and @Myrtlesmum
    So happy to know ur cdk cat's survived 3-5 years after diagnosis. Give me so much hope. I'll be happy if my cats will live this long.
     
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  30. Waheeda

    Waheeda Member

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    @TempestsMum
    Sorry if I had "hijacked" your post. But we can learn this disease together.
     
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  31. TempestsMum

    TempestsMum Well-Known Member

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    @Marje and Gracie thank you I really appreciate it, and appreciate your insight on ckd in general.

    @Waheeda lol no problem and no apologies necessary.
     
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  32. Waheeda

    Waheeda Member

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    Is semintra a new drug for cdk? The vet did not mention this. I'll ask another vet at another clinic on Monday. I chopped up the royal canin food and mix in his usual food and he growled at me and walked away. U can't trick him.
     
  33. Myrtlesmum

    Myrtlesmum Member

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    Hi Waheeda, Yes - I think Semintra (telmisartan) has been fairly recently approved for use in cats with CKD here in Australia (not sure whether it's the same situation in the US though) you may want to ask the vet about telmisartan (the generic name) though becauses sometimes they have different brand names in different countries. In Australia telmisartan (Micardis) is a blood pressure drug for humans that has been around for about 20 years. However, I don't know about using the human version for cats as it seems cats need a tiny dose and it's in a liquid suspension for cats as opposed to in tablet form for humans.
     
  34. Waheeda

    Waheeda Member

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    Hi,
    I'm in Singapore and most of our vets (I can easily say 95%) were trained in Australia. From Sydney Uni, Melbourne, Queensland etc. I'm surprised they didn't mention this before. Maybe the internal medicine specialist would be able to advise me. Otherwise I'll try fortekor if the vet allows me.
    By the way, is weruva bff back on the shelves in Aussie? Trying to get hold of some for my cats. US is too far away and shipping cost will kill me.
     
  35. Myrtlesmum

    Myrtlesmum Member

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    Hi Waheeda, No BFF is not back on the shelves yet in Australia. I will never feed my cats this food again anyway - see my 2 comments on this thread if you want more more of my opinion/thoughts http://www.felinediabetes.com/FDMB/...th-feeder-tube-need-help.184064/#post-2049388
     
  36. Waheeda

    Waheeda Member

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    Hmmm so you think there's something fishy going on. Their updates did look rather skimpy.
    Actually I requested our local supplier of Young Again food to bring in Weruva as well but she's hesitant cos of the incident in Australia. She said those for American market is also made in the same factory in Thailand.
    I'm at a loss as to what to feed my cats. No low phosphorus food here. And he's rejecting renal food.
     
  37. JanetNJ

    JanetNJ Well-Known Member

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    Can you get a phosphorous binder?(Aluminum hydroxide) then you can just feed her what you have been.
     
  38. Waheeda

    Waheeda Member

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    Hi Janet!
    Yup already on binder. But I read it can only reduce by 20%? Would you know if it's toxic if u give too much?
    My vet dispensed this supplement. Anyone ever used it?
     
  39. Waheeda

    Waheeda Member

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    Attached Files:

  40. JanetNJ

    JanetNJ Well-Known Member

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    I am not sure about that. I didn't use a binder personally.
     
  41. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Here is a link for the supplement
    https://www.petplusultra.com/en/care/supplements/candioli-renal-n-70g/889
    It seems to be a general vitamin/probiotics supplement.

    How much Aluminum hydroxide binder are you giving?
    The phosphorous level of 1.99 is not that bad at all since the upper range is 2.74
     
  42. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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  43. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Most phosphorus binder products from the vet contains sugar.
     
  44. Larry and Kitties

    Larry and Kitties Well-Known Member

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  45. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    You might try contacting this company using their contact page. Do ask what the minimal order is (500 grams would last a very long time). And do ask if their product is human grade. http://www.optigen.com.au/fine_chemicals.html
     
  46. Waheeda

    Waheeda Member

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    The vet gave Rx Phos-bind. Didn't state there's sugar. Is aluminium hydroxide safe to use or I should ask for ipakitine which is calcium hydroxide ?
     
  47. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Rx Phos-bind is aluminum hydroxide. No additional ingredients.

    With a phosphorus binder, you have to watch out for constipation and adjust the dose accordingly.

    http://www.felinecrf.org/phosphorus_binders.htm
     
  48. Waheeda

    Waheeda Member

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    No issue with aluminium toxicity? Some articles I read mentioned this.
     
  49. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    From the above mentioned page:
    Aluminium Toxicity

    You may have read that there is a risk of aluminium toxicity from the aluminium in aluminium hydroxide medications. This applies in particular to human patients on dialysis, because aluminium is used in the dialysis process. Do aluminium hydroxide binders continue to have a role in contemporary nephrology practice?(2011) Mudge DW, Johnson DW, Hawlet CM, Campbell SB, Isbel NM, van Eps CL & Petrie JJB Nephrology 12 states "Available historical evidence however, suggests that neurological toxicity may have primarily been caused by excessive exposure to aluminium in dialysis fluid, rather than aluminium-containing oral phosphate binders. Limited evidence suggests that aluminium bone disease may also be on the decline in the era of aluminium removal from dialysis fluid, even with continued use of aluminium binders...The relative contribution of aluminium binders to aluminium toxicity would appear to be minor based on the available evidence." Do oral aluminium phosphate binders cause accumulation of aluminium to toxic levels?(2011) Pepper R, Campbell N, Yaqoob MM, Roberts NB & Fan SLS BMC Nephrology 12 found that even patients on dialysis did not develop aluminium toxicity if changes were made to the dialysis process (during which patients may be exposed to dialysate water which is contaminated with aluminium), but the patients in this study were on relatively low doses of aluminium hydroxide.


    Since cats are not on dialysis, aluminium toxicity was not thought to be a concern for cats (or dogs), especially since even in humans it takes years before it becomes a problem, and cats and dogs don't live as long as humans. Recently, however, there has been increasing concern about the possible risk of aluminium toxicity in cats using aluminium hydroxide based binders. This is partly because of a study which reported on aluminium toxicity in two dogs on binders, Aluminum toxicity following administration of aluminum-based phosphate binders in 2 dogs with renal failure (2008) Segev G, Bandt C, Francey T & Cowgill LDJournal of VeterinaryInternal Medicine 22(6) pp1432-5. There is no abstract available for this study, but Treatment options for hyperphosphataemia in feline CKD: what's out there?(2009) Kidder AC & Chew D Journal of Feline Medicine & Surgery 11(11) pp813-24 reported that the two dogs in question developed "probable aluminum toxicity" after being on binders for only 62 and 65 days. The symptoms seen were "severe neuromuscular abnormalities." The dogs were on dosages of 125mg/kg per day (or 56mg per lb body weight) and 200 mg/kg (or 91mg per lb bodyweight) per day, which are not particularly high doses. However, both these dogs had been on dialysis, though apparently the dialysate water was not contaminated with aluminium.



    Partly because of this study, vets are becoming increasingly aware of the need for caution and awareness when using aluminium hydroxide binders in cats too, particularly when using large doses. In Chronic kidney disease (CKD) in dogs and cats - staging and management strategies (2015) A Presentation to the Virginia Veterinary Medical Association 2015 Virginia Veterinary Conference, Dr D Chew says "THERE IS NO KNOWN SAFE DOSE OF ALUMINUM SALTS FOR HUMANS WITH CKD. Detrimental effects of aluminum based phosphate binders as described in humans seen in humans have not been systematically evaluated in small animal patients and are rarely clinically appreciated. As cats with CKD can live for years on treatment, concerns for aluminum accumulation deserve more study as to long-term safety."


    Physical symptoms to watch for include muscle weakness or neurological problems, such as stumbling and an awkward gait (although, just to complicate matters, these can actually be signs of uncontrolled phosphorus levels too, see above). One possible early sign of aluminium toxicity is a change in MCV. This is a measure of red blood cell size. If your cat has a low MCV (known as microcytosis), this means the red blood cells are smaller than usual. Although this may simply indicate iron deficiency, it may also be a sign of aluminium toxicity. This sign normally appears before you see physical symptoms, so be sure to monitor your cat's MCV levels.


    If you are using potassium citrate (perhaps to treat metabolic acidosis), give this at least two hours apart from phosphorus binders. This is because, as Drugs explains, products containing citrate can in theory increase the absorption of aluminium, which could increase the risk of aluminium toxicity. Many therapeutic kidney diets contain potassium citrate. See above for more information on aluminium hydroxide and potassium citrate.


    Try not to worry too much. I am only aware of one case of aluminium hydroxide toxicity in cats to date (this cat was given massive doses of aluminium hydroxide, more than twice as much as she would normally be given based upon Dr Nagode's table above), and most cases in dogs have occurred in dogs taking over 200 mg/kg. In Updates in feline chronic kidney disease (2008) Dr CL Langston states "Excessive absorption of aluminum can lead to toxicity, including anemia and neurologic symptoms, but this seems uncommon in veterinary practice." In contrast, the dangers of elevated phosphorus control are very real, and very common, and controlling phosphorus is essential for your cat's wellbeing.


    If your cat has phosphorus levels that require large amounts of aluminium hydroxide, or if you cannot control your cat's phosphorus levels with aluminium hydroxide only, consider adding another phosphorus binder. Most people in this situation use lanthanumcarbonate (Renalzin or Fosrenol). See below for suggestions on dosage.


    If you think your cat may have aluminium toxicity, I would ask for a referral to a vet school or a neurologist if possible. Chelation therapy plus dialysis helped to remove the aluminium from dogs with aluminium toxicity, and indeed following treatment the neurological problems experienced by the dogs in the above study were successfully reversed.
     
  50. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Sorry for the hijacking of the thread @TempestsMum . Maybe you @Waheeda should start your own thread.
     
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  51. TempestsMum

    TempestsMum Well-Known Member

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    Nooo not at all! The information is good all on one thread as it's useful to me as well. :):)
     
  52. Larry and Kitties

    Larry and Kitties Well-Known Member

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    I have used and are currently using aluminium hydroxide binder. I am not concerned with aluminium toxicity since sadfully, they are not on it too long.
     
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  53. Waheeda

    Waheeda Member

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    Thanks for the info. Appreciate it much! I didn't mean to hijack @TempestsMum thread but our cats have similar values and we both have similar issues esp diet. She has a better vet whom she trusts unlike mine. Ended up I have so many questions to ask members here.
     
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