? Diabetes/CKD Combo. Food question

Maestro was recently dx with Chronic Kidney Disease (CKD) almost exactly 1 year from his acromegaly/DM dx. Have been exclusively feeding him low carb FF Classic Pate variety of flavors, but vet switched him to Rx Hills k/d because of high phosphorus content in FF. First few days he gobbled down the new food but is now refusing to eat it. Has been vomiting once per day on average. Still drinking, grooming, jumping up on favorite chair but has lost 4 pounds in six months (17# to 13#).
These are his recent labs....
SDMA: 20
CREA: 2.2mg/dL
BUN: 50mg/dL
BUN/CREA: 23
PHOS: 7.5 mg/dL
TT4: 1.2
UPRO: 147mg/dL
UCREA: 56mg/dL
UPC: 2.63 (>=2.0–significant proteinuria)
If you have experience with this combo of medical issues I would love to get your input on good commercial or Rx food options. Feeding a raw/homemade diet is probably not a realistic option for us.
Also, what to give to help with nausea and tremors. I suspect these are related to elevated levels of potassium and phosphorus in his system...
I currently give him 3mg Methylcobalamin daily in the morning. Thanks in advance.

 

If you could post all of the results on the lab page of your spreadsheet, it would be helpful (that is where the ranges are and it is a good way to keep track of the progression of CKD). I'm not great at reading labs.
Tagging @Marje and Gracie for the lab results.
Edit: Also @Wendy&Neko

Tanya's website is the go-to bible for kidney disease. Like feline diabetes, there is a steep learning curve. Start here

A 2017 low carb / low phos food chart can be found here

It can be done.

 

Join the feline chronic kidney disease group on Facebook. I’ve learned everything I know about how to care for a cat with ckd through the members there! Tanya’s website is also great too.

 

For the phosphorus you can lower it quickly with Niacinamide (Jarrow brand on amazon). 250 mg twice a day and retest in 2 weeks. It brought my cat’s phosphorus down from 6.1 to 4.6 in 2 weeks and now I have her on a maintenance dose of 125 mg twice a day and she’s still able to eat high phos foods like Friskies and FF.

For nausea and vomiting the go to medications are ondansetron and cerenia. Ask your vet for scripts and get them elsewhere for cheaper; I use Costco

 

The Rx food is too low in protein and will cause muscle wasting and weight loss and many cats dislike it. There are plenty of commercial foods that can fulfill the requirements for both diabetes and ckd

 

Some members also do home made food, raw or cooked to help with the phosphorus issue. I use FoodFurLife EZ Complete supplement with raw meat for Idjit. It uses egg shell instead of bone for calcium, and is lower in phos. He is not officially CKD but I didn't like the higher values in his last bloodwork and decided to be pro-active.

I queried the staff at FoodFurLife about phos and got an informative reply about that, plus information indicating that low protein diet is older school method and our kitties need enough protein to prevent muscle wasting. If you would like I can copy that information to you in a PM.

 

I agree with @Priya&Missy the Prescrfood to too low in protein.
Weruva brand has some low phosphorus options.
The website has all the phosphorus levels/protein levels etc for each food online.

You might find this interesting
http://www.felinediabetes.com/FDMB/threads/home-prepared-diet-of-crd-cats.150441/

 

His ALT and GGT ate more than mildly elevated. You might want to consider an ultrasound to see what’s going on and if his bile duct is normal. They should also look and see if his intestines are thickened which might indicate IBD if he’s vomiting so often.

In addition to the niacinamide, he also needs a phosphorus binder like aluminum hydroxide which is tasteless and inexpensive. You can read more about phosphorus control here; it’s really a priority to get and keep the P down for longevity.

He’s also anemic at 23% on the hematocrit. Once he gets below 20%, you’ll have to be more aggressive with addressing it. You say you are giving him methylcobalamin, but he also needs a multiB. Here is a discussion on anemia and B vitamins.

I hope that helps, Thanks for loading the labs onto the SS.

Are they keeping an eye on his blood pressure?