Cat With End Stage Kidney Disease Questions

[Cesrenia]

Hey all. Brand new to this forum or any cat forum. I'm a cat owner to 4 geriatric cats so it's been a rough ride. My Taqui is 14. He has end stage kidney disease. He has also had bladder infections over the past 3 years. He's been on daily fluids administered by me for months now. He's done very well and lasted much longer than they've expected. I have not wanted to prolong any suffering so I give him Pepsid every day for upset stomach which has happened twice over the past months, pretty good I think. Last couple of months he's been very annoying and vocal especially for food. I think it's dementia.H has definitely lost muscle tone but seems to have more energy which I can't understand. I've been feeding him whatever cat food he'll eat and he never seems to get enough which I thought most CRF cats don't eat well. Anyway, I noticed a pus ball in the urine today and I'm concerned because I haven't seen this before. I guess I'm really afraid of what's going to happen when the end is near because I WANT to spare him suffering and he has seemed to me to be content so far. The vet has seen him so much and I'm not sure what else they can do for him, but I'll probably call anyway to let them know. Anyone have symptoms to share that they noticed towards the end? And any advice please? I'm so worried because I've heard it can be traumatic and very horrible, and I do not want that for him. Thanks!!

 

[Jem]

First, I'm so sorry you and your kitty are going thru this. CKD is terrible.

Have you ever come across this website?
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat

It is a fantastic website that gives you so much information on CKD and the various possibilities and complications with the disease. I referred to this site all the time when my boy was sick.

As for your questions, my boy, Toby, at the end of his time, displayed pretty standard symptoms. He ate less and less, then started to drink less and less. He then was weak and hardly was able to move round and soiled himself. When this started to happen, we knew it was time for him, as we already knew we had done everything possible for the treatment of CKD. He unfortunately developed CHF and ascites, which the treatment for is completely opposite to CKD and the treatments for both counter act the other. At this point we just kept him comfortable, then when the end was near (symptoms listed above), we let him go.
We already had some pain medications on hand from our vet so that if his end was near and we were not able to get him to the vet in a timely manner, we at least could keep him comfortable until we could get him in. That could be something to consider for your kitty.
We kept our boy going well for almost a year in end stage, so don't go by what stage he is in for your reasoning for letting him go. Listen to him, pay attention to his symptoms. If he's still eating and drinking, still loves your company, is not in pain and still uses his litter box, personally I don't think he's ready to go yet.
I would bring him to the vet and see about treating this possible infection. Maybe a culture would be in order to make sure you get the infection gone for good. I mention this as you said that he has had several infections, maybe the first time it never really went away because the right antibiotic was not used, and it's the same one that keeps coming back.
With Toby, he was prone to mouth and tooth infections, we had to give him antibiotics multiple times for his mouth, but when the infection was gone he would bounce right back. So I personally would not consider an infection a reason for letting him go, if "the proper" round of antibiotics is all it takes to get him back on track. Again, this is just my opinion, I don't know your cat and am basing this on my own experience, knowing that my Toby still had a good quality of life when his mouth wasn't bothering him.

Anyway, I hope I helped you a bit, but please check out the website link. It really is a great source of information.
All the best!

 

[Mamanyt1953]

Something that may help you monitor his quality of life, and take the heartbreaking emotions, at least to a degree, out of the Hard Decision:

The Feline Quality of Life Scale Helps You Determine If It's Time to Say Goodbye to Your Cat | Catster

It won't make it easier, but it will help make it clearer.

 

[Cesrenia]

First, I'm so sorry you and your kitty are going thru this. CKD is terrible.

Have you ever come across this website?
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat

It is a fantastic website that gives you so much information on CKD and the various possibilities and complications with the disease. I referred to this site all the time when my boy was sick.

As for your questions, my boy, Toby, at the end of his time, displayed pretty standard symptoms. He ate less and less, then started to drink less and less. He then was weak and hardly was able to move round and soiled himself. When this started to happen, we knew it was time for him, as we already knew we had done everything possible for the treatment of CKD. He unfortunately developed CHF and ascites, which the treatment for is completely opposite to CKD and the treatments for both counter act the other. At this point we just kept him comfortable, then when the end was near (symptoms listed above), we let him go.
We already had some pain medications on hand from our vet so that if his end was near and we were not able to get him to the vet in a timely manner, we at least could keep him comfortable until we could get him in. That could be something to consider for your kitty.
We kept our boy going well for almost a year in end stage, so don't go by what stage he is in for your reasoning for letting him go. Listen to him, pay attention to his symptoms. If he's still eating and drinking, still loves your company, is not in pain and still uses his litter box, personally I don't think he's ready to go yet.
I would bring him to the vet and see about treating this possible infection. Maybe a culture would be in order to make sure you get the infection gone for good. I mention this as you said that he has had several infections, maybe the first time it never really went away because the right antibiotic was not used, and it's the same one that keeps coming back.
With Toby, he was prone to mouth and tooth infections, we had to give him antibiotics multiple times for his mouth, but when the infection was gone he would bounce right back. So I personally would not consider an infection a reason for letting him go, if "the proper" round of antibiotics is all it takes to get him back on track. Again, this is just my opinion, I don't know your cat and am basing this on my own experience, knowing that my Toby still had a good quality of life when his mouth wasn't bothering him.

Anyway, I hope I helped you a bit, but please check out the website link. It really is a great source of information.
All the best!

Thank you so much, this really makes me feel better. He does still act like he feels well so by no means do I think he's ready to go. I just wondered if this was a sign of the real end. But I'll take him and let them check him out, it could be the infection back again. I have read that article and it's very informative, thank you!

 

[Cesrenia]

For anyone interested in an update. Since he has battled bladder infections for so long they wanted to do a urinalysis and blood test. And of course his white blood cells were up a bit (which is usually when he's getting an infection) so he's on Orbax for that. His creatinine was down a bit which is good news! BUT he's anemic so they want me to give him a vitamin b supplement. Any suggestions as I've heard some cats don't like the taste and I just hate to force one more thing on the poor guy as he's been through so much. Thanks for any advice!!

 

[silkenpaw]

You can give the B vitamins with his SQ fluids. (You need an injectable preparation but they are cheap). They sting if undiluted, so you have to inject them slowly through the port while the fluids are running. Don’t add them to the bag, they are light-sensitive.

Also, all my renal failure cats got erythropoietin (brand name Epogen or Procrit) for anemia. It’s a hormone that the kidneys normally make; it’s necessary for red blood cell production.

 

[Cesrenia]

Thank you!!

 

[Leomc123]

Well from my experience which was very short was MC started drooling out of the blue oneday, and stopped eating and only drank water. After 4 days the vet said that she was in end stage kidney failure. She was 19 years old and was a bouncy cat for her age and then suddendly she went down hill in 4 days.

 

[Libby.]

For anyone interested in an update. Since he has battled bladder infections for so long they wanted to do a urinalysis and blood test. And of course his white blood cells were up a bit (which is usually when he's getting an infection) so he's on Orbax for that. His creatinine was down a bit which is good news! BUT he's anemic so they want me to give him a vitamin b supplement. Any suggestions as I've heard some cats don't like the taste and I just hate to force one more thing on the poor guy as he's been through so much. Thanks for any advice!!

I have my Patches on Vita B-Plex by RX Vitamins, I order it from Amazon. It's bacon flavored and she doesn't fight me when I give it to her. She's 14 and was dealing with some liver issues and at one point was anemic too so I gave her 1/2 capsule of Solgar's Gentle Iron once a day too, along with 1/4 teaspoon of liver powder mixed in with all her liver support supplements to help disguise the yuckiness.

I've been reading up on renal disease and have found many articles supporting the addition of coQ10 to keep the numbers down. It lowers bilirubin, creatinine and BUN levels. I would get him started on 200mg CoQ10 right away.

https://www.tandfonline.com/doi/abs/10.1080/1359084031000095002

 

[white shadow]

I've been reading up on renal disease and have found many articles supporting the addition of coQ10 to keep the numbers down. It lowers bilirubin, creatinine and BUN levels. I would get him started on 200mg CoQ10 right away.

The reference you offered there, L Libby. , was a human study from 2003. Perhaps the dosage you suggested was also human-based........

There's extensive coverage of Co-enzyme Q10 (CoQ10/ubiquinol/ubiquinone) use in cats with kidney disease on the reputable 'Tanya's CKD Guide" site.....including some notes on dosing which includes this

A possible starting level would be 10mg a day for a 15 lb cat, though some people give higher amounts.....Holisticat recommends 30mg a day for cats with heart disease, though some people find their cats have stomach upsets and diarrhoea at this level, so you might want to start lower and increase the dose gradually.
[my emphasis]​

Tanya's CoQ10 coverage can be found here: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Treatment of Waste Product Regulation Problems
.

 

[Cesrenia]

Thanks, I'll check it out! Y'all are very helpful!

 

[Libby.]

The reference you offered there, L Libby. , was a human study from 2003. Perhaps the dosage you suggested was also human-based........

There's extensive coverage of Co-enzyme Q10 (CoQ10/ubiquinol/ubiquinone) use in cats with kidney disease on the reputable 'Tanya's CKD Guide" site.....including some notes on dosing which includes this

A possible starting level would be 10mg a day for a 15 lb cat, though some people give higher amounts.....Holisticat recommends 30mg a day for cats with heart disease, though some people find their cats have stomach upsets and diarrhoea at this level, so you might want to start lower and increase the dose gradually.
[my emphasis]​

Tanya's CoQ10 coverage can be found here: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Treatment of Waste Product Regulation Problems
.

Yes, it is a large dose, but I gave Patches 200mg of CoQ10 daily to bring down her liver enzymes along with 280mg (70mg 4x day) of Sam-e and 780mg (195mg 4x a day) of milk thistle when she had hepatic lipidosis. I also threw 200mg of medicinal mushrooms at her twice a day. The vet calls my Patches her miracle cat because she honestly did not think she would live but her enzyme values came down at each check-up. And dramatically too. If I had a cat with kidney disease, I wouldn't hesitate to give it 200mg of coQ10. Back in the '80s I had a 7-year-old cat diagnosed with hypertrophic cardiomyopathy that I healed in 6 months by giving him 60mg of CoQ10 daily. The smallest dose I could get at that time was 30mg and I dosed him twice a day. He lived until he was 18. I wish I had known that it was good for the kidneys and I might have had him around a couple of years longer.

I am giving Patches 100mg of CoQ10 as a maintenance dose which she'll continue to get along with 195mg of milk thistle and 100mg Sam-e and 200mg of the 10 medicinal mushroom powder to support her liver.

The rule of thumb with coQ10 is around 3x your weight at minimum and more in acute or more severe cases. Human cardiac patients take upwards to 800mg or more.

Best CoQ10 for Cats & Dogs | Coenzyme Q10 Benefits

This product Purrfect Pet CoQ10 contains 50mg of Ubiquinol which is the equivalent of 100mg of ubiquinone. Ubiquinone is usually cheaper.

 

[Cesrenia]

Yes, it is a large dose, but I gave Patches 200mg of CoQ10 daily to bring down her liver enzymes along with 280mg (70mg 4x day) of Sam-e and 780mg (195mg 4x a day) of milk thistle when she had hepatic lipidosis. I also threw 200mg of medicinal mushrooms at her twice a day. The vet calls my Patches her miracle cat because she honestly did not think she would live but her enzyme values came down at each check-up. And dramatically too. If I had a cat with kidney disease, I wouldn't hesitate to give it 200mg of coQ10. Back in the '80s I had a 7-year-old cat diagnosed with hypertrophic cardiomyopathy that I healed in 6 months by giving him 60mg of CoQ10 daily. The smallest dose I could get at that time was 30mg and I dosed him twice a day. He lived until he was 18. I wish I had known that it was good for the kidneys and I might have had him around a couple of years longer.

I am giving Patches 100mg of CoQ10 as a maintenance dose which she'll continue to get along with 195mg of milk thistle and 100mg Sam-e and 200mg of the 10 medicinal mushroom powder to support her liver.

The rule of thumb with coQ10 is around 3x your weight at minimum and more in acute or more severe cases. Human cardiac patients take upwards to 800mg or more.

Best CoQ10 for Cats & Dogs | Coenzyme Q10 Benefits

This product Purrfect Pet CoQ10 contains 50mg of Ubiquinol which is the equivalent of 100mg of ubiquinone. Ubiquinone is usually cheaper.

Wow, thanks for this info about your success, definitely something I'll be looking in to.

 

[Libby.]

Yes, it is a large dose, but I gave Patches 200mg of CoQ10 daily to bring down her liver enzymes along with 280mg (70mg 4x day) of Sam-e and 780mg (195mg 4x a day) of milk thistle when she had hepatic lipidosis. I also threw 200mg of medicinal mushrooms at her twice a day. The vet calls my Patches her miracle cat because she honestly did not think she would live but her enzyme values came down at each check-up. And dramatically too. If I had a cat with kidney disease, I wouldn't hesitate to give it 200mg of coQ10. Back in the '80s I had a 7-year-old cat diagnosed with hypertrophic cardiomyopathy that I healed in 6 months by giving him 60mg of CoQ10 daily. The smallest dose I could get at that time was 30mg and I dosed him twice a day. He lived until he was 18. I wish I had known that it was good for the kidneys and I might have had him around a couple of years longer.

I am giving Patches 100mg of CoQ10 as a maintenance dose which she'll continue to get along with 195mg of milk thistle and 100mg Sam-e and 200mg of the 10 medicinal mushroom powder to support her liver.

The rule of thumb with coQ10 is around 3x your weight at minimum and more in acute or more severe cases. Human cardiac patients take upwards to 800mg or more.

Best CoQ10 for Cats & Dogs | Coenzyme Q10 Benefits

This product Purrfect Pet CoQ10 contains 50mg of Ubiquinol which is the equivalent of 100mg of ubiquinone. Ubiquinone is usually cheaper.

I remember the reason why I gave Patches 200mg of CoQ10 because I found a study with rats and liver damage and the rats were given 50mg/kg. So that worked out to around 200mg for my Patches who weighed around 9.5lbs at the time.

The Effect of Co-Enzyme Q10 on Acute Liver Damage in Rats, a Biochemical and Pathological Study

 

[Cesrenia]

Update on Taqui. He's very anemic, even with giving the Pet-tinic recommended by vet his anemia only went down a point. Afraid to use anything else not recommended by the vet for now for his anemia. They said he's not at blood transfusion level yet though. But for his infection that keeps coming back we did a culture to find out exactly what bacteria he has so we can pinpoint what antibiotic works best. I can't remember exactly what bacteria he has but it's sorta rare (of course)! So he's on Simplicef for that for 3 weeks. Also his veterinarian is in awe of how well he's doing despite his horrible bun and creatinine levels. He has had absolutely no throwing up which in the words of my vet said "he should be throwing up his toenails with those levels". (I give him 1/4 10 mg pepsid pill a day in case he's nauseous.) But somehow (thank God seriously) his body is making up for something so he's extra hungry and has actually gained weight instead of losing it which is total opposite for CKD cats. I've also been giving him 2ml of Pet Well-being kidney support gold once a day but I have no clue if it's doing anything because I can't tell any difference.

 

[Cesrenia]

Another update. The Simplicef didn't help because his white blood cell count is way up and he also has red blood cells in his urine meaning the infection is back. Did a full blood test and found out bad news, he's diabetic. His glucose was 600. That makes sense why he's peeing so much more and on my walls. They're going to start him on insulin and give a Convenia injection for his infection. Poor guy. It does make sense though why he's been so hungry lately. Although last blood test his glucose was normal. Trying to give him k/d diet but he wants junk food and at the time the vet told me give him whatever he will eat. He's also on Cerenia for nausea. Any extra advice anyone has? I trust my vet, she's really knowledgeable and has been giving me all the info she can.
Also she prescribed Glargine insulin (Lantus) which is very expensive. I can't find anything cheaper in my area for less than $300 a vial!! Yikes!! I need to open a go fund me page for poor Taqui. Anyone have any advice on how to get this medication cheaper or anything, please I'm desperate? I hate not fighting for him because of money. But it might come to that eventually. This sweet kitty of mine has cost me so much already but it's all been worth it for a good quality of life. Thanks in advance!

 

[Cesrenia]

Another thing. I'm just looking at the Pet-tinic I've been giving him for his anemia and the first few ingredients are corn syrup, water and sugar... I do not want to give this with his high blood sugar..

 

[Jem]

Obviously talk to your vet about this first, I'm just throwing out ideas here.
First, your vet is right that, especially at end stage, it more important that Taqui eats anything rather than not much of the CKD food.
Also, new(er) research shows that low phosphorus is what is important, not necessarily the low protein that is usually associated with the prescription foods.
So on that note. This is a link to a list of wet cat foods that also show the phosphorus content of each.

https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

This link also includes the carbohydrate content, which you could also look into for the diabetes.
You could perhaps save some money on getting a less expensive food that has lower carbs and phosphorus, which may help offset the expense of the insulin. It might not be much but it could still help. And perhaps with a lower carb food, you'll be able to get her levels a bit lower that you won't need to give her as much insulin so a vile will last longer. IDK, I'm not familiar with insulin/diabetes in cats.
Perhaps it would also be more cost effective to give Taqui a less expensive low carb food, and get a phosphorus binder medication from the vet instead.

As for the anemia medication, you'll have to ask your vet about that. Perhaps the vet has a different medication or solution for the anemia.

 

[Jem]

One other thing, about the nausea. When/if you get some different wet foods. Try to find several different flavors to rotate thru at every or every second meal. Sometimes, the nausea a CKD cat feels is due to the toxicity build up in the kidneys. They then THINK that it's the food making them sick, so they will refuse the food they just ate a meal prior. But by rotating different flavors, it helps to stop that cycle a bit. We had 7 different wet foods and 3 different dry foods for my Toby to eat, and it really helped. He only stopped eating if he crashed (which was fixed with more fluids), if he had a mouth infection (due to pain) antibiotics fixed it all up, and finally in the last few weeks of his life.

Is the vet positive that Taqui has nausea and it's not a tooth problem?

 

[white shadow]

.
Hi Cesrenia.

For info/advice/coaching on diabetes, I've always heard positive feedback about The Feline Diabetes Message Board.....lots of folks here have participated there and many of them have called the FDMB members "angels". They really know their 'stuff' - and, they're well-informed in feline health generally. I suspect you'll have a solution for the insulin dilemma there - along with the Pet-Tinic too.

Here they are: Feline Diabetes Message Board - FDMB
.