Getting Ckd Cat In End Stage Renal Disease To Eat

[missko]

Hi all, my Mao will turn 17 this Friday. She was diagnosed with CKD in August 2014 after receiving I-131 treatment for hyperthyroidism in July 2014. Since then, a host of other ailments have cropped up and she has been on a litany of drugs, fluids and supplements (listed at the bottom of this post). Tanya's site has become our manual, and we have been able to stabilize her after prior crashes, although creatinine levels have crept up over the past three years.

In the middle of July, Mao crashed again. In the ER, her creatinine was 5.5. A few days later at her recheck, it was 5.1. We started darbepoetin (Aranesp) and iron injections for anemia didn't respond to 2 years of vitamin B and liquid iron supplements. She seemed a little slower after each darbepotein shot.

Last Monday, Mao went for a darbepoetin recheck, and her blood pressure 230 (vs 170-190 for the past year), her creatinine was 6.1 (vs 5.1 last month), BUN 96 (vs 67 last month). The vet says she is in end stage renal failure, which is causing the listlessness and inappetance and that her blood pressure requires medication. That day, Mao started amlodipine.

Since last Monday when Mao started amlodipine and got her 3rd shot of iron and darbepoetin, she has been doing poorly. I thought she was done for when she spent a day with her head down, eyes downcast, unresponsive. Mostly, she is alert, her head perks up in excitement when we offer a treat; however, she has been eating less.

Mao has been a champion eater her whole life - indiscriminate eater of everything. Since CKD, she appetite has waned. We have been using "natural" options to pique her appetite - homemade chicken broth, sashimi, canned tuna, Fancy Feast, cat treats. After the July crash, we started her on mirtazapine, it worked like magic, she would hoover food down within 30 minutes of dosing and didn't need Pepcid, cerenia or slippery elm. Since last week's dosing of darbepoetin, iron and amlodipine, mirtazapine + cerenia + Pepcid + slippery elm hardly do a thing for her appetite. We have resorted to syringe force feeding, which makes her quite upset.

The vet pins Mao's lethargy and lack of appetite on her CKD. Perhaps that crash in July was the beginning of a downward spiral. It all seems so sudden and shocking given she was chugging along fairly steadily. She has a 3rd degree a/v block, a slow heart rate and cannot tolerate anesthesia so putting her on a IV in the hospital is a non starter.

My questions are related to her eating and whether anyone has had adverse reactions to blood pressure medication, darbepoetin or iron shots
1) How do I get this animal to eat?
2) What have other members' experiences with darbepoetin been?
3) Has anyone heard of amlodipine causing such a severe reaction?

Thanks!


Protocol
Hills k/d food
LRS 150mL / day
1/8 tsp potassium daily
1/2 Pepcid daily
3.75mg mirtazapine every 3 days
8mg Cerenia every daily
0.625mg amlodipine daily
Slippery elm daily
Vitamin B daily

 

[babiesmom5]

I am so sorry to hear about Mao. From your detailed description of treatment protocol, I think you and your vet are doing everything possible for a cat with CKD. I do commend you.

I will answer your questions based upon my experience with two different cats, both now passed. One cat had CKD. The other cat had moderate to severe non-regenerative anemia secondary to chronic inflammatory disease.

The CKD kitty was on pretty much the same protocol as yours is on now. The amlodipine did control the blood pressure which was important as she also had heart disease (Hypertrophic Cardiomyopathy). I did not notice any ill effects of amlodipine. It did its job in controlling blood pressure without noticeable side effects.

The other cat who had multiple blood transfusions, was on darbepoetin for most of a year. It was what kept him alive. I did not notice any ill effects from the darbepoetin at all. He got injections monthly and then at the end, weekly.

As for how to get Mao to eat, the protocol she is on should be doing everything possible to counter the nauseous effects of CKD, IF the nauseous/inappetence is indeed still controllable. At some point in the disease, they "hit a wall". Whether Mao is there or not is best determined by you and your vet. Once they hit that wall, short of an esophageal tube being placed, there is no way they are going to take in sufficient calories/nutrients by mouth.

You are doing syringe force feeding, which is commendable, but at some point, you have to focus on quality of life issues. I know how hard this is, believe me. I really think you do all you can for them medically, and then, out of love and compassion, honor their wishes.

Mao is very lucky to have such a loving, devoted parent as you. My thoughts are with you.

 

[Antonio65]

Hi all, my Mao will turn 17 this Friday. She was diagnosed with CKD in August 2014 after receiving I-131 treatment for hyperthyroidism in July 2014.

I'm deeply sorry for your Mao!!!

And I'm sorry for hijacking your thread for a question that sits outside your current concern, but I have read that Mao got CKD after the I-131 treatment.
Can I ask you what her thyroid and renal levels were when you had her treated? Was she already in an early stage of CKD? Did the doctors at the radio facility tell you anything about the chance Mao might get a CKD?

 

[missko]

Thank you so much, babiesmom5, for sharing your experience with your kitties on amlodipine and darbepoetin. I am hoping that the syringe feeding will give her the nourishment to turn the corner as she has done before. She is still alert and responsive, but I am fearful this might be the end as she is eating less and less on her own. I think the feeding tube is where I will wave the white flag for my darling girl.

Antonio65, I presume you ask about I-131 for your Pallina. Would I do I-131 again? No, I absolutely would not. It is not reversible. Once her thryoid function was decreased, it never grew back. How does the vet know how much I-131 to give? It's a judgement call. Unlike methimazole, the vet can't titrate I-131. Use too little and the vet does the expensive procedure again or the cat goes back on methimazole. Use too much and the cat becomes hypothyroid.

Vets say that treating the thyroid "unmasks" the CKD, e.g., treatment does not cause CKD. Mao was on methimazole for ~3-4 weeks to determine whether her kidneys were normal when euthyroid and whether she was a good candidate for I-131. When the thyroid levels were normal, the vet checked her kidney values. Mao's kidney levels were normal on methimazole, so we proceeded with the I-131. Shortly after I-131, the vet detected CKD. Her thyroid became a low functioning thyroid and as of March 2017, she was a little hypothyroid (the vet did not recommend synthroid).

I thought that the I-131 would improve Mao's quality of life versus taking methimazole every 12 hours Since I-131 and worsening CKD, she has been on many, many more pills and sub q's every day. Did she get a better life because of I-131 or a worse life? I would be very careful about undergoing a procedure that is not reversible. Perhaps if she had been on methimazole longer, the CKD would have appeared and the vet would have dosed I-131 differently.

See Mao's creatinine and thryoid levels below (at diagnosis / on methimazole / 1 mo post I-131 / 3 mo post I-131 / 6 mo post I-131) :
Creatinine: 1.2 / 1.4 / 1.6 / 2.1 / 2.3
T4: 13.2 / 1.9 / 0.6 / 1.2 / 1.3