End Stage Kidney Disease Help...

colleen086

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hello everyone!


i’m hoping for some advice in regards to my sweet 16yo cat, luna. a week and a half ago, i took her to our vet because she had dropped a lot of weight, wasn’t eating much and was very lethargic. the vet felt it was most likely her kidneys, gave her sub q fluids, and took bloodwork/urine. she also said that depending on her levels, they might need to hospitalize luna for 4-5 days to give her constant IV fluids & flush out toxins. the next day, she called to say that luna is in kidney failure. her phosphorus level was a 12.6 & the vet said anything over 10 was considered end-stage kidney failure. she did not feel luna was a candidate for the IV fluids because of how high her phosphorus was. we most likely only had a couple days left with her.


i was shattered. i was not expecting her to fade so quickly. i asked the vet if there was some kind of appetite stimulant we could put luna on, and she prescribed Mirataz, as well as subq fluids at home. Ten days later, luna is still kicking & is actually a bit better! This is because i FINALLY found something she will eat, after trying at LEAST ten things. the trick in the end, was KMR. She would not eat any wet foods i gave her [she’s always liked dry better]. She also would only eat a few bites of shredded chicken, tuna or meat baby food. but the KMR she loves. She is still a happy, cuddly, purring cat. As soon as she started eating more, most of her weakness went away.


Frustratingly, i am the one doing ALL of the research to support luna’s end days [or however long she has]. Our vet, who we have gone to luna’s entire life and for other animals too, pretty much seemed to wash her hands of it when she saw luna’s blood results. I was the one who suggested an appetite stimulant, sub q fluids and am also the one who figured out the food situation.


I saw on here that someone tried Azodyl, a probiotic, to decrease the toxins in the body of the cat. Does anyone know of any other things I can do or try to increase luna’s longevity [as long as her quality of life is still good]?


And also, how much KMR does a 5lb cat need in a day? She is SO skinny. I am trying to feed her every 4-6 hours. Thank you so much!

Colleen
 

kittyluv387

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She’s at end stage so maybe 600 mg of combined epa and dha (fish oil) per day? Kidney disease and fish oil has anti-inflammatory properties.

 

Jem

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Are you still doing the sub-Q fluids. We were able to keep our CKD kitty going for 4 years after diagnosis, and the biggest helper was the fluids.
As the toxins build up in the body they will experience nausea and just not feel well. When a cat feels unwell, they will associate their food to that feeling and refuse to eat because they think its the food. The fluids help flush the toxins which keeps their appetite up.
I would look for a variety of low phosphorus foods, you can find some on this list.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
When feeding, give her something different every time, or at least change the food after every can.

When it comes to the fluids, we gave ours 100 mls everyday, until, unfortunately, he developed CHF.
Your kitty CAN come back from this. Ours crashed 3 times over the course of his 4 years with "diagnosed" CKD, and even lived happily and comfortably in end stage for almost a year. And the only treatment he had was a diet change and the fluids (until his final 6 weeks). You can also get a prescription for a phosphorus binder if his levels do not decrease with the diet change and fluids.
I have several years of experience with CKD because of my kitty, so feel free to ask me anything.
I also wonder if maybe a vet change, who is willing to work with you, might be in order.
And Tanya's website, that someone else posted above, was extremely helpful for me as I was trying to navigate his CKD. Do check it out.
 

Docs Mom

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C colleen086 , I'm sorry Luna has CKD. But I too had a kitty, Maggie, who lived 3 & a half years past her diagnosis. Eating well, fluids, and keeping her constipation away was our daily task.

I actually have 2 bottles of phosphorus binder ( available without a Rx ) that I would be happy to send you if it would be useful. Maggie's phosphorus didn't turn out to be an issue for her.
I just lost her a week ago, 3 months short of her 20th birthday..:angel3:. We had a couple of crashes thru the past few years, but she had a really strong desire to stay with us.
The web site mentioned above was a great help ! Particularly by suggesting using Terumo needles that are MUCH sharper than the Monojects the vets give you. Makes it so much easier, 19 ga. 1 " allows the fluids to run quickly.

I wish you good thoughts on this journey, it's worth all the effort ...

Pm me with your address if you can use the phosphorus binders.

Lisa and Maggie
 
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colleen086

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thank you all SO much for such informative, thoughtful posts. i got emotional reading them because i am so thankful you took the time to give me your stories and advice. i have written a lot down, bookmarked different sites you shared to read & most of all, have decided to get luna’s test results and seek a second opinion from another vet. if luna’s previous vet isn’t invested & fighting for her, then i will find someone else who will be. as long as luna wants to be here, & is happy, i will do anything i can for her. she is worth my 100% AND a vet’s 100%.


i am amazed you were all able to keep your kitties going for so long. i don’t know how much longer luna has, but am hoping we can improve her even more.


in regards to different foods, the reason i even tried KMR is because she is having a hard time with dry food. my gut is telling me it’s because her mouth is too dry to eat it easily, but i’m not completely sure. the reason i think that is because she usually loves to try to lick & groom me but can’t right now because of her dry mouth. i have tried four different kinds of dry kibble & several dry cat treats even & every time she will try it the first time, but after one time she isn’t interested in it anymore. the KMR is the only thing so far that she stays interested in. however, about 20 minutes ago, i got her to eat 23 bites of a dry kibble. i’m hoping it’s a sign, but we’ll see how she reacts to it later. i’m hoping if we get her hydrated enough that she’ll get interested in dry foods again since she is SO picky & doesn’t want any wet foods, chicken, tuna, meat baby food etc.


Lisa, i will PM you my address for the phosphorus binder because after research [& asking the new vet i find] i’d like to try it. i am honored that you are willing to share it.


i will look into a probiotic, fish oil, the phosphorus binder, etc. i also posted in a reddit board about feline renal disease & they suggested many of the same things, including the one CKD website & of course a new vet.


luna just got her daily fluids a couple hours ago & is purring in my lap right now with a full belly from the kibble. i told her she is very special to have so many strangers on the internet caring about her.


have any of you fed KMR to an adult cat before? if so, what were your experiences with it? i’m still trying to get her to eat more solid types of foods every single time i feed her, but if KMR is all i can get her to eat, i’m hoping that’s okay.


she is drinking a lot of water & peeing every few hours. she does not seem to be in any pain at all. she is her normal talkative self after bouncing back from not eating. last week i thought i only had a couple days with her, but she is SO much better now.


i wonder if the amount of fluids she’s getting daily is enough. she gets 60ml daily. we started at 100ml every other day, but she seemed to be yoyoing a lot with that, so the vet said we could do this instead. i have questioned if 60 is too low, but she is only 5ish pounds because of her weight loss from not eating. i’m hoping i can get her to gain some weight.


i have started to write down all my questions for the new vet appointment. i don’t know who i’m taking her to yet, but emailed a vet tech friend for a suggestion.


thank you, thank you, thank you.


Colleen
 

Furballsmom

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KMR is ok but can you look into things below as well for more nutrients?

Consider some music for your baby - classical harp music, there's an app called Relax My Cat, and there's MusicForCats . com.

Also, there's chamomile tea for you :)

This might help;
18 Awesome Cat Feeding Tips By Thecatsite Staff Members

Also here is a compilation of things, --you've probably already tried some and gotten advice for others :) so there may be a little bit of duplication;

Try feeding in different locations - really, completely different, and utilize different heights. For example put a couple of books underneath the dish, next time use two thick phone books, or a small-ish box so the heights are varied....

Try sitting with your cat and scoop some food on your finger or a spoon and hopefully your kitty will lick it. Or gently tuck some food inside the cheek.

Try some raw egg yolk. Egg white must always be cooked, and some people cook the white and make a slurry of sorts by adding in the raw yolk.

Also you could try some Nutri-cal or similar product.

Try making these recipes - they're just as viable for an adult cat as for kittens;
Kitten-Rescue.com

These below can be used on their own or combined with food. Also, if you heat the food a little - stir it so there aren't any hot spots from the microwave.

Or you could heat some water, about a tablespoon, and add that to canned food. A small glass works to stir it all up.
  • Chicken, beef or ham flavored (pureed) baby food such as Gerber Stage 2 - make sure there is no garlic or onions in the ingredients
  • Tuna and/or the juice, a low mercury/low/no sodium brand is called SafeCatch
  • Salmon, mackerel
  • Sardines (make sure there are no bones)
  • boiled cut up chicken or turkey with no seasonings
  • canned kitten food any brand
  • Try mixing in Kitten Milk Replacer - there are recipes on the internet or store bought
  • Fish, tuna or BBQ flavored canned wet food (I personally have never seen BBQ flavors, but...)
  • Lickable cat treats or pouch treat 'gravy' poured over the food
  • kitten glop (recipes in website link above)
  • Bonito flakes
  • fortiflora
  • fish oil
  • green beans, asparagus mushed up, lettuce, applesauce, mashed chickpeas, black olives
  • whipped topping such as reddiwhip
  • dry pasta
  • goat milk, or no lactose cow milk
  • whole cooked eggs (the white must always be cooked) or raw egg yolk now and then
  • broth with no salt and no garlic or onion or seasonings of any kind
  • There are also commercial toppers, Applaws is a brand that can work well as a topper
  • Some good treats would be freeze dried Purebites, Orijen, Meowtinis, Meowables, Only Natural Pet, Primal
  • There are also Lickimats that you could spread types of soft food onto, even plain unflavored yogurt, and even freeze it. Licking something can help a cat to feel better emotionally The LickiMat - Food Puzzles for Cats
  • shredded cheddar cheese, string cheese
 
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colleen086

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FurballsMom, thank you so much for the list! i have tried a lot of these, but not all, so i’ve definitely written a few down! i am REALLY hoping to get her off the KMR & onto things that will give her what she needs nutrition-wise, while at the same time be good for her in regards to her kidney disease. as far as i’m concerned, i will take any & all suggestions at this point. i really appreciate you taking the time to help me. you all have been so kind.
 

babiesmom5

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I had a cat with end stage kidney disease (along with diabetes and HCM) that I managed until 20 years old.
Right now I am managing one with IBD and Stage II kidney disease.

The key in my opinion is hydration. My stage II kitty has remained stable in stage II for over a year. I credit this to my vet prescribing 1/8 of Mirtazapine (appetite stimulant) every 72 hours. This keeps her eating very well and she is not as picky. She only gets food in pouches containing a lot of liquids like Wellness morsels, Soulistic, Weruva, BFF. I use the nutritional chart from the Tanya's site using only those foods in pouches with Phosphorus under 1%

I would ask your vet about using an appetite stimulant to make your cat less picky so that you could improve her nutritional status and hydration using pouch foods like above.

An end stage CKD kitty will still need fluids, but getting as much additional fluids in the food will be most helpful.
 
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colleen086

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i wanted to let you all know that i made an appointment with a new vet for tuesday afternoon. a vet tech highschool friend of mine recommended we come to her clinic & see a vet there. i am already a bit more calm today, knowing that we’re goong somewhere else.

i also got luna to eat some kibble last nite & a bit of fish today. going to try again in a few hours, after her daily fluids. it is amazing to me how she was rebounded. i know she is still sick, but i truly believe that when she crashed it was from not eating & dehydration. now to keep her eating & hydrated!!!
 

babiesmom5

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Good for you! I think a new set of eyes looking at Luna will be very beneficial.

As my vet told me, the key to the kidney cats is "keep them eating, and keep them hydrated"!
 

stephanietx

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Have you tried mixing the KMR with either canned kitten food or some other canned food. Have you tried the old classic Fancy Feast? Most kitties will eat Fancy Feast and I know many CKD owners who feed that because it's what they'll eat. At this stage of the game, you just want them to eat, drink, and pee. You might find that she becomes constipated, which is a side effect of CKD. So keep an eye on things.
 

Jem

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I'm so happy she seems to be feeling better!!! I'm also glad you may have found a vet that will work with you!
And I totally agree that the fluids are the key to keeping a CKD cat going. Keep up the good fight, I'm rooting for both of you! And please keep us posted on what the new vet says and how Luna is doing.
 

kmoulus

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My vet just called to tell me that Speedy is in kidey failure, and I came straight to this site. I feel like I could be reading about Speedy, everything you described for Luna is almost exactly the same - except Speedy is almost 18 and also has HCM/CHF.

I went to the vet yesterday about the weakness in her hind legs and loss of appetite, I thought it was arthritis. The blood work came back today and it is not good. The doctor says Speedy's kidney failure is severe, probably stage 3 of 4.

Her phosphorus is super elevated. In October Speedy’s B1 was elevated and her creatine was 2.0, which the vet feels is OK for a 17 yo cat. At that time, her phosphorus was 4.8 and now it is 16, so that is very bad. Her sodium and potassium are fine right now.

The vet thinks she probably needs subcutaneous fluids but only a little as it can mess with her heart. We’ll do maybe 20 ml a couple times a week (she's only a little over 5 lbs, just skin and bones). The big question is will Speedy allow me to stick her with a needle. My vet also talked about a hormone we could try vs. phosphorus binders. She said 90% of cats hate taking it. She said it comes in a liquid but she is going to do some research to see if it comes in a powder or pill, because Speedy takes pills quite willingly. Does anyone know of a pill, or anything about this hormone?

We will also need to adjust her heart medicines, which overall have been doing a great job for many years and her heart rate is great. My vet thinks the cardiologist will want to reduce the Lasix and maybe adjust her pimobendan and atenolol. I have no idea how those affect the kidney but my vet says that it is really amazing that Speedy has lived with heart disesase and all these medicines for so many years and yet her kidneys remained stable until now.

My vet dodged the question about how much time Speedy might have. She did say kidney failure is the number one cause of death for elderly cats and it is not unexpected. Her goal is not to improve Speedy’s numbers for the sake of numbers, but just to make Speedy feel better so she’ll eat.
 

kmoulus

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Update: In the time it took me to write that post, my vet did some research and Wedgewood is going to make a soft chew phosphorus binder, which will be easier for Speedy to take. So now we wait for the cardiologist to weigh in before deciding about sub q fluids.

I'm so sad.
 

kmoulus

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Oh my, it looks like there is nothing more we can do for Speedy. Her cardiologist says what she really needs is IV fluid treatment but he is pessimistic about her heart disease. After consulting with my regular vet, I took Speedy to the pet ER but the advised against treating her. Based on her high levels (urea 148, phosphorus 16, creatinine I think was 6.8) they would normally treat her but the emergency vet feels that the treatment is much more likely to push Speedy into heart failure than it is to help her kidneys. They think she could only tolerate about 1/4 or the normal treatment and it wouldn't be enough.

Based on that advice, I took her home for palliative care. They didn't even charge me for the visit, just for some meds. They gave me a little mirtazepine (?) and aluminum hydroxide to last a few days, until Wedgewood ships my order. But the doctor said based on what she sees, Speedy probably has a few days left. The tech said maybe a bit longer, as "cats don't always read the book." My regular vet is slightly more optimistic that the phosphorus binder can be of some help, but I don't know.

I think I'm OK with this. It is very important to me that Speedy not spend her final days frightened in a hospital and I don't want her to die alone in a cage. When the time comes my vet will come to the house to put Speedy to sleep. I'm not sure how I will know when, but I think it's soon.

Of course I have a million regrets, it particular I wish I had spotted her symptoms sooner, I thought she was losing wight because she was old and I thought she had arthritis in her hind end when really she was weak from kidney failure. I wish I had paid more attention, taken her to the vet sooner. I am not sure how to come to terms with my failure on this. But I am OK with taking her home now.
 

kittyluv387

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Oh my, it looks like there is nothing more we can do for Speedy. Her cardiologist says what she really needs is IV fluid treatment but he is pessimistic about her heart disease. After consulting with my regular vet, I took Speedy to the pet ER but the advised against treating her. Based on her high levels (urea 148, phosphorus 16, creatinine I think was 6.8) they would normally treat her but the emergency vet feels that the treatment is much more likely to push Speedy into heart failure than it is to help her kidneys. They think she could only tolerate about 1/4 or the normal treatment and it wouldn't be enough.

Based on that advice, I took her home for palliative care. They didn't even charge me for the visit, just for some meds. They gave me a little mirtazepine (?) and aluminum hydroxide to last a few days, until Wedgewood ships my order. But the doctor said based on what she sees, Speedy probably has a few days left. The tech said maybe a bit longer, as "cats don't always read the book." My regular vet is slightly more optimistic that the phosphorus binder can be of some help, but I don't know.

I think I'm OK with this. It is very important to me that Speedy not spend her final days frightened in a hospital and I don't want her to die alone in a cage. When the time comes my vet will come to the house to put Speedy to sleep. I'm not sure how I will know when, but I think it's soon.

Of course I have a million regrets, it particular I wish I had spotted her symptoms sooner, I thought she was losing wight because she was old and I thought she had arthritis in her hind end when really she was weak from kidney failure. I wish I had paid more attention, taken her to the vet sooner. I am not sure how to come to terms with my failure on this. But I am OK with taking her home now.
I’m so sorry to hear. But you seem really brave. Enjoy your time with Speedy and spoil him like crazy!
 
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