? Kidney disease in cats

Hi. Not diabetes related but I hope you can help. My friends cat has been diagnosed with kidney disease and has been given wet and dry food by the vet. I have told her to take the dry back. Is there a forum like this one for kidney cats or a Facebook page? Also is there an appropriate food list? We are in the UK.

 

There is a page on Facebook that I joined for a while, but my cat has mild CKD (not the diabetic), and I've chosen to feed him a diabetic diet instead of the CKD one. The cats on Facebook were on a multitude of mediations and subcut fluids, and it was more than my tiny mind could deal with

 

Hi Sue, I found the forum at the 'Tanya' website really helpful (see link below). And the website itself has a vast amount of info (including some food lists):
http://www.felinecrf.org/tanyas_support_group.htm

Eliz

 

Here is a Yahoo group
https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info

 

https://www.facebook.com/groups/felinecrf/

The Facebook group

 

Hi!
I just want to give you a positive spin on CKD--
My non diabetic cat was DX with CKD at 11 years old and he is now a happy 17 years old-
It is a manageable disease.
He just had a dental and his kidney values are still in normal range after 6 years of SQ fluids at home and of course wet food etc....
Many people do not realize that you can greatly slow the progression of this disease.... not every cat responds the same but if caught early you have a good chance of quality life for a long time. This is Rico last week... he is 17 in August.

 

Wow. Thanks for all the information. My friend is a bit emotional today and is going on holiday tomorrow, so I said I'd research for her.
@jayla-n-Drevon how do you slow the progression down? Did you use one of the sites mentioned above?
Rico looks lovely. You would never guess he was 17 and had CKD, he looks so healthy.

 

@Sue484 -

There is an awful lot of reading to do for CKD - makes the learning curve for FD look like a cake walk. Tanya's Site is an invaluable resource. I'm glad your friend has you to help her.




Mogs
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Hi
Every cat will respond differently.. please keep in mind genetics as well as food and environment will play a role.
For Rico we have been fortunate because we caught it early-I have always done blood panels regularly so when at 11 years old he came back with elevated kidney values I asked "how bad is it" and my vet said bad enough to start fluids-
Fluids for us has been a HUGE part keeping his progression as slow as possible.
He has not had a phosphorus issue so I have not had to deal with that.
He does get nausea at times and I give onadestron (spelling?)
I also just (last night ) started a appetite stimulate cyproheptadine-
He is on all wet food and I recently started a B vitamin supplement a few times a week (you can get injectable as well)
He has maintained 11-12 pounds his since DX-
We have also been very lucky as his RBC count is good-
I did not use the site but I wish I had known about it because there is lots of good info in them-
1 thing I am glad I kept in mind is "if it ain't broke don't fix it" in other words tons of things can happen with CKD but if they haven't be grateful and love your kitty
@manxcat419 has lots of experience with CKD as well with other symptoms/issues

 

Ondansetron.


Mogs
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Thanks Mogs--I can never spell to right!

 

We were out for the evening...just reading and catching up now...I'll get back to you soon.

 

It looks as though you've already been given links to most of the sites - you have the Tanya's site forum there and the Facebook page I'm a member of.

As far as slowing the progression is concerned, two of the key factors are adequate hydration and controlling the cat's phosphorus levels - new research seems to indicate that controlling phosphorus is more important than controlling the level of protein in the diet. With that said, the best diet for a CKD cat is the one they'll eat - all the other treatments are for nothing if a cat starves itself to death! The gold standard for keeping a cat hydrated, especially as the CKD progresses is sub-q fluids; however, I know there is a general reluctance to prescribe those in the UK. So you do what you can - add extra water to canned food...as much water as the cat will tolerate. And encourage drinking - cats will often drink more from a water fountain than they will from a bowl for instance. Some cats like to drink from a glass or a cup too. Anything that encourages water consumption is good. The aim for controlling phosphorus is to keep it fairly low - well below the maximum level on a lab value which also has to allow for the much higher phosphorus levels that kittens have. In early stage CKD, the aim should be to keep phosphorus below 1.45 mmol/L. If the cat's phosphorus level is higher than this, you will want to feed the lowest phosphorus food you can that also contains a decent amount of high quality protein - the rx diets are very low in protein and contribute to muscle wasting. What I do with Rosa is feed the lowest phosphorus diabetic-friendly diet that she will eat and supplement that with aluminium hydroxide as a phosphorus binder - given with food, it binds to the phosphorus in the food and prevents the cat from absorbing it. The liquid that vets often prescribe is mint flavored and cats HATE it. You can buy the unflavored powdered form online. Something else to have tested is whether or not the cat has proteinuria - not all do, but if a cat does then benazepril (Fortekor) is often prescribed to help bring that down. And regular blood pressure checks are very important as CKD cats tend to have raised blood pressure which, of course, can cause damage if it goes untreated. If your friend hasn't already had a full blood chemistry done, then that would definitely be worth doing. A lot of CKD cats have low potassium levels which can cause their own set of issues as well as the obvious risk to their general health. Rosa's IM specialist says that he likes to keep potassium all the way at the high end of normal range where possible because he's seen numerous cats lose a lot of potassium very quickly so he likes to put them at a level where they can lose some without crashing.

Most of the other treatments are, as Jayla says, based on decreasing symptoms. CKD cats are prone to excess stomach acid which can often be controlled with either famotidine (Pepcid AC) or ranitidine (Zantac). If your friend notices that her cat is vomiting white foam, that is a symptom of excess acid and would give a good indication that it might be time to start one of these treatments. It is important to control excess acid because if it isn't controlled it can lead to bleeding in the GI tract which of course can cause anemia, which again CKD cats are prone to as the CKD progresses as normal kidneys produce erythropoeitin which stimulates the production of red blood cells. As the kidneys become less effective, they are less able to produce enough erythropoeitin so anemia can become a problem for them. If you do suspect a GI bleed, then Sucralfate is a good option for allowing the GI tract to heal. Though I will say that if that becomes necessary, ask for the pills not Carafate liquid - Carafate is artificially flavored with something that cats seem to find unpleasant (I believe it's meant to be a bubblegum flavoring, but that is only from what I've found on the internet - I didn't taste Rosa's, I promise)!!

Cerenia or Ondansetron can be used for nausea if that becomes an issue for kitty. And Cyproheptadine, Mirtazapine or Zyrtec can be used as an appetite stimulant. A lot of vets will give a stimulant without an anti-nausea med, though I am not a fan of that idea - I can't even imagine being made to feel hungry while feeling nauseous, so it isn't something I'd want to do to a cat either!

B-complex and B-12 are both good for improving how a cat feels overall and B-12 can also help to slow down the onset of anemia so is definitely worth considering. They are safe to give as they are water-soluble so any amount that kitty doesn't need will just be peed out.

As you know, we can't 'heal' CKD, but we can control it. A fairly big part of how fast it progresses is down to genetics and the particular course the illness takes for an individual cat, but we can help to slow that progression by adding the right treatments at the right time.

And one more thing. It's very easy to drop into a pattern of anticipatory grief knowing that this is something we can't fix. Our cats live in the moment - all they know is how they feel right now. Please tell your friend to try to remember that...and to keep doing all the things that her cat loves. For Rosa, that's going outside for walks and exploring and then coming back in the house and cuddling and purring. She doesn't know she's ill and neither does your friend's cat - and that's the way we want to keep them feeling for as long as possible. Cats still want to be cats - restricting the things they love too much for fear of what might happen is as damaging to their quality of life as the illness is. I would love to wrap Rosa in bubble wrap so nothing can hurt her, but she would hate that...she wants to explore and run around and chase bugs, so that's what we do - carefully and supervised and on a leash, but we restrict what she does as little as possible.

 

Basically it's about high quality proteins and reduced phosphorus. You can get phosphorous binders from the vets.

 

With all due respect, there's a whole lot more to it than that, especially as the CKD progresses. The sooner things like lack of adequate hydration, excess stomach acid etc are brought under control the better the outlook is for the cat. Better to be prepared to deal with these things early on than wait until kitty crashes and has to spend days in the ER because of a lack of fluids or potassium or similar.

 

UK Source for aluminium hydroxide (capsules containing the powder - fairly easy to judge dosing).

https://www.clearchemist.co.uk/alu-caps-120.html

I imagine that a local pharmacy might be able to order them. The ones I have are made by Meda (475mg AlOH capsules). (NB: on the ingredient list there are various 'E numbers' listed and some of them are toxic to cats BUT the good news is that they're the dyes used to colour the capsules; they're not in the medicine. There's a dosing guide on Tanya's Site.)

As an addendum to April's excellent information:

- Omega 3 supplementation is beneficial. I give Moxxor Omega 3 (from green-lipped mussels). Pros: capsules are nice and small (Saoirse can swallow them OK); good alternative source for cats who can't tolerate fish oil supplementation. Cons: they're not the cheapest and you have to order them from overseas (search for Moxxor online).

- Antihistamine treatments may elevate blood pressure (e.g. cetirizine (Zyrtec) , cyproheptadine (Periactin)).

It is important to avoid dietary acidifiers, e.g. cranberry (d-mannose is OK). Tanya's Site advises against use of so-called 'urinary protection' diets as they contain acidifiers.

Another thing to get checked regularly is eye health (general examination plus monitoring of intraocular pressure) - doubly so in cats with comorbid diabetes and/or pancreatitis. (Found out about this the hard way. )


Mogs
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Thanks you everyone for all your advice. I have passed on the sites for her to read whilst on holiday, and the rest will be waiting for her when she gets back.

 

Vets is the UK don't like to give SQ??
ugh that is terrible

 

When Saoirse was really dehydrated during the recovery from her eye op I asked one of our vets about about sub-qs and they were talking about using multiple injections to administer them. This is very different to the one experience I've had of a cat of mine needing sub-qs and the Irish vet who was treating her gave them in one spot, similar to what is discussed here so, needless to say, that raises question marks about aspects of our current vets' experience in certain aspects of feline treatment.

I find it both frightening and frustrating the way that vets differ in the treatment modalities they offer. I fully appreciate that they need to know a little about a lot but, based on what I have learned from other members here, there is a HUGE problem with the number of vets who don't have a relatively basic appreciation for fairly common treatments. If lay people like ourselves sharing experience can get a relatively good handle on what works and how best to treat just why does it seem to be such a big issue for veterinary professionals to learn? Take feline diabetes treatment, for example. Granted there are cats who are tricky to regulate but the basic principles are not rocket science by any fair stretch of the imagination. If we can master the basics, why can't allegedly exceptionally intelligent professionals manage it???


(A very frustrated) Mogs
.

 

Many don't seem to like to. And from what I've read on the Tanya's support group, that's fairly prevalent throughout a lot of Europe. There is at least one European country (for some reason I'm thinking Sweden) where it's actually illegal for a vet to prescribe sub-q fluids to be given at home! It's something to do with providing a medical treatment that requires skill and training without formally having that training. There is a rule about that in the US, but it's different when you're treating your own pet as part of a home care plan. And of course some vets think it just isn't fair to the cat - that it's too invasive a treatment for daily use. But if I can get sub-q's into Rosa, who is not an easy cat, on a daily basis...and she actually purrs through them then I think that 4 or 5 minutes of possible slight discomfort is more than made up for by the other 23 hours and 55 minutes in every day where they feel well. I am glad for Rosa's sake that we moved here before she was diagnosed because our old vet was very old school. My parents' dog went through kidney failure after I moved here and all they were really offered was the option to feed her a chicken and rice diet instead of commercial dog food. No fluids, no meds - and I know that's the sort of thing they'd have offered for Rosa too!

The real issue I have with a refusal to offer something like that is that, in places like the UK where they're not offered as a standard treatment, only the most informed owners who have done their research will ever ask for them. And those owners are going to do everything they can to make it as pleasant an experience for their pet as they can. Maybe some vets will never want to directly offer some treatments, but they should at least be open to the idea when people ask about them.

 

wow--this is disturbing news to me....
feeling grateful for my vet!!

 

<Shudder>

My health is so poor right now that I am not capable of actually typing the lengthy rant deserved by several vets who, over the years, have failed my beloved companions and, in some cases, completely betrayed the trust I - mistakenly - placed in them; on two occasions with fatal consequences.

There aren't enough feathers to spit.


Mogs
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I guess I'm lucky the the 17 year old with the mild CKD is eating and drinking well - I don't hink he has issues with acid. He has a number of other health issues, which in all honesty are likely to take him out sooner than CKD (probably the carcinoma). If it came to the point of giving subcut fluids and a multitude of medications, I don't think I would do that. Comfort cares only for this old guy (other than the thyroid meds).

 

I understand completely Mogs. I kept trying to tell my parents that there were other things...that they needed to ask the vet for specific treatments. But the vet just wasn't receptive to ideas. It infuriates me - they lost the dog just a few months after diagnosis and I KNOW there were things they could have done to help if the vet hadn't been so set in his ways. Then again, this was the same vet that took months to diagnose Rosa's bladder stones because she's female and was the wrong age to have them...he's probably lucky I don't live there any more because know I know her CKD is at least partly caused by a kidney stone that no doubt showed up around the same time, I'd have to be restrained from doing him some real damage!!

 

I think setting your own limits is reasonable. My limit - and I've known it from the start - would be if I had to assist feed for more than a few days for illness recovery. Rosa would hate it long-term and I couldn't do that to her for longer than an immediate support situation because that alone would hurt her quality of life too much. The fluids - she accepts fairly willingly, so I can do those. The meds...some days she gets all of them and some days she manages to spit out a pill or shakes her head at the wrong moment and we lose some phosphorus binder. Some days we try again with the same med - some days she's just too antsy to swallow a pill. You do what you can and work with what the individual cat can tolerate.

 

I'd be on the sidelines cheering you on!


Mogs
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I've come to the very same conclusion about Saoirse's care. I know in my heart of hearts that prolonged assist feeding would make her miserable. Not an option.




Mogs
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It's very difficult to set hard limits Mogs, but I have discussed it with our current vet (thankfully much more useful than our old one) and Rosa's IM specialist and we reached the conclusion that, for Rosa's sake, we have to draw a line somewhere that we will all agree not to cross. If it ever reaches the point where I'm doing things for me and not for her, then everyone involved has promised to tell me that I've crossed that line and I need to think carefully. And, for me, even though it will be a sad day when we do reach the limits of what we can reasonably, I can take some comfort from knowing that we're definitely nowhere near that at this point and that I will know, deep down, when we're getting close.

 

It's an awful job to be responsible for making those ultimate decisions. I've always been of the thought that if my cats are not happy (ie: not eating), and generally unhappy then I will make the call. Sam, my 17 year old has come many times close to crossing that bridge and has lived every one of his nine lives and some. I will spend what it takes to make him comfortable but I'm not going to have him invasively tested or surgery (he does not do well under anaesthetic). If he was younger, maybe, but he's an old guy now. He's still very happy despite the CKD, hyperthyroid (medicated), skin cancer (reduced dose of metacam, due to kidneys, and IM antibiotics to prevent secondary infection). He eats more than the other two cats. Diabetes in remission for the last 18 months and also he only has one eye, due to glaucoma about 6 years ago. This cat is indestructable!

When I had to make the decision to have my dog put to sleep (14-year-old lab) with loss of control of bowel and bladder and gradual loss of hind leg mobility, I did alot of reading on the internet on at what point others also made the decision. I read about a dog wearing diapers who was also deaf and blind, with dementia, not eating and being force fed and hydrated. I did have to wonder to whose benefit was the dog being kept alive!

I guess it's one of those things that when we get out pets, that we prefer not to think about. I know to this day, having my dog euthanised was the hardest thing I've ever had to do for one of my pets.

 

You have 1 tuff kitty!!
When Rico was DX I never thought he would tolerate fluids and internally I decided if he ran when he saw me I would not continue. He accepted it way better than I ever imagined. We have not had acid or other issues until recently and for 6 years he has done amazing with just fluids and not even a special diet as he has always been a fuss butt!
Once again I never thought he would tolerate pills and who knew?? he is ok with it as long as we do it his way which is fine with me.
I know there will be a point when he is "done" I just pray I will know when that day is as his dignity is important to him and I love him too much to let him feel bad and not want me to help him. The day I brought him home he was 11 months and I remember saying "I get to spend your whole life with you"
It still seems like yesterday.... Every morning he is by my side and I tell him I love him first thing At this point I do not regret any treatment for either of them and I pray I am strong enough to never have regrets of being selfish....

 

We use moxxor too!!
Love it !!

 

That, for me, goes too far. Unless it's a very temporary situation - recovery from surgery or similar, once a dog can't be a dog (or a cat be a cat) any more that's when I think we reach the point where we're doing it for us not them. I would like to make it clear that I think it's fine to assist feed on a temporary basis when the chance of recovery to lead a happy and full life is high. And the fluids - as long as they don't bother the animal excessively, I actually don't have a problem with those. But for a cat especially, loss of dignity is a big deal and really shouldn't continue if there's no hope of a recovery.

I had this discussion with our vet as Rosa is such a stressed-out kitty at the vet and had never been one to really tolerate intervention of any kind. Rosa's fluids prescription actually says on it - 50-100ml every day or every other day as long as tolerated by Rosa! As it happens, she tolerates the fluids very well - we have a routine where she's on my lap all wrapped up in a blanket and she actually enjoys the individual attention. None of us could ever have guessed she'd be so good about it all!

Rosa and Regan were just 4 months old when I brought them home. They've been through a lot with me - and even crossed the world with me to be here. And I wouldn't change a minute of it. We do have a special bond and, like you, I hope that when the time comes I can be completely unselfish and let them go when they've had enough.