Kidney Disease Diet+ Diabetes Question

Hello friends! I took Dusty to the vet this morning after her behaving weird for about 3 days (holidays prevented me from doing anything more earlier) and she was diagnosed with early kidney disease. Vet said the dietaries need of kidney disease food are almost opposite that for diabetic food, and that we would probably just up her insulin dose. I was wondering if anyone has had kitties with both kidney disease and diabetes, what foods you would recommend, and any other advice you could give on dealing with both at the same time. Thanks!

 

My girl had diabetes, kidney disease, and later on heart disease. When she first got kidney disease, I made very minor changes to her food. For early stage kidney disease, it’s fine to keep feeding low carb food, but try to look for options that are also low phosphorus. What are you feeding now? I was feeding raw and switched to proteins that used calcium instead of ground bone. A lot of the time I fed home made with a premix that is CKD friendly, ie. made with egg shell calcium. If you are looking that Dr. Lisa’s food list, look for phosphorus as close to or under 200 as you can.

PS: I didn’t have to change the insulin dose,

 

So I didnt find these forums until a few days ago so I wasnt feeling her food that was even remotely in the neighborhood of okay. I was going to switch her to the Fancy feast Roasted Chicken Feast, but that has 284 on the chart, which seems too high to me now? I'm really inexperienced and I've never even tried a raw diet.

 

A website that many thousands have used to understand and treat kidney disease is Tanya's CRF site. You've got lots of time left with a stage 1 diagnosis - Dakota's been in kidney failure for over 3 years but was already stage 2 at dx. He's now at 4 but he's also 18 1/2 years old so age is playing a role in it's advancement too. I've followed Tanya's site since we started the CKD walk too. The link is elsewhere on the site too but here's a direct link:

www.felinecrf.org

 

There are canned options closer to 200. The Weruva line is one that comes to mind. Most of the Fancy Feast are a bit high. Check out the sortable version of the food list for others. http://catinfo.org/chart/index.php Just put in 9% for carbs and pick a low 200 number for phosphorus and see what you can find,

Did you vet say her phosphorus was too high? It is typically one of the numbers that goes out on blood work. Not to overwhelm you in reading, but here is another good site for you: https://www.felinecrf.org/ Cats with kidney disease can live quite a few years. Neko was pretty much status quo for a couple years after her initial diagnosis.

 

Nina, I am also trying to be proactive with possible incipient kidney disease, and have decided to try the raw food diet with the supplement Food Fur Life EZ Complete. Idjit is being very gradually transitioned (only offering slightly increased amount of the new food one meal a day) and so far, so good.
I have been doing research along the way, and found this thread right here on the board:
http://www.felinediabetes.com/FDMB/threads/diet-for-chronic-kidney-disease-and-diabetes.157741/

I questioned the FoodFurLife staff about phosphorus and CKD and this was the response:
"Regarding your question about phosphorus, the typical guidance for phosphorus in earlier stages of CKD is to feed a food that is less than 1% phosphorus on a dry matter basis, or less than 250mg phosphorus per 1,000kcal. EZComplete is both.

The Veterinary / Rx renal diets typically have phosphorus at lower than AAFCO (which minimum is 0.5% on a dry matter basis). But they achieve this by trading protein for carbohydrates.

If you want to feed a low carb diet, then yes, raw is your best option. In a traditional raw diet with bone, the phosphorus is over 2% on a dry matter basis. This is because bone is used as the source of calcium - but it is also the largest repository of phosphorus in the body. By removing the bone and replacing it with an alternate source of calcium like eggshell (which is what EZComplete premix powder uses), this alone reduces the food to less than 1% phosphorus on a dry matter basis, typically to 0.8% - 0.9% DMB if using very lean meats. You can lower the phosphorus further by using fattier cuts of meat.

That said, Laurie has had 5 CKD cats since she transitioned her cats to raw 7 years ago (half of her crew were seniors when they transitioned), and she now has 2 and Carolina has 1. We've both tried feeding low protein in order to lower phosphorus further (because outside of bone, the organs and meat are the source of phosphorus, which is why the Veterinary / Rx renal diets replace meat with carbs). Lowering phosphorus further in a homemade diet is actually quite easy to do with food made with EZComplete by adding fattier cuts of meat, as mentioned above. If you target 15% fat as fed, the food will have about has much phosphorus as the Rx diets (below the AAFCO minimum), and protein will be around 40% on a dry matter basis - not quite as low as the Rx foods, which are around 30%. At about 10% fat as fed (with food made with EZComplete), the protein will be just about 50% on a dry matter basis. BUT. But it turns out that - in our experience - phosphorus really isn't the only consideration in an ideal CKD food, unless your kitty is late stage 4 or in kidney failure. Again, based on our experience.

We went back to feeding mostly lean meats. Doing extensive research, we learned why our cats do better on the higher protein diet: senior cats need MORE protein, not less. Over time, on the higher fat diet, our cats got weaker in the back end. That's muscle wasting. In a referenced piece by Dr. Mark Peterson, one of the most widely recognized small animal endocrine specialists in the world, he walks through the known needs of senior cats from published studies. It turns out, based on that info, senior cats need a minimum of 53% protein (dry matter basis) to prevent muscle wasting. So we weren't imagining it when our observation was our cats did better on a high protein diet. https://endocrinevet.blogspot.com/2011/11/optimal-protein-requirements-for-older.html

Dr. Becker has a referenced article on a study conducted in cats, designed to determine if low protein made a difference in CKD. It turns out, protein control does not impact CKD, where phosphorus control does: https://healthypets.mercola.com/sites/healthypets/archive/2018/02/13/feeding-senior-cats.aspx

So we both feed food made with EZComplete to our cats, using a rotation of chicken breast (lean), chicken thigh (fattier than breast), pork loin (lean), pork shoulder (very fatty), turkey breast (lean) or thigh (fattier), and Laurie uses fatty cuts of beef (chuck beef) and very lean cuts of beef (like top round), and each of us typically feed 2 of 3 meals a day to our cats that are lean, and one that is made with fattier meat.

What we do is control phosphorus by using a specific form of vitamin B3, niacinamide. Laurie lost her 3 prior CKD cats to problems unrelated to the CKD, and the current two have been completely stable for 1.5 years since diagnosis with this approach. Carolina's CKD cat also has hyper-T, IBD, megacolon and a hiatal hernia, and he's been completely stable for two years. Totally stable! Some of it luck-of-the-draw genetically. But this approach has been serving our kitties well."

I found this reassuring and decided to go ahead with the new diet. Best of luck with Dusty.

 

I àlso fed FoodFurLife as one of my options. More on making your own for kidney kitties: http://www.felinediabetes.com/FDMB/threads/home-prepared-diet-of-crd-cats.150441/

 

Chuck had kidney disease and diabetes. I fed him Whole Earth Farms Grain-Free Real Duck Pate Recipe Canned Cat Food. I got it on chewy after finding a can at Petco to see if he likes it.

 

I second this site: http://www.felinecrf.org/
It's a lot of information, and may seem a little overwhelming at first, but the information is easy to understand and well organized.

 

Just to be aware that, although protein restriction doesn't directly appear to affect the progression of CKD in cats, there are other reasons for restricting protein at least moderately for quality of life purposes https://www.vetmed.ucdavis.edu/hospital/animal-health-topics/chronic-renal-disease My views on this have recently changed a little based on this type of information becoming available. And while you do still have to be as diabetic-friendly as you can, in a cat that isn't in remission there is some wiggle-room with the carbs as you can compensate with insulin. For a cat that's in remission, keeping the remission may take more priority to avoid throwing them out of remission and potentially impacting the kidneys further at least temporarily while you get them regulated.

 

You can also increase fats in order to reduce protein levels, it doesn’t have to be all an increase in carbs.

 

Absolutely - and increasing fats seems to help prevent constipation, and can also help to prevent the gradual weight loss that often comes with CKD. It's actually a shame that Evo first changed and then discontinued their cat foods - there was one of their canned ones that was low enough in carbs for me to be happy AND low enough in protein for our vet to be happy because 67% of the calories came from fats.

 

@Idjit's mom

@Squeaky and KT (GA)

My Ravan was diagnosed with Stage 2 kidney disease last summer. Are you aware of using a Binder in the food to reduce the Phosphorus ? When Ravan's BG drops too low & I give him FF with gravy I add a small amount of Aluminum Hydroxide powder http://www.zzcat.com/CRF/supplies/binders.htm#drnagode


I also give him Calcitriol 2X a week you can read about it here http://www.zzcat.com/CRF/calcitriol/index.html ( I believe Dr Karen Becker & Dr. Pierson mention it also. )
The phosphorus level must be high enough before you can give it to them.It's supposed to prolong their life.

Ravan was raised on a Raw meat diet but for unknown reasons he's refused to eat it lately. He's VERY picky about canned food but I was surprised when he did eat "Purina ProPlan Focus, Urinary Tract Health Formula" carbs 4% phosphorus 187 ( it's on Dr. Pierson's food list)

If you'd like info on where I order from let me know The Calcitriol is from a Veterinary compounding Pharmacy , they are really helpful & good to talk with. The Binder Is on Amazon.https://www.amazon.com/gp/product/B07JBBNST4/ref=oh_aui_detailpage_o01_s00?ie=UTF8&psc=1

I hope this information can be of Help to someone.

 

This info is from Dr. Pierson
I definitely do not recommend the many recipes on the internet that use potatoes, pumpkin, squash, rice, etc., for CKD patients. Not only is the feeding of these species-inappropriate ingredients unnecessary, but they can be detrimental to the health of the patient.
It was a very sad day for our cats when humans got it in their mind that protein is a cat’s enemy. Quite frankly, I am getting very tired of watching cats end up protein malnourished on low protein diets including the so-called “prescription” diets – none of which would ever be fed to any cat in my care.

 

Dr Becker and Dr Pierson are my heroes
God Bless 'em!!!
When Uncle was diagnosed with diabetes it was my vet who steered me to Dr Pierson, and through DR Pierson's website that I found FDMB
BTW if anyone in the Seattle area is looking for a vet that isn't afraid of raw food, home testing and educating yourself through the help of this board, I would gladly make a recommendation

 

There's a great group on Facebook called Cats with Chronic Renal Failure. Look them up... They are super helpful

 

Thanks for tagging me - Doc's been on straight phosphorus binder for 2 years. We started out with Epakitin then moved to straight alum hydroxide powder. I had someone share a whole bunch with me when their cat crossed and they'd just ordered. I'm still using it is how much there was! It helps a lot and makes it easier to find foods he'll happily eat.

 

There was also another piece of research (abstract only here as I've struggled to find an open access source that everyone can see given that I have additional permissions on a number of sites https://journals.sagepub.com/doi/abs/10.1177/1098612X15625453 ) that actually demonstrated, flying completely in the face of what we all think we know, that feeding a commercial dry food is pretty much the only thing that appears to offer a degree of protection against CKD in cats. I know - this one's probably going to go down like a lead balloon and is absolutely not something we can do for diabetics. But it is worth bearing in mind that, for all we're constantly told that dry food is the worst thing ever for cats, the evidence actually shows the complete opposite. If nothing else, it lets many of us off the hook over feeling guilty about feeding what we're often now told was "bad" food.