please help, renal failure,kitty wont eat :(

Jewel is 14.5 years old and over the last week, she started eating less and less, then on friday, she just didnt want any food at all. so i took her to the vet yesterday to get all the usual tests done (blood and urine). the vet supsects she may be going into kidney failure, and im just waiting on the test results to know for sure.

she was slightly dehydrated and got subq fluids and the vet hoped that would perk her up and make her want to eat again, however she still does not want to eat. i have tried everything i can think of.

oh and she is a diet controlled diabetic since september and her blood glucose readings have consistently been in the 90-120 range, so she's doing fine in that respect.

please help, i dont know what else to do to get her to eat.

 

Re: please help, kitty wont eat

one option is to have a feeding tube inserted and tube feed her

 

Re: please help, kitty wont eat

the weird thing is, is that she seems like she IS hungry, and will actually meow for her food and be at my feet when i open a new can, but when i put it down for her, she sniffs it and walks away. shes never been a picky eater and ive tried so many kinds of food, even resorting to some awful dry food, but she wants none of it, even tho she acts like she does

 

Re: please help, kitty wont eat

Has the vet tried pain meds or ant-nausea? It sounds like something might make her feel crappy when she eat so even though she wants it, she doesn't have it.
Good luck and prayers she eats and is feeling better and the tests come back ok.

 

Re: please help, kitty wont eat

my first thought was pancreatitis if she won't eat.
You can try to give Pepcid AC 10mg regular strength... cut pill in 4 and give 1/4 twice a day. Daily max is 5mg for cats.
Also your vet can do fPLI test for pancreatitis.
You can ask the vet about trying an appetite stimulant.
You can get a syringe at the pharmacy and can make food watery enough to be able to syringe some food into her mouth.

 

Re: please help, kitty wont eat

i just got off the phone with the vet, and her kidney is very damaged and she is in renal failure. he suggest IV fluids to possibly help, but unfortuneately i dont have the $1000 to pay for that.

i'm so heartbroken right now

 

Re: please help, kitty wont eat

http://www.houseandhome.org/cat-health-problems

 

Re: please help, kitty wont eat

I am so sorry. Love her all the time you've got. cat_pet_icon

 

Re: please help, kitty wont eat

I'm so sorry.
I know a lot of people on the board give fluids themselves to their cats, saving a great deal of money. I've never done it but you may be able to get help with it. Change your heading to help with giving fluids-renal failure and use the 911 icon so one of them sees it.

Melanie & Racci

Edit: This link might help also: http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=1123

 

Re: please help, kitty wont eat

thanks everyone! i just got back from the vet and they showed me how to give the subq fluids at home. didnt look too hard, so hopefully it goes smoothly when i give it to her tomorrow.

im going out to get her some pepcid right now too, so hopefully both that and all these fluids will get her eating again.

she ate a little bit of tuna and some shredded chicken this morning, but not much. but she did have about 10 cat treats tho. my vet said, just feed her anything she will eat in the meantime, just so she gets food in her, and then we'll talk about a special diet once shes feeling better.

i might try the syringe feeding that someone mentions, if she doesnt start eating soon. she needs food!!

 

Did the vet mention anything about the medication Fortekor that sometimes are given when renal failure?

 

yes, he did mention some medication (which i cant remember the name of) to help the kidneys, but he wants to wait till she starts eating a bit more

ive given her some chunky food with gravy and she's licked out all the gravy, so its a start

 

Hi Jewelsmom!

Did the vet tell you any of the blood work numbers related to the kidneys? Especially creatinine and bun? Can you get those numbers from the vet and share them with us?

More to come.... :mrgreen:

 

There is a WONDERFUL resource on feline kidney disease/chronic renal failure. Please take some time to look at this site, and join the yahoo group (they saved my kitties life...and many others!!):
http://www.felinecrf.org/

THere is a difference between kidney failure and chronic kidney disease. Kidney failure is life threatening and needs to be treated aggressively. With the proper tx a full recovery is possible! Kidney disease is a progression. There are things you may need to do to slow the progression and keep them comfortable. Neither is a death sentence.

My Latte went into full renal failure due to a medication called metacam. She had a creatinine above 10 and BUN was off the chart (unable to record). I was told she would not likely survive. They offered a few nights in the hospital with an IV, but told me it was grim. Of course I agreed to the hospital (I am not rich!!!) and then found Tanya's CRF site and the yahoo group. With their help I learned how to get the proper tx and help her fight. It was touch/go for a few months. Eventually her creatinine went down to between 2.0-2.5 for the remainder of her life (3.5yrs more!!!! :mrgreen: ). She did not pass away due to her kidneys, either.

So, I just wanted to offer you some hope. Get a copy of the labwork from your vet. Read over Tanyas site, join her support group on yahoo and talk to people. Many folks here have experience with CRF/CKD and can also offer a great deal of knowledge and support. There is also an assist feeding support group on yahoo. I will come back with links to the site. They are very resourceful.

hang in there!!!

 

Feline Assist Feeding Group:
http://pets.groups.yahoo.com/group/Feline-Assisted-Feeding/

Tanya's CRF group:
http://pets.groups.yahoo.com/group/tanyas-crf-support/

You will have to submit a request for each group and await approval from the list owner. Neither of them took even 24hrs to approve my 'membership'. Just so you know there may be a slight delay before you can post.

 

i was quickly writing down the numbers as the vet told me, so im too too sure of what is what. and keep in mind that im in canada, so im not sure if the units are the same elsewhere. well i dont even know the units, sorry! but heres what i have. i'll also give the normal ranges that he told me, so maybe someone can help me to figure out what is what based on that

for 'waste' as he called it, was at 47.2 (norm 5-12)

another 'waste' value was at 744 (norm 83-181)

phosphorous (i know one of them!) was at 4.67 (norm 1-2)

and lastly red blood cell count was at 6.1 (norm 6.3-10.8)

sorry! this is all i have for now and my vet is closed for the day. i meant to ask for a copy when i was there, but i was so overwhelmed with everything that i forgot.

thank you for the website links, i will definitely be checking them out

 

thank you SO much for saying this. i know shes sick and its a battle, but its very encouraging.

i was just talking to my cousin, (who also has lost cats due to illness) thinking that she would understand, and she said i should just put jewel down right now. I WILL NOT. i want to at least try to help her and make her comfortable.

but then again, this is the same cousin who told me to put jewel down when she was diagnosed with diabetes cos its not fair for the cat and to make her suffer. huh?? i should know better than to even talk to her about this

 

Hi Jewelsmom,

It sounds promising that she's eating a little and you were able to get the fluids. Between the groups Carolyn suggested, the links for research, and this board, hopefully you'll have Jewel doing fine in no time. I hope you can stay home with her for a few days until she's feeling better. Good luck!

I'm usually able to coax Racci into eating off my fingers by sitting next to her on a big ottoman with a towel under us and making her food very watery and putting it right in front of her face. If I can't talk her into it, I'll syringe a few into her and then she usually will start eating. I also give treats in between telling her how great she is and offer water also. Sometimes baby food will work too. I make a big fuss about how yummy the food is. :lol: Maybe some of that will work for you.

Your cousin is wrong. You can do this.


Melanie & Racci

 

Here is what I am guessing....waste is usually BUN and Creatinine. Looking at Tanya's blood work section http://www.felinecrf.org/diagnosis_test_ranges_factors.htm I would suspect these are approximate conversions:

BUN 132
Creatinine 8.4
Phosphorus 14.4

These are pretty high numbers. Your cat would most likely benefit a great deal with a few days on IV/hospitalization. If this came on suddenly ( no detection of kidney disease prior), then it is probably acute kidney failure. The best tx is immediate and aggressive. In the meantime, if all you can do are fluids...then do it!

The high BUN and Phosphorus is what is making it difficult for your cat to eat. Jewels is very nauseated. I would talk with your vet about starting pepcid ASAP. Also a phosphorus binder. Keep up with fluids, and make sure her potassium levels are dealt with if low/high. There are a lot of other things to be done, but those would be the most basic and very important place to start.

Keep feeding ANYTHING she wants. I sat for a week, all day, everyday with Latte. I brought her buffets. Dozens of types of foods (unfortunately this was during the big recall, too), yogurt, tuna, salmon, boiled or rotissarie chicken, whip cream, catsure, kibble, treats, baby food, ice cream.......and the list goes on! :lol: She usually just drank the gravy from pouches and ocassionally took some licks of whip cream or baby food.

Raise her food and water bowls in case she wants to feed on her own. This will help reduce acid reflux when eating, which makes them nauseated and stop in their tracks. The pepcid will help with that as well.

Again, IF my conversions are right (I will ask some others from Canada to come take a look), then it would be a good idea to get Jewels to the hospital for a few days. In the meantime, keep doing the best you can, read Tanyas site, ask the yahoo group for guidance, and love on that girl with all your might. I am a firm believer that love is a big healer. :mrgreen:

What country are you in?

 

A tip for subQ fluids: warm the bag in some hot water, do not microwave. The warm (not hot) fluids were easier for Grey (GA) to take. Other than getting stuck, she enjoyed the fluids. I think the warmth was soothing to her.

Strangely enough, Greek yogurt was the only thing she would eat on her own. I syringe fed everything else wearing a snuggie.

I purchased a Baby Bullet blender to further grind up her food. That made syringe feeding so much easier! Why oh why, when anorexia is common with CRF, is Hill's K/D in a chunky formula?!

 

hi carolynandlatte!

thank you for all your suggestions. unfortuneately at this time, i cannot afford the hospitilization with IV fluids, so the best i can do is the subq fluids at home.

i like how you call it a 'buffet' lol that is definitely what jewel is getting right now, so many different kinds and flavours of food everywhere! she seems to like the gravy the best and occasionally some tuna. she actually went absolutely crazy, when i opened up the tuna can, howling and climbing up my leg to give it to her lol but then once the tuna was in front of her, she took 2 licks and walked away.

she does like to be spoon fed, so every hour, i come to her with food, she doesnt eat much, but at least its something. i gave her some pepcid a couple hours ago, so hopefully that helps too.

and i noticed that she has eaten about half of a 57 gram thing of shredded chicken since this morning, so thats good to see!!

i'm in canada, by the way

 

the phos is pretty high and yes Carolyn did convert them right.

can you get her into the hospital even for a couple of days?

make sure the fluids are absorbed before you give more....if she is dehydrated you will see the pouch disappear....

you will NEED to get a binder in the food....the phos at that level is preventing her from eating...

I know here in Canada they don't have Aluminum hydroxide....the vet most likely will give you some Epikitin....can you pm me and give me your address I will send you some aluminum hydroxide

i know others have benefitted from keeping their kitty in the hospital with the iv rather than subq fluids...

 

Just wondering-
Did the vet do a Urinalysis on Jewels? Xrays? Ultrasound?
Curious if an infection could be the cause to this. Something in the urinary tract could be detected via urinalysis and treated with antibiotics. Unfortunately kidney infections are difficult to diagnose. If suspected, a very long round of a/b's is often given (about 6-8 weeks).

Did Jewels eat anything different or new?

Medications?

Was CKD a condition she already had?

Here is a link to information about ARF (or what I guess is now called AKI):
http://www.felinecrf.org/acute_kidney_injury.htm

It might be good to ask your vet about another antinausea medication. Ondansetron is a popular and effective choice. Cerenia is VERY useful for vomiting, though I think a lot of people are now using it for just nausea. Latte received ondansetron 2x/day, cerenia when needed, and pepcid 2x/day.

Thanks Claudia (and Rocket)!

 

make sure you give the 1/4 pepcid ac every 12 hrs at least it will help with the acid in her system

 

Renal failure cats are on pepcid most of the time. It helps mellow the tummy out but will not deal with the nausea caused by renal failure. Showing interest in food and licking/smelling and walking away is classic nausea for a cat. Vets in the US are learning but most don't know about feline nausea treatment. The best is to get a script for Ondansetron - it can be purchased for $1 per 4mg pill from thriving pets online. Each 4mg pill is four doses. (Cerenia is good for acute vomiting but not general nausea, metoclopromide is good for dogs nausea but not for cats unless the nausea is due to stomach motility issues - vomiting food many hours after consuming food).

Don't throw an appetite stimulant in the mix without 100% covering nausea or you will be setting yourself up to deal with possible long term food aversion. Like taking one yourself when you are nauseous with the flu.

There is a board dedicated to helping owners assist feed their cats... the Yahoo Feline Assisted Feeding Forum. There is a video on the home page of a kitty being syringe fed. You will also be sent an autofile on how to go about assist feeding.

The reason you have to assist feed a cat is due to their biology. Cats livers are horribly inefficient at processing body fat for fuel - when they have to make up for a calorie deficit. Their livers clog with fat and cause liver failure. This can happen very quickly - in days with an anorexic cat, or in a few weeks with less than normal calories. So it is critical that you help your cat maintain their weight. CRF cats often have bouts of inappetance. There are a lot of CRF cats and owners on the FAF site. Carolyn has pointed to the best site for CRF information and support. They will give you help on food choices for a kidney cat, but you have to get the calories in to avoid dealing with Feline Hepatic Lipidosis on top of the kidney issues.

Assist feeding takes a lot of forms - feeding on a spoon, finger feeding with dollops of food, syringe feeding, help for hesitant eaters, feeding tubes.

Hang in there. You are in good hands.

 

Renal failure cats are on pepcid most of the time. It helps mellow the tummy out but will not deal with the nausea caused by renal failure. Showing interest in food and licking/smelling and walking away is classic nausea for a cat. Vets in the US are learning but most don't know about feline nausea treatment. The best is to get a script for Ondansetron - it can be purchased for $1 per 4mg pill from thriving pets online. Each 4mg pill is four doses. (Cerenia is good for acute vomiting but not general nausea, metoclopromide is good for dogs nausea but not for cats unless the nausea is due to stomach motility issues - vomiting food many hours after consuming food).

Don't throw an appetite stimulant in the mix without 100% covering nausea or you will be setting yourself up to deal with possible long term food aversion. Like taking one yourself when you are nauseous with the flu.

There is a board dedicated to helping owners assist feed their cats... the Yahoo Feline Assisted Feeding Forum. There is a video on the home page of a kitty being syringe fed. When you register you will also be sent an autofile on how to go about assist feeding.

The reason you have to assist feed a cat is due to their biology. Cats livers are horribly inefficient at processing body fat for fuel - when they have to make up for a calorie deficit. Their livers clog with fat and cause liver failure. This can happen very quickly - in days with an anorexic cat, or in a few weeks with less than normal calories. So it is critical that you help your cat maintain their weight. CRF cats often have bouts of inappetance. There are a lot of CRF cats and owners on the FAF site. Carolyn has pointed to the best site for CRF information and support. They will give you help on food choices for a kidney cat, but you have to get the calories in to avoid dealing with Feline Hepatic Lipidosis on top of the kidney issues.

Assist feeding takes a lot of forms - feeding on a spoon, finger feeding with dollops of food, syringe feeding, help for hesitant eaters, feeding tubes.

Hang in there. You are in good hands.

 

she had xrays and an ultrasound about 6 months and there wasnt anything abnormal at all. urinalysis was done this time and other than it being quite dilute (low specific gravity?? i didnt get the number) there was no presence of bacteria or anything else

she's on no medications right now and the vet didnt want to give her any until she starts eating more.

i was told 6 months ago when she had blood tests, that her kidneys were starting to decline but didnt get any values then, so i dont know how bad they were. but the vet didnt seem concerned at the time and never suggested any treatments or preventative things to do for it, so i figured it was okay.

she's not been vomiting at all since this started. i cant even remember the last time she puked, so its been a long while.

she's eaten some more tuna and chicken pate with gravy. probably about a couple of spoonfuls. and a little bit of cheese. she loves cheese

 

Jewelsmom (Sorry, I didn't see what your name was) -

I have a bottle of aluminum hydroxide powder (which is what you use to mix in with the cat's food to bind to the phosphorus and get it out of the body.) It was shared with me when Scruffy was diagnosed a month or so ago, and I would be happy, in the name of Maddie and Meowzi and Scruffy, to offer it to you for Jewel. I see that you're in Canada - I wouldn't expect that it would be a problem to mail across the border. It can also be ordered from Thrivingpets.com - I think the price was only around $10 US, but I don't know if they ship to Canada.

Scruffy never lost his appetite, but he was frequently nauseated, I judged by his lip-licking and the appearance he gave occasionally of being hungry but unable to eat. I gave him 1/4 of a 10mg Pepcid AC tablet every morning, and he also got 1/8 of an ondansetron (zofran is the US brand name) pill twice a day. He never stopped enjoying his food, although the low phosphorus foods (Tanya has a great list on her website) are the opposite of what we've been feeding our diabetics - everything has gravy and carbs.

There is a Yahoo group for phosphorus management, in addition to Tanya's site and the Yahoo CRD website. It wasn't heavily used, though, and although I read whatever they posted, I didn't post myself. There seemed to be a lot of people on the regular CRD/F boards who had been able to maintain their cats for years and years.

If you would like to have the AH, PM me your address and I can get it in the mail to you tomorrow.

 

thank you for the offer lynda and scruffy i will pm you my address

i really appreciate the support and kindness offered to me here. thank you all so much <3

 

just a little update: i gave jewel fluids today for the first time by myself (the first 2 times were at the vet), other than having to poke her twice because she started squirming and the needle came out, i think it went okay. i think she was more upset that i got water all over her fur than having to poke her twice lol. yes, i used a brand new needle, for the second poke.

last night, i made up a 'kitty shake' in the blender for her, and syringed food into her mouth. she was actually pretty eager to take it, and ate the rest that i left out for her, sometime in the middle of the night. i left out a smorgasbord of food for her while i was at work today, and it appears that she took little nibbles of everything. not much, but some, so its a start. im still assisting her with the feeding tho, till she turns into a monster again and wants to eat everything in sight :lol:

she is starting to perk up some more and doesnt seem as lethargic. and shes getting more vocal again. she's always liked to meow alot. i'm pretty sure she does it on purpose, just to drive me crazy, but ive come to learn what the different tones of meow mean. the 'im in pain' meow is very different from the 'im bored, play with me' meow. the former, will make jump out of bed in a heartbeat. but since she stopped eating and wasnt feeling well, she pretty much ceased all the meowing. thats one of the things that made me think something was initially wrong. i've never been so happy to hear that super loud 'im bored' meow that normally drives me insane.

i know its still an uphill battle, but slowly, but surely, we'll get there. thank you all for your support, it means so much <3

 

Good news! Hey, another thought since it worked for me a few times, how about some catnip sprinkled on the food?

 

Fantastic news! The fluids are pretty magical and certainly do help a great deal.

I have one thing to mention....

What size of needles do you have for the fluids? I ask because most vets give you a size 18ga and they are pretty big needles, so they may feel uncomfortable for Jewel... Can you ask the vet to give you smaller needles? I always ask my vet for size 22ga UTW (22 gauge ultra thin wall) because both of my cats do not like the larger thicker needles.
My Shadoe, if I don't watch closely, will try to slink away on her belly if I use the 18 ga, but with the 22ga, she is content to sit still .... the fluids will take a bit longer to go into Jewel, but if it does not feel uncomfortable, I am sure the longer time is worth it. I spend the time just to sit with my cat and talk to her so it's a bonding time while giving the fluids.

I hope she keeps perking up with the fluids and your syringed food.

 

they gave me 20 guage needles. the needle didnt seem to bother her at all, i think it was more to do with me being kinda nervous and tenting her skin a bunch of times searching for the perfect spot while at the same time, psyching myself up to put it in. by the time i finally got it, she was just annoyed that i already had her there so long and wanted to get away. slinking away on her belly describes it perfectly lol

i'm not sure why i choked, ive given so many insulin shots that i should be used to needles now. i promised jewel that next time i will do it fast. she was rewarded with lots of cuddles tho, so she forgot all about it anyway. but the first time is always the hardest and it only gets easier.

and of ALL the foods in the kitty smorgasbord, she decided the only one she wants is the dry kibble. her diabetes is screaming right now.

 

OK one more thing I recalled.... if you are to give 100cc / day, you may have better luck doing 2 sittings of 50cc and it's not as long plus spreads out the fluids and she won't be slushing around with a couple of big saddle bags of fluids.

ETA: Just how much fluids did the vet say you should give each day, and maybe you can get a copy of the bloodwork from the vet, either email to you or you could pick up a copy? it will help you to be able to look up the numbers for info online.

 

she gets 100ml once a day. i'm only able to get it in her once a day due to work

well some good news, she ate all of the kitty shake that i left out for her while i was at work! hooray! and first the time in about a week and a half, she came to greet me at the door when i got home, so she starting to act more like herself again too.

i got some low phosphorus food for her. the hills one with 0.65% or something phosphorus according to the chart on tanyas crf page. and i dunno if its because shes getting her appetite back, or if she really likes the taste of this new food, but she started chowing down like crazy. shes eaten a quarter of a can so far and still wants more!

 

I actually just lost my girl yesterday to kidney disease, but she was 20 years old, and much further along. I just wanted to mention a few things I learned about too late:

RenalZin is a phosphate binder made of lanthanum carbonate. It is supposedly binds 12 times more phosphorus than aluminum hydroxide (according to my vet, anyway). It's made by Bayer Animal Health, but in Europe. I found it on ebay from a site in the UK. It wasn't expensive, and comes in a pump that you just squirt on top of food and stir it in. It looks oddly like foundation. I'd send you mine, but I donated it to my vet already.
http://www.renalzin.com/9/Cat_Owner/Renalzin.htm
In Canada, you can get the human form of lanthanum carbonate compounded into something you can give your cat. The human drug is called Fosrenol, made by Shire Pharmaceuticals. According to the vet I talked to from Bayer Animal Health in Canada, it's relatively inexpensive to do. It costs a fortune in the US because Fosrenol is still under patent, which is why I hunted down the RenalZin.

Azodyl and Epakitin are both made by Vetoquinol. The former is designed to reduce azotemia, and the latter is another type of phosphorus binder, among other things.
http://www.vetoquinolusa.com/CoreProduc ... zodyl.html
http://www.vetoquinolusa.com/CoreProduc ... kitin.html

Flo was on 2.5mg (1/4 of a 10mg tablet) famotidine (generic Pepcid AC) for years, as well as 1 mg cyproheptadine, both twice a day. Cypro is an antihistamine, but is often used as an appetite stimulant. It's inexpensive, and you would likely only use 1/4 tablet per dose.

Lastly, and I know at least one other person mentioned this, but warming the fluids makes all the difference in the world. Flo kinda thought of it as her little hot tub every night. She seemed to know it made her feel better. And Terumo needles are AMAZING if you can find them. I think mine were 21 gauge, but super pointy and slippery, and really easy to get in.

Best of luck.

 

aaaah thanks for reminding me to warm the fluids. my vet mentioned that too, but i totally forgot. i'm putting a sticky note on the bag right now so i dont forget tomorrow.

i have 20 guage needles with a pointy tip and they go in pretty easy.

i find its hard to tell how much i'm giving her tho cos of the way the bag is. like i dont even know if i gave her enough today. there didnt seem to be a big hump, like when the vet does it. i know something must be going in her cos i could see it dripping down through the tube and the bag is getting less full and there wasnt any water anywhere.

 

Make sure you run some fluid through the tubing until you get to the warm stuff, then use a Sharpie to mark the bag where the next 100 cc mark should be. It was always an approximation for me, because I rarely stopped or started right on one of the lines, and just eyeballed it. I don't think it has to be perfect. It's possible the vet gave her more than 100 cc, but I think Flo generally got a lump. My vet says he has most of his kidney cats getting 200+ cc per day. Of course each cat is different. I was really nervous giving 200 at a time, and sometimes chickened out around 175.

Also make sure not to get the fluids too hot. I always tested it like you would do for a bottle. I think normal cat body temperature is between 100 and 103°F (37.5 - 39.5°C), so I wouldn't go too much above that. I heated water on the stove until it was pretty warm, but I could keep my finger in it for several seconds, then put the bag in for anywhere from 5-15 minutes, depending on how full the bag is.

 

Hi, there is a good thread higher up--I just posted some very important tips on it:

viewtopic.php?f=28&t=66332


Also, I used 25 and 26 gague needles on Fred, made everything MUCH better for him. I also sat hm in his kitty bed on the sofa, put the needle in, kept my hand on it for placement, put a towel and then a warm heating pad on top. He purred the entire time. The smaller needle makes it take a bit longer, but it felt good.

I think I have a few samples of these small needles left if you want me to send some to you. ust PM me your address and I"ll pop them in an envelope. That way you don't have to buy a box to test the size. I went from every size starting from 20 and 22 on to smaller and smaller until I settled on these as the beset.

ALSO, be conservative with your fluid dose--read why on my post on the thread above

ALSO, YES use the pepcid, it's the best drug ever. Fred would always swallow hard and I finally realized that meant he was nauseous. I gave him a 1/4 tab in a pill pocket twice a day. OR when he wouldn't eat the pill pocket, I would then dissolve in a little water and then mix that with his canned food.

I NEVER put him on a renal diet for 6 years--kept him on the healthy db canned stuff.

I did give him a phosphorus binder and that helped a lot too--I switched between the 2 kinds...epakatin and, huh, forgot the name, some white powder aluminion something or other I think.

good luck, your kitty should be fine with some TLC and meds.