prevention - is it possible?

abbyntim

TCS Member
Alpha Cat
Hi Dr. Kris,

Thank you for your time and expertise this week!

I currently have two almost-five-year old cats, but have had cats previously. I had the sad misfortune to lose most of them to kidney disease, and two were quite young when we lost them. At the time, we managed with sub Q fluids at home, potassium and other supplements when needed, and, towards the end, offering canned and baby food to keep them eating; those cats were free-fed kibble their entire lives.

Other making sure the cats have plenty of water and feeding less kibble, is there anything one can do to prevent kidney problems?
 

dr kris

TCS Member
Guest Expert
Hi! Thanks for the question.

This is something I think about every single day.

It hits home.

I sometimes think was there something I could have done to prevent it in my own cat. Im the vet in the house. Our pets are a family affair, but my little ones and partner look up to me to do the right things for them.

Way back in the 90’s (when I had long hair and occasional facial hair - it was the 90's afterall) I was in graduate school, and part of a team asking the question ‘can fish feel pain’ and ‘are lower vertebrates conscious’. To some, the question of pain and consciousness in animals is a given, to others, it is hotly contested. To make changes to legislature for animal welfare reasons you need ‘proof’.

After 3 years, we rocked it. Solid arguments for the existence of pain and consciousness in fish (most people who still disagree have an agenda and still cant address those arguments). These ideas were published in peer reviewed journals. Effecting what was taught in some classrooms. Compelling arguments stemming neurobiology, evolution and physiology.

We took a wide variety of pre-existing data, combined it, and came out with something that worked to explain it. I hope the same happens for cats and CKD.

Currently I think about CKD as existing in a compensated state (they have it but you cant tell at all or much at all), or non-compensated (they are actively ill).

My goal is to find them in the composted state, and try things to keep them there for as long as possible, which can be quite long indeed. Or, push them back to that status. It’s a daily endeavour of testing and trying new things.  

Still working at it.

k
 

zoneout

TCS Member
Super Cat
 
Currently I think about CKD as existing in a compensated state (they have it but you cant tell at all or much at all), or non-compensated (they are actively ill).

My goal is to find them in the composted state, and try things to keep them there for as long as possible, which can be quite long indeed. Or, push them back to that status. It’s a daily endeavour of testing and trying new things.  

Still working at it.

k
I love your explanation of compensated and non-compensated state - but it raises a question for me.   My issue is I had a cat with what I thought was IBD due to the cyclical nature of the `flareups` in that disease.  For 2 months she would look like a champ then one day puke a hairball and it would spiral down to multiple daily vomiting episodes, inappetance, anorexia, malaise, and severe dehydration.   Slowly I would nurse her back to health (didnt know about subQs at the time - but have now watched and LOVED your video).  Until she got strong again, then 2-3 months later another flareup would rear up and the cycle would repeat.    I understand that IBD and also perhaps Pancreatitis can exist in this cyclical compensated and non-compensated state if you will.   So basically it is useless to use this cyclical active/non-active presentation of symptoms as diagnostic as it could point to any of these 3 diseases?
 

dr kris

TCS Member
Guest Expert
Yes, great question Zoneout!

There are many disease / syndromes where I find myself never naturally talking about being in a compensated / non-compensated states. When I think about it, those condition would be those that are can change rapidly and it is their nature to do so (be cyclical as you have rightly pointed out), or are associated with only decline over time. There are some illness we talk about in terms of remission or on the rise (implying once the flare up is gone, the things that we abnormal become normal again).

Kidneys might fit the description cyclical or decline over time, but more often than not, I see a long, slow burn when caught early. Where less function on bloodwork does not always correlate to less quality of life or longevity. The common quote you might hear about CKD is true - by the time you detect CKD with our current methods, 70% of kidney function is lost. BUT, boy, can these cats work the remaining nephrons for years and years. Those remaining kidney units are hardcore! They are compensating somehow. Keeping them in a state of this compensation is where my thoughts go. Hence "compensated state".

Hope that makes sense!

k
 

dr kris

TCS Member
Guest Expert
PS - for my guy, fluids/food have been cornerstone for his IBD/pancreatitis. It has really worked out well for him, and smoothed out the flare ups!

k
 
OP
abbyntim

abbyntim

TCS Member
Alpha Cat
Thank you for your thoughts and explanation of compensated and non-compensated states. We were able to manage some of our cats for a long time with supportive sub-q fluids so I can see what you mean by that. We got to be quite expert at administering fluids and I think the cats came to enjoy it.

I realize one (or both) of our cats may end up with kidney disease, given the odds. I am hoping with a better diet and hydration we can prevent or prolong this as long as possible. Ideally prevent, but second-best, keep in the compensated state.
 

robinathome

TCS Member
Adult Cat
Thanks Dr. Kris for spending some time here to help us understand.  My little girl Franny 12yrs old is dying.  I had 2 opinions and in the end one doc said Lymphoma and the other said probably Bowel cancer( 2 sonograms showed a small mass) We(me and vets) tried everything. But yesterday she is not eating/drinking anymore.  I have struggled with why didn't I notice her weight loss soon enough.  What could I have done better...I think every person questions themselves.  But I do understand that as much as we try there is no perfect answer.    BUT today my question to you as a professional is when to Euthanize. Franny  is not walking well, In the last 24 hours 2 times she has thrown up a tablespoon of green/gray fluid.  But as soon as she does that she responds to my voice, when I pet her she purrs a little and she is wagging her tail still weakly.  Her eyes are still bright.  My last cat slipped into a coma and then I was able to bring my vet in to give the end shot.  I really hate saying "putting down".    Franny is not in pain, no crying, nothing.  You and your partner have been parents to many animals it sounds like.  This is only my 2nd cat to die.  I am very realistic and ready.  I am home all day and night so I just want her to be comfortable till I have to make the call.  But making it now while she is still responding seems unfair.  Any thoughts would be appreciated.  
 

robinathome

TCS Member
Adult Cat
I am getting ready, then today after I told my vet the situation and to be ready on call he told me to continue the 2ml prednisolone to help keep her comfortable??? Franny was taking Renavast for a week and Pred for 3 weeks.  I did it but not sure why or if I should have.  She still looks alert but in her special place waiting to die.  
 

dr kris

TCS Member
Guest Expert
Is that picture of Franny in your avatar? She is a beautiful cat.

Saying goodbye is the hardest thing. These little creatures represent all the best things in life. Innocence, love, sharing, and just being who you are. When you lose them, it's like we lose a piece of all of those things. Trust your instincts. The timing for your decision might never feel right. Did I do this too early or too late? Everyone asks those questions. The most important question for me is did I make the most of those last days. And you are. You are with her. And that is the right thing to do.

Steven Speilbergs A.I. (2001)

In the last scene, David, gets to go back to his mom. To spend that one perfect last day. Together. It was his only wish. At the end of the day, the curtains are drawn, and that is his last memory. 

That is how I want things to be when it is time for my Zack to go. I want to spend that perfect day with him. I cant ask for more than that. Then I will draw the curtains. The last things he will see is the family who loved him his whole life.

k
 

robinathome

TCS Member
Adult Cat
wow Dr. Kris, thank you so much.  Yes that is Franny just 2 weeks ago when she was up to still hanging out sitting on the scratch pad.  I pray for her passing tonight.  I had a great day just being around her today, all day.  Tomorrow is another day...I will see.  But people like you really help us get through it all.  Thank you again for your support on this website.  Goodnight!
 

goholistic

TCS Member
Top Cat
 
PS - for my guy, fluids/food have been cornerstone for his IBD/pancreatitis. It has really worked out well for him, and smoothed out the flare ups!

k
Interesting you say this! My Sebastian has chronic pancreatitis, and fluids are absolutely crucial in keeping the flare-ups at bay. When I say he gets 100 ml of sub-q fluids every other day, some assume he is in kidney failure. But he is not. It is for his pancreatitis. Staying on topic, I wonder if giving him these fluids might essentially "stave off" kidney disease, even though they are for another condition. 
 

dr kris

TCS Member
Guest Expert
GoHolistic and AbbyNTim,

That is my gut instinct.

I know many cats, like mine and yours who actually started SQ fluids for a different reason (commonly pancreatitis or IBD), had concurrent CKD, but by all appearances, their treatment regimen could be argued to “stave off” the CKD. I lean towards this thinking for my own cat!

At very very very minimum, these renal insufficiency cats show up much less often on my doorstep suffering from chronic dehydration or out of control uremia (essential toxins in the blood your kidneys are supposed to be filtering out). When when this is true, you are probably eating better. You can consume more protein, which are the building blocks for all your essential organs. And then you have a better body mass.  All of these things are associated with longevity.

I do provide this theory to my clients in practice. There is no published studies to tell you one way or another on this, but to me it makes sense, and for some patients, including my own cat, I regard it to be true unless proven otherwise!

k
 

catpack

TCS Veteran
Kitten
Do you see any harm in putting a non-CKD cat on RenAvast as a "preventative?"

I picked up a bottle for my 16 yr old who is still in good overall health aside from arthritis and possibly IBD, though it could be food intolerances...all is controlled by diet. However, he does have diminished kidney function, though I am told it is just due to his age.

All other bloodwork is good, and has actually improved over the last 9 mo since his diet change (it wasn't bad to begin with.)
 

dr kris

TCS Member
Guest Expert
Hi CatPAck!

I've never used RenAvast - I've checked it out but could not confirm what the actual ingredients were.

I have a tendency to move towards fish oils and Vitamin B12 supplementation if we are suspecting some sort of kidney/pancreatic situation though!

Hope that helps,

k
 

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