OTJ-friendly treatments for CKD

Wiley had a new fructosamine and blood panel this week. The fruc was normal (albeit high end) and his BUN, creatinine and SDMA values indicate stage 2 CKD. The vet really emphasized the need to get him on a kidney diet - i.e., Hill's k/d. I was hesitant since it seems that his diabetes might be in remission, and I wouldn't want to start him on a high carb food now.

In the meantime, I am going to try an OTJ trial. But I wonder if it's worth it if I will might need to change his food...? I have tried to feed him Weruva and he didn't like it- so that food is out. I am still trying other foods that are on the low carb/low phos list with little luck. Any other suggestions for me? Note that his phosphorous level is currently is in the normal range, and he has no protein in urine. Does that mean I shouldn't try a phos binder? Are their other supplements I should think about if I feed him non-prescription diet?

So, I guess I'm not sure what to do. He is definitely experiencing symptoms of CKD (PU/PD/inappetence/constipation), but I'm not sure if I actually need to switch to a prescription kidney diet. I know Tanya's site suggests it. And I realize that it might be better to feed him a kidney diet and succumb to the high likelihood that the DM will return.

Anyone with CKD kitties have thoughts/suggestions?

 

I'm thinking of ordering some of the Hi-Tor Neo. Has anyone tried that food?

 

I have. Rover would eat it occasionally, but never finished a can. It's labelled right on the can and noted on various websites as not a complete food.

Rover would not touch the K/D wet. It is very gummy and sticky. The K/D foods are CKD low protein / high carbs - at least 30% carbs! I found because it was low protein, Rover ate/craved it like candy.

I don't think that the Tanya site necessarily recommends a prescription kidney food diet. It is too low in protein for early CKD, leading to muscle mass loss.

http://www.felinecrf.org/which_foods.htm

With a diabetic cat, most beans stay with the lowest phosphorus, high protein LC they can find and the cat will eat, and treat with a phosphorus binder (can be constipating) when phosphorus gets too high.

 

I would either choose a food lower in carbs and phosphorus, of stick with what you are currently feeding and add a phosphorus binder. More importantly start doing sub q fluids at home to prolong his kidney health.

My ckd kitty is stage 2 We do fluids three times a week, vitamin b complex, extra vitamin b, and benazapril (he has proteins in his urine). So far we mostly kept his food the same but I started getting him bff brand food (he's not my diabetic cat though.... it's too high carb if he was) that is a bit lower in phosphorus. Like your cat at the moment his phosphorus levels are normal. There are foods that are both low carb and low phosphorus.

 

Definitely going to talk to my vet about a phos binder and subq fluids. I've heard that subq fluids are a great treatment but can be contraindicated with heart issues, and Wiley has a heart murmur so not sure if it would be a good option. I definitely think the phos binder is worth looking into since he isn't really liking much of the low phosphorous food I've bought. (I have lots of food to donate!).

In what form do you purchase and give the vitamin b? I haven't done much research yet on additional supplements, so I'm curious!

 

SQ fluids are extremely effective in prolonging CKD--BUT as I recently found out after my 1 was on pred (diarrhea) for about a week and he went into heart failure from the fluids/pred combo..... so please have your vet advise you--his cardiologist has told me if his values rise or he begins having ckd symptoms to give 35 at most at a time (he used to get 100-150 every other day) Your vet will have to see what stage the heart is in--and if he can tolerate fluids at all. It is a tricky balance....
We did start fluids much earlier than is recommended now but it has worked for us-he is 17 now-and now his heart is top priority ...

My other is early ckd and he has been started on SQ--(no heart issue with him)
I have tried Hi Tor and neither my diabetic or other boys will eat it-
They usually like Max cat from Nutro-some of them are 8% carb and pretty low phos-there is a list--I will try to find it-- Phos binders work well-
Both of mine get injectable B12 I got mine from the vet-it was less than 20$ and will last longer than the exp. date.

 

OK--there is a list of low phos and carb but I am not sure how to link it-
@rhiannon and shadow (GA) may be able to assist....

 

Here's a low carb/low phosphorus food list

 

I have the list- thanks!! I've been going down the list for 3 weeks trying to find something he will eat!

I've tried 2 of these flavors and he liked them pretty well but I need to chop it up some, as he tends to prefer pate style or consistent texture. I plan to buy more this weekend. Thanks for all of your tips and letting me know about your guy with his heart failure. Poor guy! I'm so glad to hear that he turned out okay.
Sounds like I definitely need to have a cardiologist consultation along with my vet's input.

 

My ckd boy has developed a heart murmur as well. It's ok to give fluids with a murmur, but not if there's heart failure.

6 weeks ago he was shown to have a low red blood cell count which means boarderline anemia which is common in ckd cats. Vitamin b deficiency is common because of all the extra peeing. This is why I started the vitamin supliments. I'm giving him 1 ml twice a day of
https://smile.amazon.com/gp/your-ac...7557054&returnSummaryId=&shipmentId=D3sVZ1L0H
NutriVed B complex and an additional 500 McG caplet twice a day of vitamin b 12 methycobalamin
https://smile.amazon.com/gp/your-ac...6807459&returnSummaryId=&shipmentId=DWBMRkPCH

Any excess b12 can just come out in his pee.

Then 100 ml 3 x a week of sub q's.

Plus benazapril but you won't need that unless kitty tests positive for proteinuria. We may have to add a high blood pressure med tomorrow.

 

Pred can cause CHF in a cat with a heart problem; combine that with too much fluid and you can lapse into CHF.

Fluids can be given to a heart kitty. If 100 mL is Rx'd, break the dose into 2 portions. Give 50 mL 12 hours apart. Squeaker had RCM, a 2/6 murmur, and pred caused one event of CHF. When he got to the point of Sub-q for his kidneys. I just doses him 50 every 12.

As for B supplements. You can use human B12 but need to look for sugar free and it should ideally be methylcobalamin rather than cyanocobalamin. The system has to convert cyano into methyl before it can be metabolized. Additionally, there is concern about the cyanide in the cyanocobalmin form. You would also need a B Complex. The standard dosage for both is 1/10th of the human dose. Many people use Yarrow B Right for kidney cats but when I was checking it out for Squeaker that product did contain sugar. So I just went to the health food store and bought plain B12 and B Complex to use.

If you are starting sub-q, the least expensive place to get needles is calvetsupply.com. The Terumo UTW are the preferred needle. You can get different gauges, they run about $8.59 + shipping for 100. http://www.calvetsupply.com/product/1857/Syringes_and_Hypodermic_Needles

 

Are you cutting pills and pilling him? Or is there a powder version that can be made into a slurry? Or a liquid? Thanks - I'm super new to this!

 

I get b caplets and open them and sprinkle it on the food. My b complex is a liquid I also mix into food.

 

On Facebook you can look for the group Cats with Chronic Renal Failure.... They are super helpful and will look at the lab reports and give advice

 

I understand--I opened 6 cans this morning

 

Super helpful- thanks!

I am looking them up now. Again thank you!

 

I very much regret putting Keno on Hill's k/d. It is so high in carbs - 35% and it made her BGs very high.

I have a phos binder and will use it if I can't get her regulated on something low phos because the binders bring their own set of issues like constipation. But I'm hoping I won't have to use it.

 

Been looking around today and online and haven't found one without sweetener. Some have stevia or sorbitol...I assume we don't want any sweetener/sugar at all? Do you mind sharing which brand you use?

Do you mind me asking which brands you use for the caplets and liquid? The links you posted don't work- they are trying to open items that are on your Amazon order history so I can't see/open them.

Have you had any luck finding some low phos foods she likes? I'm still on the hunt, although Wiley seems to like the Max Cat so far - and I've been feeding him Wellness for years, so luckily the Wellness Core Beef, Venison etc one is on the list. I stocked up on those today. He loves FF and I think he's bummed I've stopped giving him any. I'll probably look into a binder soon. Did you get one from the vet or just online?

 

Finding food that Keno likes is not an issue - she likes everything. But she is sensitive to food changes and we had a bad experience with Weruva - it raised her BG even though it was low carb. So I have to go slow when switching foods.

I ordered this phos binder on the recommendation of someone from the Facebook CKD group. http://www.thrivingpets.com/index.php/review/product/list/id/1337/

 

Thanks so much for sharing!

 

Oh sorry didn't realize that wouldn't work. I use Nutrived liquid b complex NutriVed B Complex Plus Iron Liquid but that one has sugar....

but the caplets of b12 should be fine.


Vitacost Vitamin B-12 Methylcobalamin -- 500 mcg - 300 Capsules https://www.amazon.com/dp/B0046IET7C/ref=cm_sw_r_cp_api_Qv65xbS7726TF

 

Please come to the Facebook group Cats with Chronic Renal Failure... I know they can help you.

 

Zobaline B12 methylcobalamin is suitable for diabetics (available online). I think some people use the Vitacost brand of B12 but you'd need to check the ingredients or wait for another member familiar with it to post more details about whether it's OK for all your kitty's health issues.

With FD & CKD kitties there is some question over how much to give as one study raised concerns about potential negative effect on the CKD side of things. If you go to Tanya's Site for further info and ask one of the well-respected specialist CKD support groups online they should be able to give you good input on this. Talking of which Tanya's Site has a support group plus there's also a CKD group on Yahoo (don't know whether or not the latter may be affiliated with the Facebook group). Here's the link for the Yahoo group:

https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info


Mogs
.

 

I had to buy Solgar brand at my local health food store. It is plain cobalamin but did work well for Squeaker. Both the B12 and B Complex Solgar brand were the only ones I could find that did not contain any sweetener.

 

Regarding the Solgar brand B Complex- do you get the capsules? If so, how much do you give each day?

 

Yes, the capsules. Dosage is 1/10th of a capsule. You have to open the capsule and do as well as you can to break it into 10 doses. A real pain, but if you keep the empty B12 caps you can store the B Complex doses in them.

 

You can also buy empty capsules online - thrivingpets.com has them. The sizes for cats are 3, 4 and 5, with 5 being the smallest. For the above issue, you'd probably want 5s. I keep all three sizes on hand, as they're great for putting tablets into before pilling - goes down easier and doesn't dissolve in the mouth. If you're giving several meds, you can often fit two or even three in one #3 capsule. Makes life much easier!

 

Thanks Tricia. I am thinking of adding it to a liquid slurry that I am starting to syringe feed him that already includes a small amount of Pepcid AC. I do like the small gel cap option if I decide to start pilling him. Thanks for the size info!

 

Hello Janet - Are you or anyone you know in need of Sub-Q fluids (Lactated Ringer's Solution)? My cat of 19 years passed away last month after 3 years of receiving the fluids. I now have 10 bags remaining of Braun's 1000 ml Lacated Ringer's Solution (Expiration Dec 2017). I'm unable to return them to the manufacturer and I'm hoping to find someone who can use these. Thanks.

 

Yes I'm still using them.

 

I am using Lactated Ringers now, as well. Although I have yet to really be successful at giving the fluids. Wiley refuses to sit still. (And I thought treating diabetes was hard - Ha!)

 

Giving fluids while the cat is eating helps. Holding cat between your thighs while kneeling on the floor facing a corner of the room worked for one of my cats. Also, a long IV admin line gives you some leeway with "travellers."

 

I found the best way to keep my cat still was placing her in a small box with a towel inside to rest on. Within the confines of a box, she was much easier to keep in place and it just became part of the process.

 

The method I used for Squeaker was: when I had him in the area where I had the fluids set up I would pull a towel around his chest, pull it up over his back (leaving scruff accessible) then I would tuck it around his behind.

Just a bit of advice. You can get Terumo UTW Needles for under $10 per hundred, a variety of gauges at http://www.calvetsupply.com/category/s?keyword=needles

You can purchase the EZ IV Harness to help with unruly cats: http://www.ezivharness.com/

If you need to give lesser amount of fluid mark the bag with an eyeliner pencil at the appropriate level then when you are done wipe the mark off. It is not advisable to mark the bag with a Sharpie or pen as there is concern about the ink leaching through the bag and into the fluids.

 

Thanks -I tried both of these methods and neither worked. He ignored the food, which isn't a surprise because he has never been food motivated, nor has much of an appetite lately. In trying to hold him, he freaked and ran - pulling the needle out in the process. This happened four times. He even bit my partner who was helping and he never bites.

I'm thinking I'm going to need to put him in his carrier in order to give the fluids, which I hate to do since he hates being confined. I just don't know what else to try. I wish he understood that I am just trying to help him.

 

Thanks for the tips. I am totally looking into that EZ IV harness!!