Raw diet for cat with CKD. Any ideas?

[lwndlnd]

My senior kitty was diagnosed with stage 2 CKD today. I’m beyond devastated. I know that cats with CKD may live long and happy lives but I’m just so hurt that my baby isn’t fine. Literally crying right now.
I feed my cats homemade raw food. I don’t want to feed her dry food or prescription renal food cause I know that this isn’t good and isn’t helping as it expected to. That’s why I wanted to ask, how can I prepare food especially for my kitty with CKD? I know about phosphorus restrictions, but what else? What should I add and what I shall remove? How to keep her healthy as long as possible? I’m so worried.
Any support will be much appreciated. I will also be grateful for any researches, studies and recourses where I can find more information about feeding kitties with CKD raw food. If some of you can share your personal experience with situations like that please do

 

[Furballsmom]

Hi
At stage two, your biggest issue is determining the phosphorus levels in every ingredient you're feeding, which although you comment you're aware of the issue, is very challenging.

You don't have to utilize prescription kibble. Weruva brands, including Weruva WX which isn't prescription are low to extremely low in phosphorus, and there are other brands of wet;

https://felinecrf.org/canned_food_usa.htm

 

[lwndlnd]

Hi
At stage two, your biggest issue is determining the phosphorus levels in every ingredient you're feeding, which although you comment you're aware of the issue, is very challenging.

You don't have to utilize prescription kibble. Weruva brands, including Weruva WX which isn't prescription are low to extremely low in phosphorus, and there are other brands of wet;

https://felinecrf.org/canned_food_usa.htm

I’d be happy to feed her Weruva, but I’m from Ukraine and we don’t have it here. I know good wet foods with low phosphorus that we have in my country, so I def will be feeding her it from time to time. I just can’t afford feeding wet food exclusively cause it’s expensive as hell. So I’m searching for options how I can adapt homemade raw for her needs. Her phosphorous level is only 1.6, which means it’s elevated only a tiny bit (normal values in our lab are 0.9-1.5) so I’m considering it’s a good thing for now. She has elevated creatinine and urea tho, and we are waiting for SDMA results, which I think will be elevated too

 

[Tobermory]

This article might provide some guidance, lwndlnd .
Feline Nutrition - Phosphorus Can Be Key for Cat Kidneys | Hare Today

 

[furmonster mom]

I used Niacinamide to manage phosphorus in my ckd kitties.
Here is an article on it: Niacinamide for CKD

 

[Furballsmom]

I apologize, I missed your home location.

 

[sophie1]

I think you can continue feeding your cats their raw diet, with a focus on meats that are relatively low in phosphorus: poultry and rabbit. If you can research the nutrient info for the ingredients you're using, try calculating the Ca ratio and keep it as close as possible to the ideal of 1.1:1. Then, discuss how to handle the phosphorus issue with your vet.

I'm no vet nor particularly knowledgeable in this area, but from what I've read online, the best way to handle phosphorus is to monitor blood levels, and take steps if they start creeping up. Niacinamide is an interesting option, and there are prescription medications that can be used to bind phosphorus. One option is to add cooked egg whites to the food in place of some of the muscle meat because egg white is a high quality protein that's very low in phosphorus. Not sure if you can get powdered egg whites which would be most convenient, but simply using fresh eggs, separating out the yolks and making something like custard with them for yourself, then scrambling the egg whites and adding to the food should work fine.

 

[furmonster mom]

On egg white substitution:

This is a good option that I have used as well.

It is important to cook the whites as they contain avidin enzyme. Too much avidin will create heart issues as it raises histamine levels. Cooking the whites neutralizes the enzyme.

Vitamin B neutralizes histamines, and the yolks are chock full of vit B and other great goodies for skin and coat. So I usually include them into the food as well.

I make a kind of slurry by cooking the egg whites, chopping super fine (like diced onion, a spatula works well for this), then adding them back with the yolks. Add to the food batch.

 

[sophie1]

There's enough phosphorus in egg yolks that I'm not sure you get much benefit from adding whole eggs?

A large egg is about 2 ounces, and the white and yolk together contain about 125 mg phosphorus, most of which is in the yolk. In comparison, 2 oz of chicken breast (just for an example) contains about 130 mg phosphorus.

Eggs are great for cats which is why I happily add them to my cats' homemade raw food - I used to add fresh eggs but now I use Alnutrin for convenience. But, not sure that adding whole eggs will appreciably lower phosphorus content.

Maybe the right approach isn't to monkey with the food....adding large amounts of egg white will potentially dilute some important nutrients. The article on niacinamide looked very promising - thanks for posting that!!

 

[lwndlnd]

I think you can continue feeding your cats their raw diet, with a focus on meats that are relatively low in phosphorus: poultry and rabbit. If you can research the nutrient info for the ingredients you're using, try calculating the Ca ratio and keep it as close as possible to the ideal of 1.1:1. Then, discuss how to handle the phosphorus issue with your vet.

I'm no vet nor particularly knowledgeable in this area, but from what I've read online, the best way to handle phosphorus is to monitor blood levels, and take steps if they start creeping up. Niacinamide is an interesting option, and there are prescription medications that can be used to bind phosphorus. One option is to add cooked egg whites to the food in place of some of the muscle meat because egg white is a high quality protein that's very low in phosphorus. Not sure if you can get powdered egg whites which would be most convenient, but simply using fresh eggs, separating out the yolks and making something like custard with them for yourself, then scrambling the egg whites and adding to the food should work fine.

Thank you for the idea! I’ll try to read more information about it. For now, I decided to continue feeding my CKD cat her raw food. She just gonna have her renal supplement our vet has prescribed, raw without the real bone (turkey or chicken for now) and also a probiotic for fermentable fiber to help with toxins in her blood. In 20 days we will go to the vet to check her blood levels to see what’s going on there. We will also have a urinalysis in a few days to check on signs of proteinuria to figure out our next steps.

Actually, I’m not adding eggs when making my cats food. But when feeding I give them one quail egg per day. Is it ok to continue this for my CKD kitty?

 

[lwndlnd]

There's enough phosphorus in egg yolks that I'm not sure you get much benefit from adding whole eggs?

A large egg is about 2 ounces, and the white and yolk together contain about 125 mg phosphorus, most of which is in the yolk. In comparison, 2 oz of chicken breast (just for an example) contains about 130 mg phosphorus.

Eggs are great for cats which is why I happily add them to my cats' homemade raw food - I used to add fresh eggs but now I use Alnutrin for convenience. But, not sure that adding whole eggs will appreciably lower phosphorus content.

Maybe the right approach isn't to monkey with the food....adding large amounts of egg white will potentially dilute some important nutrients. The article on niacinamide looked very promising - thanks for posting that!!

Thanks for your thoughts! I will definitely do my own research on this subject here.

I see a lot of homemade raw recipes for cats with CKD and a lot of them include rice or smth like that. I don’t want to give my cat carbohydrates as they also contribute to developing kidney diseases. But I’m wondering, should I think about restricting proteins at least a little bit? If so, how could I manage this without adding carbs to my cat’s diet? I thought about some vegetables, but cats are not that good to deal with that kind of fiber. So what are you guys think?

 

[Furballsmom]

But I’m wondering, should I think about restricting proteins at least a little bit?

I'm not a vet but according to what I'm seeing, at stage 2 you don't need to do that yet. It becomes the challenging balance later, of trying to keep weight and muscle mass while allowing the kidneys a lighter load to "process".

I think you want to look at these pages. The author discusses information that is related to food ingredients;
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Which Foods to Feed, and Which to Avoid
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - How to Use the Cat Food Data Tables
If you scroll down on this page, there are commercial raw foods listed, some of which you might be able to obtain.
https://www.felinecrf.org/canned_food_usa.htm#raw_foods
Also, I don't know if there's anything here that might be useful for your location;
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Obtaining Supplies Cheaply in the UK

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - What You Need to Know First

 

[F+V]

Thank you for the idea! I’ll try to read more information about it. For now, I decided to continue feeding my CKD cat her raw food. She just gonna have her renal supplement our vet has prescribed, raw without the real bone (turkey or chicken for now) and also a probiotic for fermentable fiber to help with toxins in her blood. In 20 days we will go to the vet to check her blood levels to see what’s going on there. We will also have a urinalysis in a few days to check on signs of proteinuria to figure out our next steps.

Actually, I’m not adding eggs when making my cats food. But when feeding I give them one quail egg per day. Is it ok to continue this for my CKD kitty?

Did you get the blood test results?

When she was diagnosed, how was specific gravity in urinalysis?
Was ALP elevated?

 

[lwndlnd]

Did you get the blood test results?

When she was diagnosed, how was specific gravity in urinalysis?
Was ALP elevated?

Hi there and thanks for your questions! We did get her blood results back after almost a month of changes I’ve made in her diet. Her kidney values had dropped a little, not significantly but it was still great to see even some improvement. We will go to the vet for more blood tests in a month and a half to see if it will be more improvement. That’s our goal

Her specific gravity was 1.030, my vet said it’s great to see even tho so many articles say that this is too low.

Tiger’s ALP was okay, but her AST was twice higher than it should be. She is on her liver supplements (not medication) for a month just in case, even tho my vet said this increased value is not qualified for any assumptions or diagnosis because my cat’s other liver values are ok and she shows no symptoms.

Feel free to ask more questions if you need, I’m happy to help

 

[F+V]

Hi there and thanks for your questions! We did get her blood results back after almost a month of changes I’ve made in her diet. Her kidney values had dropped a little, not significantly but it was still great to see even some improvement. We will go to the vet for more blood tests in a month and a half to see if it will be more improvement. That’s our goal

Her specific gravity was 1.030, my vet said it’s great to see even tho so many articles say that this is too low.

Tiger’s ALP was okay, but her AST was twice higher than it should be. She is on her liver supplements (not medication) for a month just in case, even tho my vet said this increased value is not qualified for any assumptions or diagnosis because my cat’s other liver values are ok and she shows no symptoms.

Feel free to ask more questions if you need, I’m happy to help

That's good news, at least it's not getting worse! How did the SDMA test go? Was it elevated as well? It may be worthwhile getting x-ray and ultrasound too.
I've read for cats fed protein rich diet some values tend to be higher and that normal reference ranges were created decades ago when cats primarily ate dry food/high carb.
What do vets look at to assess kidney functions in blood work and urinalysis? SDMA, phos, creatinine, bun, ALT, AST, USG, and total bilirubin?

 

[lwndlnd]

That's good news, at least it's not getting worse! How did the SDMA test go? Was it elevated as well? It may be worthwhile getting x-ray and ultrasound too.
I've read for cats fed protein rich diet some values tend to be higher and that normal reference ranges were created decades ago when cats primarily ate dry food/high carb.
What do vets look at to assess kidney functions in blood work and urinalysis? SDMA, phos, creatinine, bun, ALT, AST, USG, and total bilirubin?

Her SDMA was 16.8, which is considered borderline value. It is advised to redo the test in two weeks but me and my vet don’t see it as necessity, especially because this test is very expensive and we are sure that my cat has CKD. Some people may say that SDMA is like 100% marker for CKD staging or CKD diagnosis in general but that’s not true. It can be skyrocketing when all the other kidney values are fine or it can be normal when all the other kidney values are skyrocketing.

Of course, we did x-ray and ultrasound, everything is fine in there. Her liver had some changes tho but we figured it out.

Yes! That’s definitely true. I’ve also read this and thought about this. I’ve also read that cats who are fed rich protein diets can have some values elevated (especially CREA) but still within normal range, just at the higher end. That’s not a case with my cat, unfortunately.

No vet should look at one exact blood value and make a diagnosis. All the values are always should be assessed comprehensively. From what I’ve read and from what my vet have said, the most important values to assess kidney disease in cats are CREA, BUN, phos in blood. And USG, UPCR in urine. SDMA can be great too but I’ve already talked about this. The point is that if one value are increased while others are totally normal, it’s better to observe and control those values. No diagnosis should be made just from one elevation. ALT, AST, ALP and total bilirubin are liver values.

For example, Tiger is 12. Her CREA, BUN and phos were increased. That’s what led us to her diagnosis. Not every cat has phos elevations tho. Many cats also have great USG and normal UPCR, as my Tiger. So, from my opinion and knowledge, BUN and CREA taken together are the key values. On the other hand, I have two younger cats as well, Waffle and Brownie. They are 2 years old each, and their CREA was as high as Tiger’s. All the other values were totally normal, so no diagnosis for them. Just will be looking at those values soon to see the picture of what’s going on again. Creatinine could be higher in muscled cats or cats who are very active, also if they are fed a protein rich diet.

 

[F+V]

Her SDMA was 16.8, which is considered borderline value. It is advised to redo the test in two weeks but me and my vet don’t see it as necessity, especially because this test is very expensive and we are sure that my cat has CKD. Some people may say that SDMA is like 100% marker for CKD staging or CKD diagnosis in general but that’s not true. It can be skyrocketing when all the other kidney values are fine or it can be normal when all the other kidney values are skyrocketing.

Of course, we did x-ray and ultrasound, everything is fine in there. Her liver had some changes tho but we figured it out.

Yes! That’s definitely true. I’ve also read this and thought about this. I’ve also read that cats who are fed rich protein diets can have some values elevated (especially CREA) but still within normal range, just at the higher end. That’s not a case with my cat, unfortunately.

No vet should look at one exact blood value and make a diagnosis. All the values are always should be assessed comprehensively. From what I’ve read and from what my vet have said, the most important values to assess kidney disease in cats are CREA, BUN, phos in blood. And USG, UPCR in urine. SDMA can be great too but I’ve already talked about this. The point is that if one value are increased while others are totally normal, it’s better to observe and control those values. No diagnosis should be made just from one elevation. ALT, AST, ALP and total bilirubin are liver values.

For example, Tiger is 12. Her CREA, BUN and phos were increased. That’s what led us to her diagnosis. Not every cat has phos elevations tho. Many cats also have great USG and normal UPCR, as my Tiger. So, from my opinion and knowledge, BUN and CREA taken together are the key values. On the other hand, I have two younger cats as well, Waffle and Brownie. They are 2 years old each, and their CREA was as high as Tiger’s. All the other values were totally normal, so no diagnosis for them. Just will be looking at those values soon to see the picture of what’s going on again. Creatinine could be higher in muscled cats or cats who are very active, also if they are fed a protein rich diet.

Yes, I've also heard that the SDMA isn't 100% reliable, so the vet office we first went to doesn't offer that testing.

Our kitties just turned 5 and Valentine had CREA outside the "normal" range at 2.22 and Figaro at 1.79 which is within the range. Vet told me V might have kidney problems because of the elevated CREA and probably didn't even occur to him that my cats were on high protein diet because no other cat is in this counrty....
However, her BUN is actually within the range at 27.1 and F actually has an elevated BUN at 29.5. They both had USG of >1.035. They have muscles and had been pretty active outdoors till we recently moved across the ocean....

And this is irrelevant to kidneys, but both had a high cholesterol level. I read somewhere that it's ok in cats as long as that's not very high >750mg/dl.

 

[lwndlnd]

Yes, I've also heard that the SDMA isn't 100% reliable, so the vet office we first went to doesn't offer that testing.

Our kitties just turned 5 and Valentine had CREA outside the "normal" range at 2.22 and Figaro at 1.79 which is within the range. Vet told me V might have kidney problems because of the elevated CREA and probably didn't even occur to him that my cats were on high protein diet because no other cat is in this counrty....
However, her BUN is actually within the range at 27.1 and F actually has an elevated BUN at 29.5. They both had USG of >1.035. They have muscles and had been pretty active outdoors till we recently moved across the ocean....

And this is irrelevant to kidneys, but both had a high cholesterol level. I read somewhere that it's ok in cats as long as that's not very high >750mg/dl.

Sorry I’m not that good in understanding values in those measures But I think all three of my cats had CREA around 2.1 mg/dl (~180 mmol/l). I have four of them, actually. But Simba’s kidney values are all great and not even a little elevated, even tho he is the biggest one of them (if we were talking about muscles, yk). Those blood results are really tricky, so all we can actually do is find a vet who we trust and do our own research when possible. It’s really bad that we don’t have that much of a studies yet about cat’s blood results on high protein moisture rich diets. But I’m hopeful it will change.

I think you should talk to your vet about their diet. Or find a vet online who can help you to understand and interpret all of this numbers according to your situation. 5 is a very young age for CKD but it’s not impossible. Waffle and Brownie actually had their BUN outside the range but in the lower end, so it was really confusing. I just remembered Waffle had her phos a little higher than it should be but my vet still didn’t want to diagnose CKD, as long as she’s only 2, ultrasound all great and BUN low. I’ve actually gotten a second opinion back than and they told me they didn’t think my youngest have CKD too based on everything.

What about your kitties UPCR? How was it?

 

[F+V]

Sorry I’m not that good in understanding values in those measures But I think all three of my cats had CREA around 2.1 mg/dl (~180 mmol/l). I have four of them, actually. But Simba’s kidney values are all great and not even a little elevated, even tho he is the biggest one of them (if we were talking about muscles, yk). Those blood results are really tricky, so all we can actually do is find a vet who we trust and do our own research when possible. It’s really bad that we don’t have that much of a studies yet about cat’s blood results on high protein moisture rich diets. But I’m hopeful it will change.

I think you should talk to your vet about their diet. Or find a vet online who can help you to understand and interpret all of this numbers according to your situation. 5 is a very young age for CKD but it’s not impossible. Waffle and Brownie actually had their BUN outside the range but in the lower end, so it was really confusing. I just remembered Waffle had her phos a little higher than it should be but my vet still didn’t want to diagnose CKD, as long as she’s only 2, ultrasound all great and BUN low. I’ve actually gotten a second opinion back than and they told me they didn’t think my youngest have CKD too based on everything.

What about your kitties UPCR? How was it?

Finding a vet we can trust is as challenging as interpreting their blood test results to see if the cat has kidney problems especially in a country where nobody else is feeding their cats raw food V wasn't diagnosed with CKD but I'm taking her to cat exclusive clinic on Monday to do the SDMA etc., and fingers crossed the vet there is even remotely familiar with raw meat diet. The first vet didn't fill out UPCR or Phos or Total Protein in test results for some reason. I felt their blood work and particularly urinalysis were not comprehensive, unfortunately.

 

[lwndlnd]

Finding a vet we can trust is as challenging as interpreting their blood test results to see if the cat has kidney problems especially in a country where nobody else is feeding their cats raw food V wasn't diagnosed with CKD but I'm taking her to cat exclusive clinic on Monday to do the SDMA etc., and fingers crossed the vet there is even remotely familiar with raw meat diet. The first vet didn't fill out UPCR or Phos or Total Protein in test results for some reason. I felt their blood work and particularly urinalysis were not comprehensive, unfortunately.

You should definitely redo urinalysis and ask them about calculating UPCR. Not all cats with CKD have proteinuria but it can definitely mean something. It’s a great diagnostic tool. I hope everything will go as smoothly as it can. In our country no one seems to feed cats raw too, so I’m struggling with that as well. Vets also don’t have enough information to rely on and that seems to be as challenging to them as it is to us. I’d say it’s better to monitor V’s values and see how it goes. But additional testing is important. Redo her blood tests and be sure ALL kidney values are included. As well as with urinalysis. I hope it will help