? 06/01 Mowgli AMPS 210 Start Phosphorus Binder?

Yesterday

After our latest bloodwork on 4/29, our new mobile vet told me that Mowgli's numbers were great and that he didn't recommend any changes in diet or anything. However, I was concerned in particular with the fact that Mowgli's phosphorus went from 4.0 in January to 6.2 . The vet said 6.2 mg/dL is with the normal range.

Anyway, I just read on here that phosphorus over 6 is not acceptable. So I am assuming I need to transition Mowgli to a low phosphorus diet and maybe use phosphorus binder as well?

We have fed Mowgli a raw diet his whole life, but it does have a bit of bone in it so I'm assuming it is too high in phosphorus now. For now I can buy some Weruva canned foods that are low phos, until I can make a low phos - raw mix with EZ Complete since it looks like it is out of stock at the moment.

Does this sound reasonable? Also, is it okay to use phosphorus binder at the same time as Cabergoline? If so, what binder do you recommend? Aluminum Hydroxide vs Chitosan, etc.

Here are all of Mowgli's latest kidney values (the rest of bloodwork results are in LABS tab of SS):

BUN: 21 mg/dL
Creatinine: 1.7 mg/dL
BUN/Creat ratio: 12
Phosphorus: 6.2 mg/dL
Urine SG: 1.053

@Wendy&Neko

 

EZ Complete should be in stock again by the end of next week. Alnutrin is a good substitute in the meantime, the only difference being you have to add liver (either fresh or freeze dried) and an Omega 3 source like fish oil or green lipped mussels.

@Suzanne & Darcy is using niacinamide as an alternative to aluminum hydroxide and is seeing great results with Darcy. Here's more about it: https://www.rawfeedingforibdcats.org/feline-ckd-niacinamide-in-phosphorus-control.html.

 

Yes. That phosphorus is too high and will damage his kidneys. I am using niacinamide where I take a 250 mg capsule of Jarrow Niacinamide and use tiny spoons ordered from Amazon to fill #4 size gelatin capsules. I split it into 10 capsules for a dose of 50 mg. That is the starting dose for Niacinamide. I also was using Aluminum Hydroxide powder, but that dropped him too low, but that was probably because he was also eating very low phosphorus foods.
You may want to first try the diet switch to low phosphorus foods and do a recheck in a few weeks. That may be enough for now.

 

You want to bring phosphorus down to 4 - 4.5

ETA: I am talking about the blood phosphorus level (not, of course, the level in food!) Those reference ranges for phosphorus levels that the labs have are very wide and they include the higher phosphorus levels that would be appropriate for a kitten with a lot of bone growth going on... they need more phosphorus, calcium and magnesium to build bone. So while a level of 7 might be good for a kitten it is bad for an adult cat. But luckily Mowgli is not that high, but that is a real increase from his previous labs.

 

Thanks for the response Katherine! Would you say the Alnutrin with Egg-Shell Calcium is the way to go?

I will read up on this option, as I haven't heard of it before.

I will definitely start him on low phosphorus food now. Are you feeding commercial canned or are you making your own low phos raw diet?

 

Yes. You want to avoid any bone at this point. Get boneless ground meat and just mix the powder in with liver and a few capsules of fish oil. My kitties love EZC and I tried switching them to Alnutrin that is much blander (and cheaper) and they were like . They will eat it, but reluctantly and with a bit of coaxing. If you start with the Alnutrin, Mowgli might not be as spoiled as mine are.

 

Is there any research on what kind of an improvement one can expect from switching to a low phosphorus diet alone?

Had your cats ever eaten raw before? I wonder if Mowgli would take to Alnutrin just fine since he has eaten raw his whole life.

 

My cats never ate raw before EZC, so Mowgli will probably do very well on Alnutrin. Lots of cats on the Raw Feeding for IBD kitties FB group also like it. Somehow mine think they are special. Ruby was eating low phos Weruva and Olive was eating FF and Dr Elsey’s kibble before I switched them both over so they’re used to stronger flavors.

 

I only know from personal experience. Ruby's phos levels dropped from 4.8 to 3.7 in the three months since late February when I switched from Weruva to raw boneless and all of her kidney values went lower (Ruby's labs are in her spreadsheet so you can see). I don't use a binder and water down her food a lot. I did that with the Weruva too but it didn't make as dramatic of a difference. As 6 is high but not terrible, removing all bone from the raw could make a big difference.

 

That's what I was going to say. 6 is not terrible. It is higher than you want, but it is not a number to panic over. That is why I suggested that you try feeding very low phosphorus foods and recheck Mowgli.

 

Well the update on Mowgli is that he doesn't want to eat very much today... My mom also reports that since he started on Cabergoline he has seemed down. Impossible to tell if the problem is the Cabergoline or the high phosphorus level right?

 

I wonder if we should discontinue Cabergoline temporarily to see if that's the issue?

 

Or you could try cabergoline every other day and see if that helps. The GI symptoms seem to go away with time.

You got some good suggestions on diet. When Neko’s kidney numbers started rising, I switched to lower P raw or raw with egg shell calcium instead of bone. That held off the need to add binder for quite a while.

 

When Darcy's phosphorus level was high, he did not want to eat.... but of course he also had a high BUN. Mowgli is not like that. Many people on this board have reported diarrhea for a few days. It may be from the Cabergoline, but will probably pass unless something else is going on (pray not.) I'm rooting for Mowgli. Darcy sends his regards!!

 

Are vomiting and inappetence potential side effects of Cabergoline? For sure I think we will try to skip tomorrow's dose and see if he improves. We will also switch him to raw with egg shell calcium.

 

Yes, GI upset (temporary) can be associated with starting cabergoline. That can mean diarrhea, vomiting, inappetance.

 

I hope that's what it is! We will skip Cabergoline tomorrow and hope for the best.

 

I suggest joining a group for kidney cats. I like the fb group Cats with Chronic Renal Failure.