Phosphorus binder questions

Twylasmom

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Twyla was just prescribed an aluminum hydroxide phosphorus binder (Thriving Pets) for her CKD (late stage 2 with a 6.1 phos level) and I am a little confused on the dosing. My vets instructions were to give 1/4 tsp in every meal, regardless of how many meals. On Tanya’s site the recommendation is based on weight and phos level so for Twyla (who weighs 10 1/2 pounds) the recommendation is between 1/4 and 3/4 tsp.per day. Twyla likes to eat smaller meals so if I did 1/4 tsp per meal I could easily exceed that. Should I split the difference at 1/2 a tsp per day divided between meals?

On the Thriving Pets website they recommend mixing the binder and water with the food and letting it sit for fifteen minutes before feeding. Is that what you all do or do you just mix it in and serve? The wait time is supposed to let the binder fully dissolve and not be noticeable taste wise.
 
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FeebysOwner

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I started to give Feeby, who had a 6.0 phos level & creatinine at 3.0 at last blood testing, 1/8 tsp (~125 mg) of Phos-Bind (35gm powder, as the 'strength' matters too) per day, as a precaution - and this was for a cat that was at the time weighing 11.5 pounds. This was also something the CKD forum, and Tanya's web site seem to agree with. The Phos-Bind is supposed to be odorless and tasteless (I've tasted it and it seems to be true, at least to a human). Never read anything about Phos-Bind requiring some sort of set-up period. In fact, I just mix the powder thoroughly into her food. But Phos-Bind is a bit grainy - so, I suppose all of the phos binder products are and perhaps that is the reason for the set-up time.

If you really want to split it equally - assuming some of these meals involve the same food, add the amount of phos binder to the total, and then when you split the food into different meals, you are also splitting the binder accordingly.

I can't speak to the total amount to give regarding Thriving Pets because they all do vary. But, if you go on the low side, and she eats it regularly, you can check her phos level in about 4 weeks and see where it is - and adjust accordingly. There is no perfect answer without testing what does and does not work for your cat. There are also mini-measuring spoons that enable you to go much lower than 1/4 tsp. I got the ones that were recommended on Tanya's web site.
 
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Twylasmom

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I started to give Feeby, who had a 6.0 phos level & creatinine at 3.0 at last blood testing, 1/8 tsp (~125 mg) of Phos-Bind (35gm powder, as the 'strength' matters too) per day, as a precaution - and this was for a cat that was at the time weighing 11.5 pounds. This was also something the CKD forum, and Tanya's web site seem to agree with. The Phos-Bind is supposed to be odorless and tasteless (I've tasted it and it seems to be true, at least to a human). Never read anything about Phos-Bind requiring some sort of set-up period. In fact, I just mix the powder thoroughly into her food. But Phos-Bind is a bit grainy - so, I suppose all of the phos binder products are and perhaps that is the reason for the set-up time.

If you really want to split it equally - assuming some of these meals involve the same food, add the amount of phos binder to the total, and then when you split the food into different meals, you are also splitting the binder accordingly.

I can't speak to the total amount to give regarding Thriving Pets because they all do vary. But, if you go on the low side, and she eats it regularly, you can check her phos level in about 4 weeks and see where it is - and adjust accordingly. There is no perfect answer without testing what does and does not work for your cat. There are also mini-measuring spoons that enable you to go much lower than 1/4 tsp. I got the ones that were recommended on Tanya's web site.
This is helpful. Upon digging, Thriving Pet provides a link to Dr. Nagode’s
Dosage Protocol and based on Twyla’s phosphorus level and weight she would need about 500 mg per day divided between meals, and there is a link to the spoons. Thriving Pets is 1200 milligrams per teaspoon. So based on my math between 1/4 and 1/2 a teaspoon should be a good daily amount - right? No one told me their would be math! Twyla has a follow up visit on July 1 to recheck bloodwork already scheduled.
 

FeebysOwner

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1/4 of a tsp would be 300mg, so just from my personal conservative viewpoint on feline meds, I would say that is a bit high. I would certainly do NO more than that for a whole day. I still contend that starting slow and adjusting thereafter based on bloodwork is the best way to go.

Yes, sadly math is involved - every time I turn around!!!!
 
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Twylasmom

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1/4 of a tsp would be 300mg, so just from my personal conservative viewpoint on feline meds, I would say that is a bit high. I would certainly do NO more than that for a whole day. I still contend that starting slow and adjusting thereafter based on bloodwork is the best way to go.

Yes, sadly math is involved - every time I turn around!!!!
Based on the info linked from Thriving Pets the Dr.Nagode doses tend to be more generous than what others may suggest. Tanya’s site seems to back that up. I think I will start out on the conservative side especially since I have concerns about constipation. I have already ordered the smaller spoons since that should be helpful with those tiny amounts. I trust my vet, but they didn’t give any guidelines on dosage as compared to number of meals, which was a bit frustrating.
 

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I think I will start out on the conservative side especially since I have concerns about constipation.
IMO, wise choice! Just have some Miralax on hand if you notice anything 'suspicious' in the litter box. Usually, a small dose of about 1/4 tsp a day - when needed - should do the trick. Keep us posted.
 

babiesmom5

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How was Twyla's phosphorus value at your followup on July 1 Twylasmom Twylasmom ? I ask because my cat was recently started on the Phosphorus binder from Thriving Pets too. Her Phosphorus was 6.4 and her weight is 3.1 kg (6.82lb.). According to my calculations from the Dr. Nagode's Protocol, she would get 310 mg powder or about 1/4 tsp/day. I was going to split this into two 1/8 tsp dosages in the food. My vet said my calculation is right, but said because the food I am feeding is regular cat food, (not kidney food as she won't eat it), he said to give her 1/4 tsp Phosphate binder twice a day. This has caused some constipation.
Just wondering how your cats values were on July 1. Thank you.
 
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Twylasmom

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How was Twyla's phosphorus value at your followup on July 1 Twylasmom Twylasmom ? I ask because my cat was recently started on the Phosphorus binder from Thriving Pets too. Her Phosphorus was 6.4 and her weight is 3.1 kg (6.82lb.). According to my calculations from the Dr. Nagode's Protocol, she would get 310 mg powder or about 1/4 tsp/day. I was going to split this into two 1/8 tsp dosages in the food. My vet said my calculation is right, but said because the food I am feeding is regular cat food, (not kidney food as she won't eat it), he said to give her 1/4 tsp Phosphate binder twice a day. This has caused some constipation.
Just wondering how your cats values were on July 1. Thank you.
I can’t be much help. Twyla’s phos went down to 4.4 on July 1, but I ended up not using the phosphorus binder on a regular basis since she was eating about 75% prescription dry food. Unfortunately her hyperthyroid meds dropped her thyroid levels to below normal levels and I spent the last couple of weeks of July trying to get her to eat anything as she went off the dry. I wasn’t using the phosphorus binder and her phos went up to 5.4 on August 1. However, she is back to eating the prescription dry as most of her diet so that should help get the phosphorus back under control (she has also started subq fluids). If I feed her non prescription wet food that is higher in phosphorus I will put in 1/16 to 1/8th of a teaspoon in that a long as it isn’t within a couple of hours of her eating her prescription food, which contains potassium citrate (apparently aluminum hydroxide shouldn’t be given with the citrate.)

The important thing is to get the phosphorus levels checked after a few weeks to see how it is working for your cat. And Miralax as needed, of course.
 

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Thank you for your response. I have a follow-up appointment with the vet in about 6 weeks. Fortunately, your kitty will eat prescription food, but at 21 1/2 years old, my vet said to feed her whatever she will eat.
It's a juggling act for sure with meds, fluids, food, supplements etc.
 

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B babiesmom5 - I can't speak to the Thriving Pets brand of phosphorus binder, as I bought Phos-Bind. I have not given Feeby (18+yo) routine phos binder, but she weighs 12 pounds, and her last phos count was 5.9 as of 6/21 with a creatinine of 2.9.

According to what I was advised by the CKD group on io., a dose per day of at least 1/8 tsp would be sufficient to start off with - with testing 30 days out if given daily. Feeby will not eat kidney diet foods either. And based on their low protein level, they are not appropriate for elderly cats, even those with CKD.

Do you use Tanya's website at all? Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org)
 

babiesmom5

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Thank you for your helpful response. The dosage the vet recommended has caused constipation, so I think I'm going to slow the Phosphate binder to 1/8 tsp twice a day to start, not 1/4 tsp twice a day.
Yes, I do use the Tanya's website; very informative. Thanks!
 

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The dosage the vet recommended has caused constipation, so I think I'm going to slow the Phosphate binder to 1/8 tsp twice a day to start, not 1/4 tsp twice a day.
A lot of folks report having to give their cats Miralax, or something similar, to offset the effects of phosphorus binders, even at lower doses.
 

babiesmom5

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I have Miralax, but it is a fine line with my cat. She also has IBD and it doesn't take much to precipitate diarrhea. I see some using Epikitin which perhaps doesn't have the constipating side effect. Do you have any insights on that?
 

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I see some using Epikitin which perhaps doesn't have the constipating side effect.
I thought I had heard it didn't taste very good, but that doesn't seem to be the case when I look at Tanya's web site. The only thing I know about it is that it a calcium-based product, unlike Phos-Bind and others that are aluminum hydroxide based. So, a cat's calcium level needs to be taken into consideration. Tanya's web site has a section that discusses Epakitin.
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease -All About Phosphorus Binders (felinecrf.org)
 
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