Kidney Disease continued...

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babyg

babyg

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I cancelled the appointment with her regular vet this morning since the tests we were going to do didn't make sense at the moment.
Still waiting to hear back from internal medicine, but I got some stuff emailed back to me. They have for diagnosis: Renal insufficiency (IRIS stage 2), and the notes say "No treatment is currently required for the CKD, however renal values, urinalyses, and blood pressure should be monitored to determine if additional treatment are needed in the future" and "We recommend rechecking her renal values every 3-6 months to assess the progression of her chronic renal disease."
The GI panel results don't make sense to me; I see findings consistent with pancreatitis but not sure about anything else.
I should know more once internal medicine calls me back, and then I will report here and on the kidney forum too.
 
Finally spoke with internal medicine. At this time they are not recommending sub q fluids or any special diet or change in food, other than (if possible) to encourage her to eat wet food so she stays more hydrated. I personally feel like her renal values didn't start to go up until I began trying to feed her canned, so I'm not entirely convinced if that's the route to go down again? But they are currently not concerned about phosphorous levels in the food. They said they don't recommend anything different unless clinical, which includes having high phosphorous levels and low calcium.

I asked about the SDMA and urine protein creatine ratio tests, and they admitted we don't really need those but from an academic level they are 2 of the 5 markers (blood pressure, BUN, creatine are the others) that they use to stage. They said to get her bloodwork and urinalysis rerun in 3-6 months to see if anything has changed.

In some way I feel like I should be doing something, though, to change this and keep her stable, but they aren't really recommending anything. Food seems like the only thing I can kind of make a decision about at this point, and I'm not sure what is best to do. She loves her dry food, she's 15, she has an appetite...so part of me feels like let her eat whatever she wants and be happy. I can work the insulin around it. But then another part of me is of course concerned how much her diet will impact her prognosis.

Definitely have a lot of research and thinking to do. If anyone has any stories or experiences they would like to share regarding their journey with their CKD cats, please feel free to.

As for the GI panel, it does show she has pancreatitis and also that she may have some intestinal dysbiosis. Anyone know anything about fecal transplants? They will consult with their GI expert and get back to me tomorrow.
 
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If she has what they are calling intestinal dysbiosis, I would highly recommend starting her on Visbiome Vet probiotic. This has been a game changer for my cat with IBD. Before starting it, every time I tried to reduce his Prednisolone dose to every other day from a daily dose, he started getting diarrhea again. After starting the Visbiome, he has been able to go to EOD dosing and his stool is perfect with no vomiting.
 
Just adding my two cents…

There are plenty of studies lately on the positive effect of a healthy GI microbiome and its impact on the kidneys, a list of articles that I had stored on my computer:
- Feeding cats with chronic kidney disease food supplemented with betaine and prebiotics increases total body mass and reduces uremic toxins: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268624
- The Effects of Nutrition on the Gastrointestinal Microbiome of Cats and Dogs: Impact on Health and Disease: https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2020.01266/full
- Microbiota and probiotics in canine and feline welfare: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111060
- Effect of feeding a selected combination of galacto-oligosaccharides and a strain of Bifidobacterium pseudocatenulatum on the intestinal microbiota of cat: https://avmajournals.avma.org/view/journals/ajvr/74/1/ajvr.74.1.90.xml
- Effects of Lactobacillus acidophilus D2/CSL (CECT 4529) supplementation on healthy cat performance: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924845/

If she has pancreatitis, my understanding is that it's a painful condition, especially during flare-ups. Have you noticed something?
There is an ios IBD group: https://groups.io/g/Feline-IBD-Support
and a pancreatitis group as well: https://groups.io/g/FelinePancreatitisSupport

For CKD, it would be better to follow Suzanne's advice and lower her dietary phosphorus intake. Her phosphorus level might seem in the lab range but it is a bit higher than what is ideal, and it has increased from last year. You definitely don't want it to increase further, it will make Baby feel really sick and it will negatively impact her kidneys. If she eats kibble, give her kibble, many people in the CKD group haven't managed to switch their cats to wet food and that's fine, as long as she has access to water. Just make sure that it's low phosphorus. In CKD stage 2, you'd want to give her food that contains less than 250mg/100 kcal, or if you prefer dry-matter-base values, around 0.6%.

I don't remember if her BP was checked, you want it checked and treated asap if hypertension is there. The standard molecule used is amlodipine, with an initial dose of 0.625mg/day.

She doesn't have proteinuria, so that's very good.

For now, that's all you can do, the CKD might progress, or it might not progress. Its cause is definitely NOT something that you've provoked. Remember that many many many senior cats do develop some CKD, and nobody really knows what causes it. No point in blaming yourself!
 
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If this was my cat would be looking for lower phosphorus food as the phosphorus is slightly over 5. As for pancreatitis, nothing in the labs is consistent with it as I don’t see a SpecfPL and other labs don’t test for it. I agree wet food is better for ckd and fd.
 
Daphne and Aida said:
If she has pancreatitis, my understanding is that it's a painful condition, especially during flare-ups. Have you noticed something?
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Her food consumption had steadily decreased over the course of a week to where she didn't want to eat much without prompting and she had lost some weight, but she is now back to eating good and regaining weight.

Daphne and Aida said:
If she eats kibble, give her kibble, many people in the CKD group haven't managed to switch their cats to wet food and that's fine, as long as she has access to water.
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I wonder if that's why her levels began creeping up since I started feeding her wet food, because while I'm not an expert finding and reading phosphorous levels in food, it looks like the Friskies mixed grill pate (which is what she was mostly getting) has higher phosphorous levels than her dry Purina Dietetic Management.

Daphne and Aida said:
I don't remember if her BP was checked, you want it checked and treated asap if hypertension is there.
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Blood pressure was good. They said 133/82.

Daphne and Aida said:
For now, that's all you can do, the CKD might progress, or it might not progress. Its cause is definitely NOT something that you've provoked. Remember that many many many senior cats do develop some CKD, and nobody really knows what causes it. No point in blaming yourself!
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Thanks, I truly appreciate that. I tend to question myself and where I could have gone wrong with things and really hope I didn't fail her in some way.
 
I'm still working through Tanya's CKD site, and am thinking of having bloodwork and urinalysis rechecked in about 1.5 months? since her site recommends testing every 1-3 months for stage 2, so I'm thinking 1.5 is good since it's halfway. In the meantime I'll continue working on getting BGs under control with her current dry diet while researching possible lower phosphorous options before making a decision what to feed next. Just don't want to bounce her around like a yo-yo. :p
 
I'm not an expert but wanted to chime in on the wet food switch. Prior to my cat's diagnosis she never had any kidney issues. She had bloodwork taken the day of her diagnosis which showed great kidney values. I switched her to all wet immediately, mostly Fancy Feast and some Weruva/Tiki, and her next bloodwork 1-2 months later showed Stage 2 CKD. It was a huge bummer and I'm not sure if it's the specific wet food that bumped the numbers up. Unfortunately she seems to have a chicken allergy so it's been hard finding low phosphorus wet food that's also low carb.
 
Riyah said:
I'm not an expert but wanted to chime in on the wet food switch. Prior to my cat's diagnosis she never had any kidney issues. She had bloodwork taken the day of her diagnosis which showed great kidney values. I switched her to all wet immediately, mostly Fancy Feast and some Weruva/Tiki, and her next bloodwork 1-2 months later showed Stage 2 CKD. It was a huge bummer and I'm not sure if it's the specific wet food that bumped the numbers up. Unfortunately she seems to have a chicken allergy so it's been hard finding low phosphorus wet food that's also low carb.
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That's very interesting. Sometimes it seems like darned if you do, darned if you don't, right? It's hard to pinpoint cause and effect, but it really makes me wonder because we were fine too until the switch. Wish cats and food were more straightforward.
 
I suspect it’s the wet food chosen and not that it’s wet food. What is the phosphorus content in both foods? You can find that on tanyascrf although the data might be dated. Manufacturers often change the content of the food. That’s why sometimes all of a sudden food your cat used to like might no longer be appealing when you buy it again. You would need to use a converter to figure it out.
 
tiffmaxee said:
I suspect it’s the wet food chosen and not that it’s wet food. What is the phosphorus content in both foods? You can find that on tanyascrf although the data might be dated. Manufacturers often change the content of the food. That’s why sometimes all of a sudden food your cat used to like might no longer be appealing when you buy it again. You would need to use a converter to figure it out.
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Oh for sure. Unfortunately, with the chicken allergy and diabetes her options are limited, and on top of that she is SUCH a picky eater! Fancy Feast is the only wet food she'll eat consistently. She likes the Turkey and Giblets (Phosphorus As Fed 0.46, Phosphorus Dry Matter 1.95) and the Ocean Whitefish (Phosphorus As Fed 0.47, Phosphorus Dry Matter 1.98). So way too high but it's been a struggle to find more options. Like you said, the list on tanyascrf site is dated. I see so many new brands that I'm sure have food with lower phos values but it's a little overwhelming to try and gather data for all of them. Right now I've been mixing in some lower phos options to hopefully get her to associate those better foods with the FF taste.
 
Not sure if this link has been posted here, it’s from catfoodnerds:
https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf
It has been updated in May 2024. Lists North America options.

I’ve been following discussions on nutrition both here and in Tanya’s group without intervening, and I’ve done some independent courses on nutrition for canines and felines, to be sure that I take the right decisions for my senior cats.
The most important thing in my opinion with senior cats, regardless of their health status, is to limit dietary phosphorus intake. Generally, the big 3 brands (Mars, Palmolive and Hills) try to formulate foods with lower phosphorus in their senior commercial foods, whereas other brands don’t necessarily do so. One big exception being Weruva of course, and I am oh so envious of you folks because here in Europe the choices are so limited!! As a matter of fact, there have been some independent studies on commercial European pet-foods, and the results are scary: more than 80% don’t follow the FEDIAF recommendation and have enormous amount of phosphorus, leading to many many pets having kidney issues just because of that. So, for now, I stick to the big 3 brands (although Hills is off the table, they both loath any of its formulations).

The second most important thing with senior cats is protein intake: cats need a substantial amount of dietary protein, and specifically senior cats, with their slowed metabolism and tendency to sarcopenia, need even more protein. The problem is that protein from animal sources is very rich in phosphorus, and of course, cats can’t eat beans…So, we have to make sure that the quality of the protein is optimal: what this means is that the protein has to be closer to 80% digestibility. This way, we can give a controlled amount of protein and reduce the total phosphorus load and at the same time provide all of the amino acids our babies need. There is a list somewhere that compares the different animal source proteins and their digestibility, can’t find it right now maybe someone else has more luck? From what I remember, eggs are close to 90% digestibility, and pork ranks very low.

The third thing is hydration. Cat’s have a very low thirst threshold, so we have to make sure that they do stay hydrated no matter what they eat.
 
Riyah said:
I'm not an expert but wanted to chime in on the wet food switch. Prior to my cat's diagnosis she never had any kidney issues. She had bloodwork taken the day of her diagnosis which showed great kidney values. I switched her to all wet immediately, mostly Fancy Feast and some Weruva/Tiki, and her next bloodwork 1-2 months later showed Stage 2 CKD. It was a huge bummer and I'm not sure if it's the specific wet food that bumped the numbers up. Unfortunately she seems to have a chicken allergy so it's been hard finding low phosphorus wet food that's also low carb.
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You know, I don’t believe that just this food change could have been the source of your cat’s CKD in just the span of 2 months, maybe there were other things?
Are you in Tanya’s CKD group?
 
Daphne and Aida said:
You know, I don’t believe that just this food change could have been the source of your cat’s CKD in just the span of 2 months, maybe there were other things?
Are you in Tanya’s CKD group?
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I am! I've posted there in the past. What other things would potentially be the cause?
 
Riyah said:
I am! I've posted there in the past. What other things would potentially be the cause?
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No, I mean that I don't know if it's physiologically possible for a kidney to sustain such a massive injury and go into failure in the course of just one to two months.

I mean, the studies I talked about, where they found that too many European commercial petfood contained up to 8 times the RA of phosphorus per AAFCO, they found that pets develop CKD after being fed this food for more than that.
In the US, the petfood is much more regulated, and you can be sure that no petfood manufacturer would survive if they were formulating like they do in Europe.
So, even if the food you gave her for a couple of months was very high in phosphorus, it isn't likely the cause of Lily developing CKD.

The causes for CKD are multiple and vague, many times there isn't just one cause. It can be a combination of congenital predisposition, environmental exposure to different types of toxins, GI microbiome unbalances, stress, dietary phosphorus load, etc… the list is very long.

Let's not hijack RJ's thread, if you want we can continue this discussion privately, ok?
 
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