? (LABS)Chuck has kidney failure

Chuck has been going down in dose pretty quick. A year ago he was on 18 units twice a day and today he's on 6 units twice a day. He's been losing weight pretty quick recently despite getting the same amount of food and having great numbers.
He's down to 9.9 pounds again. Vet weighed him in at 10.0 today. His blood work came back bad. I put the values in his lab sheet along with a chart at the bottom of his lab sheet showing his weight loss.
The vet started him on 120ml sub q fluids once a week. She said to get him low protein food and that if it's down to protein vs phos to pick the lower protein one. She said he's anemic and dehydrated. She also said he's only got about 25% kidney function right now. He gets 4T water in his meals plus 2-5 more in his snacks each day.
I've stopped ALL of his supplements a week or so ago because he wasn't eating all of his food love he used to. Should I start any of them again?
I don't know where to start with dealing with this. I'm going to check out Tanya's site and search the threads here.
Any advice on food choices? He currently eats 9Lives meaty pate (Souper sipper, chicken, and chicken & tuna) with some poultry FF for snacks. He's been eating this for 2 years now.

 

So sorry you have to deal with all of this. I do not have advise just offering an ear and some scritches for Chuck!

 

@StephG I'm so sorry you have a new diagnosis just as Chuck's diabetes seemed to be doing better. Sadly, many of our kitties do develop kidney issues as they get older. The good news is that you've caught it early - although he has raised kidney levels, they really aren't all that bad at all. His phosphorus is raised, so you will want to try to find lower phosphorus foods for him and he may well benefit from a phosphorus binder too. I made a list of low phosphorus, low carb foods based on Dr. Lisa's food list last year, which you can see here https://docs.google.com/spreadsheets/d/1nMBzt57Zi0PcAJ-gSt0NxrTyc3Twi7A0L8o2H2gGkoM/edit?usp=sharing Hopefully something on that list will meet with his approval. The other thing you will want to keep an eye on is his potassium level - cats with kidney issues are often low in potassium and need a supplement. It looks as though there was no electrolyte panel run with the new blood work you have, so that would be something to request at his next appointment.

Personally, I disagree with your vet's words about food. Phosphorus control, especially for cats, is far more essential than reducing the level of protein in their diet. It is phosphorus that hastens kidney damage, and can also cause a cat to feel too nauseous to eat if the level gets too high.

The other thing I do notice is that his amylase is raised which may be an indication of pancreatitis. If you start seeing pancreatitis symptoms, then that may require supportive treatment. There is inflammation evident in the raised protein levels, but that could equally be inflammation from his IBD, so may not be indicative of anything you aren't already aware of.

 

Oh - and as regards the 25% kidney function, that is technically correct. What it isn't is any sort of indication of survival time, or how he's feeling overall. Cats can cope very well with as little as 10% of kidney function, so I would focus less on the percentage of function and more on how Chuck is feeling in himself.

 

First, HUGS! When you're handed that 'kidney failure' note, it sort of knocks your socks off for a bit. I got that for Dakota 3 years ago...he's still plodding along. He has more trouble with his 18 year old joints than his kidneys....yes his has progressed to stage 4, he's lost weight, he's 'boney' but he's still enjoying the same things he's enjoyed all his life.

 

Only have a minute to reply. Thank you for the support.
I also disagree about the protein after reading some on Tanya's site.
Chuck is pretty boney and skinny. Like he was at the beginning of his fd diagnosis. I was trying to put some weight on him for a few weeks now.
Thank you for the food list .That is very helpful. Any guidelines/suggestions on what level of phos to stay under?
I will get labs done again in 6 months. Earlier if we have complications.
Home urine tests show protein in his urine (10 panel human dip strips) but it does with my civvie too.

 

The high total protein tends to indicate dehydration. Are you giving subQ fluids?
As already said, the high phosphorus should be lowered. It should be on the lower part of the range. A high phosphorus makes a cat feel bad and not want to eat.
Also note that the urine specific gravity values obtained via test strips are not accurate at all.

 

He got 120ml yesterday. She said to give 120 ml once a week for a couple weeks to treat dehydration.

 

Will he eat his food if you add water? That will help hydrate him without salt. I used to add as much water as I could to keep Max hydrated. Once a week fluids won’t keep him consistently hydrated. Most cats with creatinine in the 2’s don’t need sub-q fluids if you can get them to drink enough.

I’d also get him checked in about three months but I tend to need to know changes early.

 

That particular spreadsheet only includes foods that are low enough in phosphorus (250mg/100kCal or less) for a CKD cat. If you can find one on the lower end of the range that he'll eat, that's great. If not, then even the higher level foods on the list are OK especially in early CKD.

 

He gets 2 tablespoons water in his two main meals plus 3 tablespoons (1 in his 3 snacks) so he gets about 8-9 tablespoons in a day from his food. Sometimes he doesn't eat one or two of his snacks.
I've increased his meal water to 4 tablespoons. He's not eating as well as he used to but he gets two cans of 9 lives a day plus another ounce or two of fancy feast

 

Thank you.

 

Hi Steph, sorry about the CKD diagnosis, but you’re getting some great advice here! Colin also developed CKD and one of his fav foods was the Whole Earth Duck Pate, kinda high in fat, but very low phos and fairly affordable. I see the Wellness mentioned in the chart @manxcat419 linked. I was told that shortly after Dr Lisa compiled her chart, Wellness changed formulas. HERE is the link to that thread. According to Julia’s chart, most are now too high in phos, so if you decide to try wellness you may want to contact them to verify the numbers.

 

Sorry about the kidney diagnosis. It's even more common for our high dosers. Chuck looks fairly early stage. Neko had it for a couple years. Has your vet ever checked Chuck's heart out? Heart conditions are also common with acros (which we suspect with Chuck) and fluids are counterindicated with heart conditions. Or at best, less fluids spread out instead of a bunch once a week. As much fluids as he will tolerate orally is good.

I agree with the others that addressing the phosphorus is important at this point. If he won't eat any of the "good" foods, you can always get a phosphorus binder to add to his food. Though I would do that under the vet's supervision.

 

She said his heart sounds good but we didn't do any specific tests. I will try to get some samples of lower phos foods to see what he will eat. He loves friskies but that all pretty high.

 

Restrict phosphate intake:
Phosphate restriction is key for cats with CKD so we can either formulate a low-phosphate diet or select an OTC cat food relatively low in phosphorus.
For this purpose, a phosphate content that is < 100 mg per 100 kcal is ideal, especially in a cat with severe kidney disease. This can be done either by feeding a prescription diet (again, these are too low in protein) or having a homemade diet formulated.
In cats with mild or early kidney disease, use of an OTC diet with lower phosphate levels may be used. If an OTC diet is selected, look for one that contains < 250 mg of phosphate per 100 kcal. You may have to call a company for specific information. Fish-based cat foods are often high in phosphorus, so I stay away from these diets for cats with CKD.
I’m sorry for your kit- I’ve had a couple with kidney failure & it’s all too common! It’s so hard to find anything they’ll eat & then add the restricted carbs & phos. is difficult at best! I found this article on my vets website. I hope it helps!

 

Do any of you use famotidine regularly? I know Chuck's appy is "normal" compared to others but it's not normal for him. He used to lick his dish clean every time. Once his numbers were closer to regulation he used to leave a very small amount (maybe an ounce) in his dish and eat it later in the cycle. He always ate his snacks unless he was too scared (I watch a toddler and he's scared of her) to come out.
Anyways, bottom line is he's not eating like he used to and losing weight which is mostly muscle mass. I want to get him eating enough again.
I looked quick to see if YAZ mature was okay to feed but really didn't find a clear answer.
He ate that right before switching to lantus in April 2017. Now he won't touch it. I'm desperate to get some weight on him.
These pics are from Aug 25 weighing 11.2 pounds. He's down to 10 now so he's smaller and even more boney.
ETA: I found YAZ mature on Tanya's site. It seems like it's a low phos food. I might try to convince him to eat it.

 

I used famotidine daily for our CKD cats. 1/4 of a 10 mg Pepcid AC worked well for them. YAZ mature is low in phosphorus, so is OK for a CKD cat (it has to be the mature version though), coming in at around the same DMB phos % as most of the renal prescription foods. However, it's still a dry food. I would continue to give him as much wet food as he's prepared to eat, and just use the YA as a top-up.

 

That's what I was thinking... Give him yaz mature for snacks to give him a calorie boost.
I'm going to see if I can find a can of Whole Earth Farms Grain-Free Real Duck Pate to see if he will eat it.

 

The higher phosphorus levels will contribute to lack of appetite. Getting that under control is the best thing you can do. At this point I also started looking for higher calorie, but low carb wet foods for Neko to try to keep her weight on. Raw food is also higher in calories per volume eaten. There is some debate about whether famotidine is as great for CKD cats as previously was thought. Are you raising Chuck's food bowl?

 

It's on a table that is an inch higher than the stool he sits on. I will try raising it higher tonight. He is eating a little better. I gave him some pepcid last night because he had puked a few times over night while DH was talking care of him.
I'm going to try making a mashed dish for Chuck with yaz mature and some warm water. Maybe that will entice him to eat some and also counteract the dry food moisture issue.

 

I got Colin’s at Petco

 

Can you get just one or two cans? Merrick responded to my email with an awesome email. Pretty impressed by their "Parent support team".
Said they stand behind the product and would refund me if he didn't like it. I hope they do if I can't find it by the can.

 

At the Petco store you can buy it by the can, not sure about the website. Once I knew he liked it I bought it by the case from Chewy.

 

Petco also carries Organix which is low carb, low phos. Colin didn’t like it, but maybe Chuck would.

 

I picked up a few cans of WEF at Petco. Chuck ate it right up! I'm thrilled but we will see how he does after a few meals and then I'll order a couple cases.

 

Chuck got his second round of sub q fluids tonight. It was supposed to be Tuesday but DH won't be home to help so we switched to today.
Somehow I managed to place the needle so the fluid ended up by the top of his legs, not on his chest or behind his shoulder blades. Hopefully it will still work the same way. Does that description make any sense? Trying to describe where the lumps are without confusing anyone and end up confusing myself! Anyways he doesn't seem to hate it but didn't enjoy it. I fed him treats the whole time. I warmed the bag in warm water to around 83° before I started because I read that can help them tolerate it better. I know that's still cold compared to their body temp but I didn't want to risk getting it too warm.

 

Sometimes the fluids end up there. It’s notbing you did wrong.

 

Question about the sub q fluids. My vet gave me a 60ml syringe and butterfly type needles to hook up to it. Then I slowly push the fluids in through the syringe. I don't have IV tubing and I don't hang the bag.
Is that an appropriate way to give them? Or should I be calling and asking for tubing?

 

Yes, that's one of the two appropriate methods for giving sub-q fluids and can be easier if you have a cat that won't sit still. Tubing is the other method and, while it's more commonly used, neither is any more or less appropriate than the other.

 

Okay, thank you. He definitely doesn't hold still so I guess that worked out great for us.

 

Steph, that's what the IM vet showed me when Teasel was so ill this past July. It works well and there's less of a contraption to deal with. You can also regulate the rate of fluid delivery very easily.