? What do I feed when one is diabetic and one has CKD?

Discussion in 'Feline Health - (The Main Forum)' started by Daddy Jack's Mommy, Apr 17, 2019 at 10:29 AM.

  1. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

    Joined:
    Feb 18, 2019
    My oldest fur baby (Celie, my 14 year old calico) was just diagnosed with CKD. I have no idea what I should feed her. My vet recommended rx canned food. I said no. I told her that I now feed Fancy Feast (and Dave's canned food), and she said to keep doing that. I'll also be giving her sub-q fluids 3x a week. Although I have given fluids to my dog many years ago, my experience with CKD is zero. I want to make the right choices for her health and well being. I also want her to continue being the happy little girl that she is, so I wonn't sacrifice quality of life to keep her alive.
    I was seriously considering making my own cat food, and then yesterday I learned about Celie. Now I'm unsure of what to do next. Homemade food is high in protein, and Celie needs lower protein. But I'm not convinced that it has to be as low as those rx foods (at roughly 20% protein). I read an article (an interview) with Dr Pierson yesterday, and she said she is appalled at how low the protein is in CKD diets. She stated that 40% protein is sufficient, as compared to the 60% and higher that they eat in the wild. Fancy Feast is 40% protein, so I lucked out with that one. Or have I? I have found some recipes for homemade cat food for those with CKD, but all of them are high in carbs, and Jack can't do carbs. None of them should do carbs.
    I don't know where to go from here. Have any of you made homemade food for a cat with CKD? Did your other cats eat that as well? I need to find a diet that all 5 can eat, as my life style and circumstances would not lend themselves to feeding them different foods. They won't even use their own bowls, for crying out loud! They walk around and take turns eating from all of them.
    I would love any information, suggestions, or ideas on how to best manage her diet and how I can make her life easier for her.
    Thank you.
    ~ Carolyn
     
  2. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Did your vet say what stage she is in? A cat with CKD needs a low phosphorus food. Fancy Feast is very high in phosphorus so I wouldn’t use that for Celie. Making your own food would be a good idea. Just be sure the supplement you use gets calcium from eggshells rather than bone, which would be too high in phosphorus. @Idjit's mom can give you some info on homemade. If you decide instead on canned for all, look for low carb, low phosphorus (under 200 on Dr Lisa’s chart). If you have her bloodwork results, you can post them here for more info. Here’s a great site on CKD
    https://www.felinecrf.org/
     
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  3. Idjit's mom

    Idjit's mom Well-Known Member

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    Apr 3, 2018
    Hi Sharon, I have already told Carolyn about the FoodFurLife product I use. But she is concerned about the protein %, since her vet recommends low protein. I remember reading something about that being a more outdated approach, but I can't seem to find just where. I think I would be concerned with a low protein diet, since just to my thinking, if there isn't enough protein then would the body begin to break itself down to get enough? I just don't know enough about CKD at this point.
    Oh, I just remembered where, it was an email from the FFL folks. I will try to get that info to Carolyn for her consideration.
     
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  4. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Carolyn, this is the response I got when I contacted FoodFurLife about my concerns with phosphorus and preventing kidney disease.

    Regarding your question about phosphorus, the typical guidance for phosphorus in earlier stages of CKD is to feed a food that is less than 1% phosphorus on a dry matter basis, or less than 250mg phosphorus per 1,000kcal. EZComplete is both.

    The Veterinary / Rx renal diets typically have phosphorus at lower than AAFCO (which minimum is 0.5% on a dry matter basis). But they achieve this by trading protein for carbohydrates.

    If you want to feed a low carb diet, then yes, raw is your best option. In a traditional raw diet with bone, the phosphorus is over 2% on a dry matter basis. This is because bone is used as the source of calcium - but it is also the largest repository of phosphorus in the body. By removing the bone and replacing it with an alternate source of calcium like eggshell (which is what EZComplete premix powder uses), this alone reduces the food to less than 1% phosphorus on a dry matter basis, typically to 0.8% - 0.9% DMB if using very lean meats. You can lower the phosphorus further by using fattier cuts of meat.

    That said, Laurie has had 5 CKD cats since she transitioned her cats to raw 7 years ago (half of her crew were seniors when they transitioned), and she now has 2 and Carolina has 1. We've both tried feeding low protein in order to lower phosphorus further (because outside of bone, the organs and meat are the source of phosphorus, which is why the Veterinary / Rx renal diets replace meat with carbs). Lowering phosphorus further in a homemade diet is actually quite easy to do with food made with EZComplete by adding fattier cuts of meat, as mentioned above. If you target 15% fat as fed, the food will have about has much phosphorus as the Rx diets (below the AAFCO minimum), and protein will be around 40% on a dry matter basis - not quite as low as the Rx foods, which are around 30%. At about 10% fat as fed (with food made with EZComplete), the protein will be just about 50% on a dry matter basis. BUT. But it turns out that - in our experience - phosphorus really isn't the only consideration in an ideal CKD food, unless your kitty is late stage 4 or in kidney failure. Again, based on our experience.

    We went back to feeding mostly lean meats. Doing extensive research, we learned why our cats do better on the higher protein diet: senior cats need MORE protein, not less. Over time, on the higher fat diet, our cats got weaker in the back end. That's muscle wasting. In a referenced piece by Dr. Mark Peterson, one of the most widely recognized small animal endocrine specialists in the world, he walks through the known needs of senior cats from published studies. It turns out, based on that info, senior cats need a minimum of 53% protein (dry matter basis) to prevent muscle wasting. So we weren't imagining it when our observation was our cats did better on a high protein diet. https://endocrinevet.blogspot.com/2011/11/optimal-protein-requirements-for-older.html

    Dr. Becker has a referenced article on a study conducted in cats, designed to determine if low protein made a difference in CKD. It turns out, protein control does not impact CKD, where phosphorus control does: https://healthypets.mercola.com/sites/healthypets/archive/2018/02/13/feeding-senior-cats.aspx

    So we both feed food made with EZComplete to our cats, using a rotation of chicken breast (lean), chicken thigh (fattier than breast), pork loin (lean), pork shoulder (very fatty), turkey breast (lean) or thigh (fattier), and Laurie uses fatty cuts of beef (chuck beef) and very lean cuts of beef (like top round), and each of us typically feed 2 of 3 meals a day to our cats that are lean, and one that is made with fattier meat.

    What we do is control phosphorus by using a specific form of vitamin B3, niacinamide. Laurie lost her 3 prior CKD cats to problems unrelated to the CKD, and the current two have been completely stable for 1.5 years since diagnosis with this approach. Carolina's CKD cat also has hyper-T, IBD, megacolon and a hiatal hernia, and he's been completely stable for two years. Totally stable! Some of it luck-of-the-draw genetically. But this approach has been serving our kitties well.

    We hope this helps, please let us know if you have any further questions.

    Best Regards,

    Laurie & Carolina
     
  5. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    That’s why I asked what stage CKD. Early stages you don’t restrict protein, but I’m not sure what stage you start. I’m sure the link to Tanya site will have that info.
     
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  6. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    If you post your lab results, we can help determine the stage of CKD. My vet told me similar stuff to what your vet told you but when I posted the lab results I got, @Marje and Gracie (who is a WHIZ at reading test results) assured me that China did not need sub-q fluids yet and she wasn't as "sick" as the vet would have had me believe.
     
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  7. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

    Joined:
    Feb 18, 2019
    @Sharon14 @Idjit's mom @Chris & China (GA)
    I so appreciate that all of you have responded. I'm overwhelmed. I'm going to attempt to upload pictures of the test results. I hope this works...
    The vet said that the elevated EOS indicates allergies, which may explain why she scratches her ears and nose to the point of hurting herself sometimes. I took her to the vet because she has been vomiting, she has lost some weight, and I also wanted to see what was going on with her ears. I don't have a copy of the urinalysis, but the vet said that it indicated there is no protein in her urine and nothing of concern in that test. I'll get a copy next time I see her.
    Celie results.jpg Celie results 2.jpg
     
    Last edited: Apr 18, 2019 at 2:57 PM
  8. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

    Joined:
    Feb 18, 2019
    @Idjit's mom
    Thank you for putting my mind at ease, and for taking the time to give me such a detailed explanation. I had sent FoodFurLife a request through their contact tab (on the website) to inquire about using this product for cats with CKD. I have not yet checked my email to see if they responded. But your email gives me my answer. I am so relieved to know that I can prepare food for all of them this way, and that it will benefit all 5 of my cats. There's no doubt in my mind that this is the best option and that this is what I will do. Thanks also for explaining what meats you use, as I was curious to know how to proceed first and worried about getting meats that were harder to find or more expensive. Chicken, turkey, and pork... it's all easy. :smuggrin:
    And I greatly appreciate the links to the studies.
    Do you include this vitamin in their food?
    And now I will ask you the silliest questions of all (and I feel a bit embarrassed to ask)...
    Who are Laurie and Caroline? I thought your name was Lou. Am I mistaken? There are soooo many names of humans and cats, and I'm beyond terrible with names to begin with. :confused:
     
  9. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    They're the makers of the FoodFurLife product.

    They are also the ones that "control phosphorus by using a specific form of vitamin B3, niacinamide." (that's all part of their reply to her original email)
     
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  10. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    Ha ha ha ha ha ha ha ha!!!!!! I had, at one point, thought that it switched to Lou's story. Thank you for explaining that!
     
  11. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    @Chris & China (GA) thank you for making that clear.
    @Daddy Jack's Mommy sorry, I guess I should have formatted the response in Italics. I was just so proud of myself for remembering where that info was and then locating it. But you never know, I might have a secret alternate identity or two! (Chris does)
    I also use beef chuck. It's not Idjit's favorite and so I mix the chicken breast and beef half and half per serving. He has refused the pork by itself so far, I'm glad I only made a very small amount. I had to use it up by sneaking in very small amounts into his chicken dishes.
     
  12. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    To be honest, I was impressed with that myself!
    :)
     
  13. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    I’m not able to look at the labs and post tonight but I will in the morning if that’s ok. My apologies and thanks for your patience.
     
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  14. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

    Joined:
    Feb 18, 2019
    That's absolutely fine! I appreciate
    No worries! I appreciate your help, and had no expectation of the time frame.
     
  15. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    @Daddy Jack's Mommy

    I’ve had three cats with CKD and one with polycystic kidney disease which presents as CKD but it is quickly fatal once the numbers start to rise. The other three cats with CKD all passed from something else and were stable with CKD for a very long period of time.

    Lou posted some great info from Laurie and Carolina who are friends of mine and very knowledgeable about CKD.

    Celie appears to be in Stage 2. Was a urine test done? I’d be interested in seeing her urine specific gravity. I agree totally with what has been posted on RX diets for CKD. They are way too low in protein. Yes, their benefit is being lower in phosphorus than you can generally get to with other foods but then ingredients are also terrible. With a cat with CKD, you want a really good quality diet with excellent protein and lower in P. I totally agree that, if you can get your kitties to eat raw with EZ Complete, you’ll be giving excellent protein and lower P.

    However, when the P gets to be over 6 like Celie’s is, you have to be more proactive. It’s odd to see a cat in Stage 2 with such a high P level. She needs to have a binder on her food now. The best one, IMHO, is aluminum hydroxide. It’s a tasteless powder and you mix a bit of it in with each serving of food to bind the P in the food. Even with the lower P level of EZC, you can’t usually get the P level to drop significantly without a binder and her P level should be more around 4-4.5. The other concern is that when Ca x P is approaching 70, then we worry about tissue calcification so it’s really important to get the P down.

    Here’s a great discussion on Phosphorus control. Here’s what you need to know about phosphorus binders and how to dose them. I always used the aluminum hydroxide from Thriving Pets.

    Subq fluids are not usually started until the creatinine is 3.5 and, some vets specializing in CKD, believe even higher. Celie should get as much water from drinking and from what you add to her food. Once the creatinine gets above 3.5, it’s a signal that she can’t keep up with hydration but she’s not there yet. One main reason to not start subq fluids too early is that some cats are stable with CKD for many, many years and starting fluids too early can risk building scar tissue from the larger gauge needles needed (even if you use 21g as opposed to the harpoon-sized 18g). Also, you can overhydrate a cat and it’s just not necessary to start fluids as soon as your vet is suggesting. You can read more about hydration also on Tanya’s.

    Besides P control, the other parameter that has a lot to do with longevity and how the kitty feels is preventing anemia. Celie is not anemic yet but once the hematocrit (HCT) reaches 30%, you’ll want to start giving B vitamins as indicated in the anemia discussion.

    The other two things are, as Lou said, adding niacinamide to the diet and potentially using calcitriol. When I had my CKD kitties, calcitriol was not used unless the kitties had secondary hyperparathyrodism but more people are now using it to prevent that condition. You’ll need to read the discussion on calcitriol and talk to your vet.

    That’s probably more than enough to get you started. Tanya’s is the gold standard for treating CKD so I’d read as much as you are able starting with phosphorus control as that is what really needs to be addressed now.

    Let me know if you have questions.

    Also...her ALT is mildly elevated. I’d keep an eye on it but it is a very mild elevation.
     
    Last edited: Apr 19, 2019 at 1:11 PM
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  16. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    Marje, thank you so much for looking over her blood work. I have zero experience with CKD, and I really felt overwhelmed. I'm feeling calmer now, knowing that there are things I can do to help Celie to feel better. She's such a sweet little girl, but very feisty! These last few days of being sick have made her pretty grumpy. It's sad...
    When I took her to the vets on Tuesday, it was not her usual vet who saw her. Today, I took her to see the vet that I like the best in that practice, and let him know that I want him to treat Celie from here on out. I took her today because she didn't eat or drink one single thing all day yesterday, and most of today. I believe, and Dr G agrees with me, that she reacted to the cerenia that I gave her Wednesday night. About 3 hours after I gave it, she became lethargic and is slowly coming out of that state today. She has finally eaten a little, and drank a good amount of water. And Dr G gave her some fluids this afternoon. It's so nice to see the light back in her eyes tonight. I was so worried about her yesterday and earlier today. As far as a urine test... I thought one was done, as the vet took urine and told me it all looked good. But Dr G said the first thing he's going to do is a complete urinalysis. So, the vet on Tuesday wasn't very thorough. I'm taking Celie in on Wed morning for a urinalysis and an X-ray. Dr. G said he wants more blood work, but we can wait a little on that. My finances are not good, and he understands that.

    Thank you for the links to Tanya's site. There is a wealth of information there.

    I'll get her started on a phosphorous binder right away. My only concern is that all of the cats eat from each other's dishes, and there are no rooms in my micro small dwelling to separate them. So it's going to be challenging to completely keep her from eating food that doesn't include a pho binder. I just briefly looked up some stuff on pho binders, and I gather that it's not good to include it in the diets of cats who have healthy kidneys.

    I'm also going to order EZ Complete.

    And I'm leaving you with a picture of my girl Celie.

    Celie in bed.jpg
     
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  17. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    I'm sorry that I didn't respond directly to you on Wednesday. I was so overwhelmed for a few days, trying to decide what I should do to help Celie and trying to learn as much as I could about chronic kidney disease. Thanks for the good information you shared, and for giving me the link to Tanya's website. I really didn't mean to overlook your response to my questions. Thank you, Sharon, for taking the time to answer me. I really appreciate the help that I'm getting in this group with my sugar baby Jack, and now with Celie. And I hope to pay it forward, as soon as I calm down!
     
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  18. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    When I had Celie to the vet on Tuesday, urine was collected and tested. I was told that everything looked good. However, the vet who saw her on Tuesday wasn't my usual vet. It was the same practice, but a different vet. Celie has been very lethargic and not eating since Wednesday night. Yesterday I took her to see Dr. G, who is my usual vet and the one that I really love. He immediately noted that there wasn't a complete urinalysis done on Celie, and he's going to do that on Wednesday along with an x-ray. When I get the results of that urine test, I'll post it here. He didn't do that work last night because I came in at the end of the day as a sick visit. He did, however, give her fluids.

    On a very positive note, there is a marked improvement in Celie today. She was purring so loud that I could hear her all the way down the hall when I first got up. And she's been eating wonderfully and so far has held it down. It seems to me that she reacted to the Cerenia tab that I gave her Wednesday night, as those symptoms started a couple of hours after I gave her that tab. Dr. G agrees with me, that it could have been a reaction to the medication.
    Thanks Marje for all of your help. I hope that you're enjoying your weekend.
     
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  19. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    Great news!
     
  20. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    That is correct. Cats with health kidneys should not be feed exclusively food with phosphorus binders. A little of such food is fine.
     
  21. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    You’re welcome! Please tag me when you get the results.

    I’m glad she’s feeling better.
     

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