RX, Wet, Low Protein, Raw...... Thoughts?

[carolina]

Hi Dr. Kris!

I have four cats and a dog, thankfully none of them with CKD..... But since it is such a prevalent and devastating disease, I try do do the very best in trying to prevent it in the future..... If there is such a thing as "preventing it", anyways....

For one thing, I feed raw - I feed a balanced homemade raw diet and my pets really thrive on it - it actually saved my cat Bugsy when he was pretty much hopeless in a gigantic IBD flare where absolutely nothing would work.

Anyways - Here are my questions in re. to diet and CKD:

1. I often see "low protein diets" being prescribed for cats diagnosed with CKD.... That often involves commercial foods with grains and vegetables added which to me sounds counterproductive when you want a cat to be at its best health, provided that cats are obligated carnivores.
   This also means a raw diet is quickly dismissed, since it is high protein...... When IMHO the issue to be addressed should be the phosphorous levels, not the protein levels. It is perfectly possible to achieve low recommended phosphorous levels by simply adjusting your raw diet accordingly - supplementing the calcium with eggshells instead of feeding bones, and substituting some of the meat for egg whites as a source of phosphorous free protein are a couple of examples of how that can easily be done.
2. Prescription DRY RX Renal Diets....... and Fluids - Well.... That sounds like an oxymoron to me.... All I know about kibbles is that it is dehydrating..... And all I can think of when I think of CKD, is the higher the fluid intake, the better...... So.... What's the point of feeding a Kibble and prescribing Fluids?
3. Last but not least - I was curious if you have noticed in your practice a correlation of long term diet and CKD prevalence?
   Do cats who were fed kibbles all their lives present with the disease more often that those fed an all wet diet? Or it is all a genetic gamble?

Thank you so much in advance Dr. Kris!!!

Carolina

 

[dr kris]

Carolina!

Love the questions! And the attention to detail you have for all those furbabies!

1) For my thoughts on low protein and cats with CKD, see this thread here I posted this morning that discusses cats, protein and carbs:
http://www.thecatsite.com/t/282665/canned-food-grain-free-or-with-some-carbs

Protein restriction can be contraindicated in acute renal disease (you need building blocks to build your organs, right!), and certainly has it’s place in stable CKD. So in my books, protein restriction is done only when there is a physiological reason to do so - where the suffering and deterioration caused by uremia outweigh everything else (usually stage III or IV CKD). So there are big wins that can be made with tweaking the diet and protein restriction in some cats, but it cant be blanket recommendations for all cats. Therefore, if protein restriction is determined to be not required by your vet, and you are already feeding raw, it makes sense to me that you don't have to stop doing so.

Also, for those cat’s with elevated phosphorous levels in the blood (which is when the typical recommendation to restrict phosphorus comes in to play), it is easy to figure out - the proof will be in the pudding. Im not a nutritionist, but if you modify the diet the in the way that you indicate, you simply re-test the blood at 2, 4 and 6 weeks. If it’s working, you’ll know as the elevated phosphorous will come down.

2) Dry renal diets. I have a post somewhere in this series that I wrote about Uncle George. I should have made that Uncle George, Bob, Charles, Alexander, and Aunt Bertha and Mabel. I have seen many a cat that despite all your best efforts, they will starve themselves rather than eat the best wet or homemade formulations. They can be very opinionated with their food. They have a preference for the dry stuff.

And then I have ooodles of clients that it just wont ever work out for them - for a variety of reasons, feeding dry is what keeps the wheel spinning in their world. Our clinic is in a "good financial" area (i.e. many people have stable income and money), so we are able to provide advanced medicine. But at the same time I see people struggling to make ends meet. Mortgage payment, daycare, groceries, and hustling to keep it all together. Sometimes that bag of dry gives them the hope and knowledge that they are on the right track. It’s something they can change for their cats in a world of things that you cant. Not a perfect one, but a step in the right direction. But it’s a gateway that gets them thinking about things they never thought about before. Cats live a long time. And sometimes these very same people will come back - and they are ready for more knowledge, and different approaches.

   
3) I see exactly what you are saying about dry + fluids. It’s a good question.

The decision for fluids is made independent of whether you feed raw, commercial or cooked homemade. The ideal situation actually is pure, voluntary water intake. Just drinking it and getting it from your diet. When your kidney function is 30% of what it used to be, things change with that. When you get to an age where your ability to sense and process the nutrients that you could in your youth, things change again. When you have concurrent illness, and medications on board, the outlook sometimes gets grim. Unchecked, we get to our “average age” of 14 years old in cats. I say different. I think that if we preempt these issues, we obtain the true potential of their longevity. The dehydrated cat coming into the clinic to see me is a daily basis event. Many of these guys have been chronically dehydrated for a while, even while consuming wet diets (“he drinks  a lot of water” is almost always said after I tell them about their cats dehydration). It’s the back end plumbing that’s the bottleneck. The Uncle Bob cats with a bag of fluids will do better.

3. So far, no correlation in type of food and CKD prevalence. Which doesn't mean there isn't one, but we haven't proved it yet (probably because CKD is multifunctional - many different sub types). There is a correlation however with weight loss and decline in longevity. And weight loss can be secondary to CKD. So i’ve always got my eyes open like a hawk for weight loss. Any weight loss. And nutrition plays huge into that. That is where a lot of my current effort are in an attempt to increase longevity with CKD! Can these sort of strategies help prevent? Time will tell.

Thanks for the questions,

k

 

[carolina]

Thank you so much for your answers dr kris ! You gave me much to think about!
It was very refreshing to read your perspective on diet - even your perspective on kibbles, which diet I am adamant against about it.... You did have a point.

Great tip re.weight loss - the only weight loss here was when I changed them from kibbles to raw.... but that was a slow change and on purpose, towards their goal weight - after that they have been maintaining it beautifully.

Thanks again for taking the time to write such a detailed answer - I really do appreciate it!

Carolina, Lucky, Hope, Bugsy, Mac and the dog - Bruce!