Is Anyone Using Calcitriol for their CRF Cat??

Just got bloodwork back for Blackie 1 1/2 weeks after his CRF "crisis" (see below). You can see a spreadsheet with all of his bloodwork in my signature. My vet is recommending Calcitriol and I just don't know enough about it or how it will affect Blackie's glucose. My vet said the only drawbacks to using Calcitriol are the cost and that bloodwork would have to be more closely monitored. He also did not recommend phosphorus binders which I was thinking about doing. He said I could add them if I wanted, but he didn't think it was necessary.

FYI - Almost 2 weeks ago Blackie stopped having much of an appetite. I syringe fed until we could get him into the vet. They had us do 75ml fluids bid and added an appetite stimulant. We rechecked the blood after 2 days and kidney values were better. We did the bid fluids for a week then went to once a day. I stopped the appy stim after 3 or 4 days. Blackie is currently eating well and seems to feel good, but the latest bloodwork had the creatinine and BUN going up again. We also started him on Zenequin for a possible kidney infection and he is still getting that with 2.5mg of Pepcid.

If you have any info or opinions about this, please let me know. Thank you for your help.

 

If your cat recently crashed, all bloodwork will be off the charts for a while. How are Blackie's phosphorus numbers right now? Calcitriol is used to reduce phosphorus, but it usually is a drug of last resort given cost and monitoring. You'd use it if testing shows the cat has developed secondary hyperparathryoidism. That said, its use for controlling phosphorus is somewhwat controversial. My vet looked into it for Tabriz, but decided against it and I'm glad he did because phosphorus binders have controlled Tabriz's levels just fine.

For example, when Tabriz crashed in May of last year, his phosphorus level was above 20 (beyond the scope of the machine). After a few days on IV we were able to get it down to about 12, but obviously that was still too high. We put Tabriz on Dr. Nagode's protocols for aluminum hydroxide (see http://members.bellatlantic.net/~vze2r6 ... inders.htm). The protocol is very aggressive, but it did the trick. Many listmembers at the Feline CRF Yahoo group have used those protocols with excellent results. Tabriz still gets phosphorus binders a year later despite his levels falling below 6 (usually if a cat crashes badly they need treatment for life). The dosages vary depending on what phosphorus is, but aluminum hydroxide does work. You can read more about phosphorus levels here: http://www.felinecrf.org/treatments.htm ... us_binders. They also discuss calcitriol and when it is used. If you cat hasn't used binders at all, jumping to calcitriol wouldn't be my first choice. Tabriz crashed REALLY badly (BUN over 200, creatinine 12.4) but binders and a renal diet alone were enough, and over a year later I'm still not interested in jumping to calcitriol. There is a Yahoo Group I understand devoted to its use, so you might be able to glean more about it from that. Here are some other links that may help:
http://www.felinecrf.org/diagnosis.htm#minerals
http://members.bellatlantic.net/~vze2r6 ... index.html (tons of technical references here about calcitriol)

 

I have no experience but you might want to join Yahoo's Calcitriol group.
http://pets.groups.yahoo.com/group/Calcitriol/

 

Thank you Wendy for all of that information. Blackie's phosphorus isn't that bad. It got up to 6 at the blood work last week, but today it was down to 5.7. From what I've read the Calcitriol is only helpful in keeping phosphorus in check if you start it before the phosphorus gets too high.

I did join the Calcitriol yahoo group and read a lot of their info. I posted but haven't heard back yet. I will also check out the links you gave us.

Thanks for your help.

 

We use calcitriol. I'm not sure what your question is?

Phos should be below 6 for it to be the most effective, although it is still partially effective up to a phos level of around 8. I disagree with your vet on binders; if Blackie is already on a low-phos diet and getting a phos level of close to 6, he should be started on a binder soon. Otherwise, you could give a low-phos diet a try first, but I wouldn't wait too long in reducing his phos; it really needs to be kept under control.

Without going into too much detail - I just want to quickly correct a couple of mis-statements in this thread. 1. The issue is renal secondary hyperparathyroidism, not hyperthyroidism. 2. Calcitriol is not considered a drug of last resort: "it is desirable to administer calcitriol at low doses as early as possible in kidney failure to avoid PTH excess from occurring in the first place." See http://members.verizon.net/~vze2r6qt/ca ... triol2.htm It is however true that this is a controversial treatment; some internists object to using it for various reasons. See Tanya's site for details on that.

This is a confusing piece, but it may help you understand the mechanics of what happens in kidney failure, and why calcitriol therapy may help: Calcium Phosphorus Balance

 

Oops! Missing "para" was definitely a typo. The old eyes are not what they used to be. Have edited my post to say what I meant to say. As for the other, it was my understanding that calcitriol was used later rather than sooner. After re-reading Scooter's website, I see I was under the wrong impression. My vet considered giving it, but opted not to after reading up on it. He didn't feel he knew enough about it to test and monitor appropriately. I also wasn't comfortable about it because though I read some of the technical papers, I didn't understand enough about how it worked to ever pursue it later.

 

Merlyn was on it for a few years. I dont know if it helped but I know it doesnt hurt. Earlier is better than later to start and its most effective if phos is below 6.0, as WCF said.

One of the bigger problems with it is that very few compounding pharmacies are set up to deal with it because it involves eeny meeny beyond micro amounts of it when its compounded.

I confess that I did not have Merlyns PTH and ionized Calcium tested before we started, and only did it once when he was on it.

 

Thank you all for your replies. After reading your replies and researching on the yahoo group & felinecrf.org, I decided to try it. My vet is calling the rx into a compounding pharmacy today and I should have it on Monday or Tuesday. From what I read, the Calcitriol is supposed to reduce the phosphorus. Is that right? And if so, should I still use a phosphorus binder or wait a few weeks? Some one from LL is going to send me some aluminum hydroxide, so I don't have it yet anyway.

Thanks again. This journey with Blackie is teaching me soooooo much.

 

Do you know where your vet is calling the rx in to? There are only two compounding pharmacies that Dr Nagode is comfortable recommending w.r.t. to compounding calcitriol because compounding it requires skill and knowledge; Triad in CA and Franck's in FL. Franck's has voluntarily stopped compounding veterinary meds until they resolve their troubles with the FDA, so they have asked a third pharmacy - US Compounding Pharmacy in Arkansas - to prepare it for their clients. See Dr Nagode's post in msg 11382 in the Calcitriol group.

 

I never used calcitrol only ipakitine. But I have been trying to do some research on crf since my civie, Phoebe, has it. I have been thinking about adding more taurine to her diet. Have read it can help but still a little leery to try it. Have a message in with my vet about using it.
I do hope Blackie improves on his new regime!

 

My vet called the rx into Monument Pharmacy which is in Monument, Colorado. My vet has used them before and from talking to them, it sounds like they have been compounding Calcitriol for cats for a while. He is prescribing 15 nanograms once a day in a sardine flavored liquid. We'll recheck blood in a week and then I think 2 weeks. I hope this is a good pharmacy.