? Stage 4 CKD and Diabetes

(Sorry if you've already read my post on the fb group and this is a duplicate!)

Morning,

Sadly we just found out this morning that Penny has Stage 4 CKD her bloods 6 months ago were totally fine but she'd been drinking and weeing more the last couple of weeks so I wanted to rule out kidney and thyroid issues before I just put it down to her diabetes. We aren't sure how old she is as we adopted her as a stray, maybe around 15. She's totally fine in herself - really active and bright!

I don't have her blood results in person yet but her urea was 30.1 and her creatine was 422. She is going on a course of antibiotics in case it's a renal infection and we were advised to put her on a renal diet. She will be going back in a month for more blood tests and a blood pressure test.

I'm feeling a bit overwhelmed at the moment! We now have a hyperthyroid foster cat who we are struggling to regulate (and needs sedating for blood tests) and now Penny has got both CKD and diabetes.

Some good news - our vet is really happy with how her diabetes is being controlled. She rang me to ask what method we have been using and to ask about home testing as she wants to recommend this to her other clients!

As far as I'm aware CKD needs a medium protein content and low phosphorus. I'm guessing I treat the CKD first and almost worry about controlling the diabetes again after we transition her food? She's currently on around 4% carbs and is on Blink! food. I've been reading through http://www.felinecrf.org/ which is fab, and looking at the list of recommended renal foods. Some of them seem so high in carbs!

I was thinking about getting this one... do you think this looks suitable for both her diabetes and CKD?



Do any of the others on the list look suitable?

Thank you,
Bex and Penny

 

Hi! I have you all my opinions on the fb post, so I'll just say hi so you know someone saw this post. Ha ha

If it went from no ckd to stage 4 that quickly there's a good chance that an infection is playing some part.... And I would get those fluids going. Looking forward to seeing what the labs say.

 

Hi Bex,
I'm in UK too and going through something similar with my cat Angel, though they said he is in early stage 3. I was so overwhelmed, now it's 3 weeks in and I'm coping a lot better. If you have a look at my last thread it might help?
What was Penny's phosphorus level? Angel's was sky high at first, plus his white blood cells were up. He had no other signs of infection but I asked for him to get anitbiotics just in case, and his numbers are now much better.
The only food I've found that seems to address both problems is the integra protect renal in the foil trays available from Zooplus. The vets gave me royal canin which is too high in carbs so I'm now giving him the very least amount with his meds. There are mixed feelings on protein as some cats have done ok on low phos and good quality protein.
If you join the felinecrf support group and post your bloodwork, (they have a template for this which you can download and then fill in and send to moderators) and maybe post a link to it here as well? They've been so helpful to me and Angel. How are Penny's vitamin b levels?
There is also something called porus one which I got for Angel, the vets hadn't heard of it but looked it up and were supportive.
If Penny is stage 4 she may need fluid therapy at home, apparently most UK vets are resistant to this but mine have said they are supportive of this when the time comes.
I'll post a link to my thread if I can work out how?
https://www.felinediabetes.com/FDMB/threads/angel-update.241205/
x

 

Thank you for such a nice message, it made me tear up!

I'll have a read through your thread <3 I'm so overwhelmed at the moment, I'm moving house this week too so everything's a bit stressful! I'll attach the bloods in a sec, I need to save them to the computer as they're on my phone at the moment! I've got the Purina mousse for now, she seems to like it. It's probably a bit high in carbs, I'm looking at changing over to the Specific Kidney Support (9.4% carbs so slightly better than 11.5%). I thought maybe the phosphorus was too high in the Integra ones? But I'm a bit lost at the moment! She's been on Blink! until now - I'm changing her over 1/4 new to 3/4 old at the moment, I hope it helps her I'm worried I'm going to make things worse if her diabetes isn't as well controlled...

They didn't check her B levels - that's something I need to ask them to have a look at next time I go. We should be back in 3 weeks but I might push for 2 weeks (by then she will have finished her antibiotics and hopefully been on her new food for a week).

Porus one looks interesting... I'll mention it to the vets! Do you think it's helped?

I need to speak to my vet about fluid therapy too.. she's a bit constipated at the moment so maybe she is a bit dehydrated her eyes look okay and did the skin pinch trick and she looks okay.. really hope the antibiotics and diet change help her values a little bit <3

 

Thank you for your replies on fb! I'll post the labs now xx

 

These are her labs xx

 

Any chance she ate something toxic? Like a houseplant?

 

I'm going to tag @Marje and Gracie who is good at reading labs.

 

I don't think so! She can't jump up on surfaces and we don't have any house plants anywhere she can get to them (and they're all non-toxic ones!)

 

Hi Becky,

For the Integra Renal Protect wet foods (all dry matter % values):

Protein: 34% DMB (Tanya's Site guide is 35% but I'm not sure whether this might be a little on the high side for a stage IV kitty.)
Phosphorus: 0.7% (Tanya's Site target is as close to 0.49% as possible.)
Sodium: 0.74% (Tanya's Site target is 0.25% or as close to that as possible, but not quite as critical as protein and phosphorus content.)
Carbs: 10.87% (Note: The % kcals from carbs is 7.0%, so it's suitable for feline diabetics.)

If you're not already a member, I'd suggest joining the Tanya's Site support group because their members might be able to give you more specific guidance for stage IV. Also, other FDMB members with experience of managing CKD cats may have further advice to offer.

Lots of helpful info at the following site:

felineconstipation.org

Mixing in a couple of teaspoons of water with each wet food meal can help a bit with fluid consumption.



Mogs
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Just had a quick gander at the labs. One thing to ask your vet about is whether Penny may need to start taking a phosphorus binder.

Tanya's Site recommends starting a binder if:

* Serum phosphate level > 1.9mmol/L

- OR -

* Serum phosphate x serum calcium levels >= 5.0.

Penny's labs see both of those boxes checked (P = 2.2, P x Ca = 2.2 x 2.7 = 5.94).

See this link for further helpful information:

Tanya's Site - Phosphorus Control


Mogs
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Is there any chance you might be able to get Penny's blood pressure checked sooner? According to Tanya's Site, in most cats any hypertension is quite easily controlled with medication (amlodipine being generally regarded as the best medication for this - one dose every 24 hours). Your vet will be able to give you appropriate advice in this regard. If you do see the vet sooner than originally arranged, ask him to give Penny's eyes a once over too.

My reasons for suggesting this is as a general safety precaution, and not to be alarmist, but I feel it is important that we caregivers have good information so that we can make better decisions about the care of our kitties. In this instance, I think it's important to know that, left untreated, hypertension may cause further serious problems (may put additional strain on the kidneys, increases risk of stroke, risk of sudden blindness).

My civvie, Lúnasa (aka The Noodle), is IRIS stage III and she became severely hypertensive last year. Thankfully, she has been doing well on her amlodipine once a day - sometimes a little too well and I have to decrease the dose for a few days. (I have an oscillometric blood pressure meter and I monitor her at home now. It's really easy to use, just wrap a cuff round her front paw and the machine does the rest, much like the way human meters work.)

More info at the following link:

Tanya's Site - Hypertension


Mogs
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Thank you for this! I'm going to email the vets now and see if we can get her in to check her blood pressure sooner, and see if I can shift her other appointment forward a week too as she will have been on the renal food for a full week (and a transition week) and will have finished her antibiotics by then.

 

Do you think she still needs a phosphorus binder if she is moving on to a renal food with lower phosporus in it? I'll drop that in the email to the vets!

 

There's a great group on Facebook called Cats with Chronic Renal Failure.

 

Just realised the 11.5% carbs is DMB! The food she's transitioning to (Purina mousse) is 7% cals from carbs so that's a bit of a relief

 

It'll depend on the impact of the food on serum levels. Your vet may want to wait to make a decision on whether to initiate a binder until after the next round of blood work where the effect of the renal therapeutic diet should be making itself felt.

Here some helpful resources:

Management and Treatment of Feline CKD (Excellent piece by Sarah Caney. Very good overview, more indepth/practical coverage of topics is available on Tanya's Site.)

IRIS Pocket Guide to Stages and Treatments

IRIS Detailed Guide to Treatment of Feline CKD

(First document is attached below.)


Mogs
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hi Bex, sorry I haven't been around much, poor you dealing with all this AND a move.
It could be an infection making Penny's phos. levels so high, Angel's were sky high but in the normal range after his antibiotics. I was giving him a phosphorus binder with the integra protect at first, but am trying him without.
Apparently stress can make wbc's temporarily high, that might be worth remembering if Penny gets her bloods checked very shortly after moving.
I'll have a look into the purina mousse myself, (not literally, ugh) as Angel likes the moussey foods.
Fingers crossed Penny's next set of results will be so much better xx

 

Your in good hands here...prayers

 

Hey have you come across PorusOne
It claims to reduce the blood uraemic toxins by absorbing the precursors in the GI tract prior to their absorption into the blood stream. (it's not binding phosphorus but the nitrogen waste in the GI tract prior to it being absorbed into the blood stream which then requires its excretion via the kidneys)
It means that you can still maintain a higher protein diet and protect the kidneys from the toxins easing their workload.
Perhaps discuss it with your vet. It seems to have good results, reducing the nitrogenous waste in the blood stream, which helps protect the kidneys but will also make kitty feel better.

A member recently mentioned it and was trying it, I can't remember the name. @Critter Mom can you remember.

 

Hi Bex and Penny!

Did your vet happen to let you know that diabetes is the #1 cause of CKD? It isn't often mentioned in any articles or available literature when it's in the context of pet/animal health (on purpose I suspect), however you'll find plenty when in the context of human health. For cats, age, genetics and infection are frequently pointed to as culprits, however it's a well established fact that when blood sugar levels are out of control, damage is inevitably done to the red blood cells in the kidneys, which leads to CKD. This is why type 2 diabetics typically end up on dialysis (usually later in life) if they do not drastically reduce carbohydrate consumption.

Wet food is many many times better than any dry food you could feed your cat, so it's really wonderful that you're already doing that for Penny. Have you considered at all looking at feeding her a raw, fully carnivorous diet? I am a huge believer in the healing power of real, natural foods. It does take some work, but I have seen first hand that it can absolutely make all the difference for cats, dogs, and humans!

https://feline-nutrition.org/health/phosphorus-can-be-key-for-kidneys

That is a fantastic article concerning CKD in cats that talks a bit about the issue of diet and phosphorus levels. I truly hope Penny's health concerns improve with time. Thank you for being a loving cat mom who goes the extra mile for their feline friend!

 

It's Cassandra (@SweetAngel).


Mogs
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Hi Bex,

Here's a really good journal article on diet for CKD cats (and droolers!):

Nutritional Management of Chronic Kidney Disease in Cats and Dogs


Mogs
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Thank you thank you thank you for this! I took her in today and her blood pressure was super high. We've already started meds. I wouldn't have known to push them for this if you hadn't mentioned it ❤️

She's been on an IV all day today and had a laxative as she was having issues with constipation. She's like a new cat, I feel awful because now it's clear she was dehydrated! Her eyes are so bright and moist, her nose is wet and she just seems so much happier. And she's done a normal poo!!

Her creatinine has dropped to 368 from 420ish last week which was nice to hear. We are finishing off the antibiotics, transitioning her to the renal food, giving her the blood pressure tablets and then going back in 2 and a bit weeks to get her full bloods redo, recheck blood pressure, urine tests etc.

Our vet was supportive of us using sub Q fluids in the future too. She wants to see how things are when we next go in and see if her levels even out a bit, so didn't want to start immediately. But it's great to know she's supportive if we need them ❤️

 

Sub q's are great for keeping them hydrated. High blood pressure is so common. My cat Zimmy had it...wasat about 230...hes lucky he didn't go blind. I've had CC'S bp tested and so far she's ok.

 

Hi Bex,

I'm really sorry that Penny's hypertensive but I'm relieved that you've caught it and I'm glad she's being treated. (((Penny))) One needs the test because there's no howlingly obvious outward sign to pick up on.

Presumably Penny's been given amlodipine for the hypertension. What dose is she on?

Tip: Assuming that your vet has prescribed amlodipine, note that it can initially cause GI disturbance in some cats. Hopefully Penny won't have any issues but should it upset her tum, I'd suggest asking the vet about an Rx for ondansetron. I had to do that for my little Noodler. The first amlodipine dose really put her off her food, and the second dose made her throw up but she's grand on it now, thank God.

Yay for normal poop!

Here's a very helpful resource:

felineconstipation.org

Mixing a little canned pure pumpkin or psyllium husk can help with constipation. You can get canned pure pumpkin on Amazon or eBay (e.g. Libby's - make sure it's NOT the pie filling!). They're big cans but you can freeze it into portions in an ice cube tray and defrost what you need each day.) Tip: Start with a very small amount and work upwards.

WRT hydration, one of the easiest things you can do is to mix a couple of teaspoons of water into each wet food meal. To help get more fluids into Lúnasa, I use the liquid from Sheba Classic Cat Soup to flavour her water. It's a bit carby at 16.9% and she's not diabetic but the liquid from one pouch does her for two days and with heavy dilution it helps me get 80-100ml of extra fluids into her each day, plus it helps with admin of supplements and washing down meds properly. It might be an idea to try something similar to help Penny take in more oral fluids. I'm going to tag @Bron and Sheba (GA) to ask if she can tell you how she makes her broth that's suitable for a CKD-FD kitty.

Good news on the creatinine. If you're not already doing so, I can't recommend highly enough getting copies of all the test results. You could then add them to Penny's spreadsheet and track her progress over time. Also, occasionally there can be mistakes or oversights. Because we have more time to devote to our little ones than our vets do, we can sometimes catch things that might otherwise have been missed. Case in point: recently one of our members received blood test results from a specialist hospital where several values made very little sense (including a red blood result that no cat could get and remain alive!). It transpired that the results had been entered into their computer system manually, the person entering the data accidentally skipped over one result so the rest of the test result numbers were recorded against the wrong test descriptors. The caregiver was able to get the error corrected before the results were forwarded to her general practice vets.


Mogs
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Really glad to hear that, Janet. Long may she stay that way! (((( CC ))))


Mogs
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You aren't kidding. She's got enough going on. Don't need to add that to it. Lol

 

Sheba was early stage CRD so the chicken broth I made for her was Ok. I think it would have too much phosphorus in it for a CRD kitty....sorry.

 

@Bron and Sheba (GA) - Thanks for responding, Bron.


Mogs
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TLDR; Advice needed please

Some good news, Penny was back at the vet yesterday. I need to get a copy of the result but the blood pressure meds have bought her back down to normal levels rather than off the scale! And it's pushed her creatinine back down to high normal levels! Her BP meds are 1.25mg Amodip (amlodopine) once a day.

I'm not sure about her phosphorus levels etc, I need to check when I get a copy of the results tomorrow.

The less good news, apparently there were trace ketones in the urine sample I took in yesterday morning. She was on an IV all day anyway for some fluids to help her constipation/dehydration related to her kidneys so I think might have helped her. They also gave her some more insulin as her BG was so high. I've tested her last night, this morning and at lunch time (now) and no ketones on the urine strips.

The problem is I've changed her food from 4% carbs to 7% carbs, and I don't know if it's that or any of the other changes with her kidneys/BP etc but the insulin just doesn't seem to be doing the trick! Is it just that she needs a much bigger dose? I don't want to increase it too fast. I'm tempted to switch her back to the 4% carbs when I knew what her BG levels were doing - now they just seem to be constant! Does this seem sensible? I'm so scared of her going into DKA if she has ketones. I've ordered a blood ketone reader which is arriving tomorrow for peace of mind... it's impossible to tell the ketostix colours without natural light! I barely got any sleep last night as I was just waiting for her to wee; she'd had a butador at the vets because she was getting stressed having her bloods/BP taken so she was a bit out of it anyway, I couldn't stop worrying she might be going into DKA.

Any advice would be much appreciated. She's fine in herself today and the effects of the sedation have gone (other than needing a poo!). I've got a micralax enema to give her today (I should have given it last night but I was too stressed with waiting for her to wee!).

It's just one thing after another at the moment! Got bloods back for her sister yesterday too and they think she might be hyperthyroid (but the machine is playing up so need to go back again to check...). I spend all my time/money at the vets at the moment! I just want them all to be okay <3

Thank you! (Does anyone know how to get rid of the weird green formatting on some of my boxes on the spreadsheet?) xx

 

Even on her old food, with higher insulin than when she was on it last time, her bloods are out the window. I don't understand what's going on and why they're so high!

 

She n might be high too because she doesn't feel well. Are you giving her daily sub q's at home? That would have a big impact to help her feel better.

 

@Bandit's Mom -

Bhooma, would you be able to sort out this problem for Bex, please?


Mogs
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Hi Bex,

Glad to hear that Penny's responding well to her BP meds and that her creatinine levels have come down. (((Penny)))

Any joy on the poop front yet? How are her hydration levels? Is she eating OK?


Mogs
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Hi Bex, just sent you a PM. Will need editor access to fix the SS

 

Thank you! She's pooping regularly again although they're generally quite small, hard poos. We have some micralax enemas to give her at home which hopefully will help!

She's still loving her food and seems to be better hydrated at the moment.

I got a blood ketone meter yesterday which is a relief as at least I can test her if she's acting off rather than waiting for a wee!

Do you think improving her blood pressure could be having an affect on her blood glucose values? Xx

 

Thank you!

 

Most welcome. It's done. PM me if you have any SS issues at any time!

 

Hi Bex,



Glad to hear that Penny's become more regular. I'd say that makes her feel a lot better. (((Penny))) Also, good that your BBK meter has arrived. I think they're a great investment.

I have no idea about how improvements in BP levels might affect BG. If higher BP made the cat feel bad then an improvement in that respect might have a beneficial effect on BG levels, but that's just pure conjecture.

By way of general info, WRT the change in foods, some cats have a low carb level that seems to suit them better. For example, some cats do well on an ultra-low carb diet (<2%), others might do better on a food in the 6-8% range. The only way to determine whether that might be a factor is trial, error and testing.


Mogs
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Hi Bex, I had a kitty with stage 4 CKD two years ago and the subcutaneous fluids seemed to help him feel better and eat just a little. If you have someone to help you with it it isn't that hard. A little difficult if you are on your own but I did do it myself a couple of times.