Phosphorous binders

Discussion in 'Feline Health - (Welcome & Main Forum)' started by lenistar, Feb 21, 2012.

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  1. lenistar

    lenistar Member

    Feb 5, 2012
    Hi everyone,

    Does anyone have experience with phosphorous binders, specifically with Renalzin? The safety, side effects, effectiveness, etc.?

    Moritz's latest blood test showed that his creatine was almost too high. This could be due to an infection (a possible infection was also indicated in the blood test), but to be safe, I'm considering things that might support his kidneys.

    Thanks so much!
  2. SonnyB

    SonnyB Member

    Feb 9, 2012
    We had good luck with Chitosan, which is the active ingredient in Epakitin. Our vet prefers it and said the only real difference is price. We used it, along with sub-q fluids for several months with our angel, Worf.

    There are others, some not as easy to find. For some reason aluminum hydroxide rings a bell, but I'm not certain if that was it.

    Good luck!
  3. Lisa dvm

    Lisa dvm Member

    Dec 28, 2009
    Phosphorus binders do not "support" kidneys and do have side effects. They should only be used when necessary.
  4. lynda and scruffy (GA)

    lynda and scruffy (GA) Member

    Dec 28, 2009
    Dr. Lisa,

    Can you expand on your comment about phosphorus binders? Scruffy's got lymphoma - currently supposedly in remission - and his last bloodwork, on 2/16, was:

    BUN 138 (range 15-34)
    Creatinine 6.0 (range 1.0 - 2.2)
    Potassium 4.5 (range 2.9 - 4.2)
    Ionized Calcium 1.60 (range 1.2 - 1.32)
    Phosphorus 10.1 (range 2.6 - 6.0)

    Aside from fluids (he also developed a heart murmur at the same time he got all this other stuff), what alternative treatment is there to deal with these numbers? Since we accidentally discovered a high total calcium level in January, every blood test (done weekly) has gotten worse. Two weeks ago, ultrasound showed that the tumors in his liver and spleen were gone after three chemo treatments, and the ICa went back into the normal range at 1.31, but the phosphorus level was still 10.1 That lasted exactly five days, when the phosphorus level went to 10.4.

    I have aluminum hydroxide, miralax, azodyl, and low phosphorus foods, prescription and regular. And desperation......
  5. Lisa dvm

    Lisa dvm Member

    Dec 28, 2009 time to type much but with a phos that high, binders are warranted.
  6. Julia & Bandit

    Julia & Bandit Well-Known Member

    Dec 28, 2009
    One thing that wouldn't hurt before binders is switching to a kidney-friendly diet--phosphorus binders should really only be used as a last resort once the cat has gotten super picky with food.

    Take a look at my response in this thread for food selection tips:
  7. Lisa dvm

    Lisa dvm Member

    Dec 28, 2009
    I realize that "kidney friendly" means different things to different people so understand my comments below refer only to the Rx diets:

    I am sick to death over watching cats starve to death on low protein Rx "kidney" diets. This is a topic that I hit on very heavily during my CKD phone consultations. I do not - and will not - ever use the Rx "kidney friendly" diets except in very rare cases since I don't find them to be terribly "friendly" to the rest of the cat's body.

    I don't mean to be nasty here but it seems as if many of my colleagues have forgotten their second grade math as it pertains to HYPOREXIC cats (diminished appetite).

    Diet A = 20% protein

    Diet B = 40% protein (Note that most vets will gasp at the thought of feeding a CKD cat 40% protein but, again, they have forgotten their basic math.)

    If a cat is going to eat a good amount (say, ~6 ounces give or take) of Diet A at 20% protein, he will probably meet his daily need for protein.

    However, if he slows down to, say 3 ounces per day, he will end up protein malnourished when eating diet A yet so many vets stick to their guns with these low protein diets and forget that:

    6 ounces of a 20% protein diet = 3 ounces of a 40% protein diet - in terms of daily protein intake.

    Basic is the absolute grams of protein ingested per day that is critical.

    I don't agree with this statement because it is not taking into account the patient's serum phosphorus level. Some cats, even when eating low phos diets, still need binders. I don't like to see the phos over 6.

    DISREGARD THE (typical) LAB'S REFERENCE RANGE....which is notoriously inaccurate when it states that it is ok for a cat's phos to be up to 7 or 8 like many ref ranges state.
  8. Julia & Bandit

    Julia & Bandit Well-Known Member

    Dec 28, 2009
    I was not referring to a prescription kidney diet as kidney friendly but rather a low phosphorus, low sodium diet with a high quality protein source (as indicated in the linked explanation)--either raw or commercial. I've read that low protein diets have only shown to be beneficial in end stage renal failure, and should not be fed long term because they can cause muscle wasting in cats.

    As for phosphorus binders, it's been my experience (but I've only observed perhaps 4 or 5 cats progress through CKD so I don't have the same amount of experience as a vet) that they tend to be needed once the disease has progressed to the end stages, which is usually when the cat begins to refuse food. Kidneys in early stage kidney disease will likely still excrete phosphorus and a binder will not be needed, while cats in later stages will have higher levels because the damaged kidneys cannot excrete phosphorus from the body as well. Since the original poster does not seem to even have a diagnosis of renal disease and does not mention an elevated phosphorus level, I'm assuming the phosphorus levels are not so high as to necessitate a binder and a low phosphorus diet alone is appropriate.

    Elena, the section on phosphorus on Tanya's CRF page is very informative if you want to learn more about it:
  9. Lisa dvm

    Lisa dvm Member

    Dec 28, 2009
    And herein lies the conundrum: Advanced CKD cats have a low appetite. Feeding low protein diets to hyporexic cats defies the second grade math discussed in my previous post.

    This is what I am fighting among my colleagues. Julia - you are absolutely quoting correctly that the Rx renal diets are being pushed on advanced CKD cats but that is what I am strongly challenging.

    There needs to be a serious paradigm shift in this way of thinking otherwise, we will just keep watching our advanced (and even earlier) CKD cats waste away and die.

    On a very good note, I am heartened to read threads on the FDMB showing that YOU GUYS GET IT!! More than the mainstream vets....

    This is not exactly how I would word it.

    Some people are under the mistaken impression that PBs can chase down phos that is already in the blood. It does not work that way. That is like closing the barn door after the horse is gone. PBs work by binding the phos in the food and are worthless otherwise. I had to remind a colleague of this when he was having his client use oral PBs (ALOH) on an anorexic cat. He thought that it would help lower the serum phos....completely misunderstanding how PBs work.

    All very true but my point is that sometimes people wait too long before using binders and also don't understand how they work. For instance, they try to cram a bunch of binders (the daily amount) into a small amount of food...that this advanced, hyperphosphatemic CKD is barely eating....completely missing the point of how they work. ie...the less food a cat is eating, the lower amount of binders are needed.

    I agree. That is why nobody can comment on the OP's specific question without more information.

    Also, given that aluminum is toxic, I do try to hold off on ALOH as long as possible but when to start is dictated by the serum phosphorus, not necessarily the diet. (Of course, it obviously makes sense to start by putting as little phos into the body as possible by feeding low phos diets.)

    My gripe is that I can formulate homemade diets that are very healthy (using MEAT, not grains) and are low in phos..... so I know that Hill's, etc. could do the same thing if they just were not so focused on the bottom line profit margin...and were not so focused on protein starving many of the cats eating these diets.
  10. Karen and Flo

    Karen and Flo Member

    Dec 28, 2009
    I'm very new to this whole phosphorus binder discussion, but Flo, my 20 y/o OTJ (for 3 or so years) girl is now @ vet on IV fluids, with a creatinine of 6.9. This after 24 hours of IV fluids which came after 6 days of 100cc LR sub Q BID, and 2 years or so of 100cc once per day before that. She's been on Wellness grain free canned for years now, and has been doing well on it, save for her kidneys. Dramatic downturn over the last 6 months or so. She had a very bad reaction to gabapentin in July, and I don't know if that did any damage or not. I just changed vets, and he is determined to have her on a "prescription" kidney diet, and wants to start phos binders. He prefers lanthanum carbonate, and was planning to have it compounded from the human drug, when I happened upon the Renalzin website. It appears, however, that it is not available in the US.

    Values from blood draw/urinalysis 2/16/12:
    BUN 119
    Creatinine 6.3
    Phos 10.7
    SG 1.010

    In house 2/22/12 (after almost a week of BID sub Q)
    Creatinine 7.0

    In house from this morning 2/23/12, after 24 hours IV fluids
    Creatinine 6.9
    BUN 77
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