Would like to hear your experience dealing with CKD

[Sillycat41]

Hello again,
Due to my health issues I haven't posted since January. I'm still looking for advice from those of you who have dealt with kidney disease and hoping for ideas to slow the progression. Members have suggested reading Tanya's Comprehensive Guide to Feline Chronic Kidney Disease, but I feel overwhelmed by the amount of information posted there!!

Jengo is 16 now and still vomits 2 or 3 times a week... clear foam, never with food, but on rare occasions speck of blood. His regular vet had surgery and is off for 6 months. The new vet changed his medications. He is no longer on 2.5 mg Prednisolone twice a week which the 1st vet put him on for IBD. I read that the main symptom of IBD is chronic diarrhea... Jengo had never had diarrhea. I assume that he has some kind of irritation in the GI tract plus frequent nausea... licking lips and looking like he doesn't feel well but maybe not IBD. ??

The new vet put him on daily Pepcid plus Cerenia and Mirtazapine ever other day but he still vomits. Now she wants to try Omeprazole. I'm wondering how hard these medications are on his kidneys?? On his last test his Creatinine number was 2.2 (normal range 0.4-1.4) and BUN was 34.8 (normal 9.0-29.0). Phosphorus was slightly elavated. Not sure what stage of kidney failure this is. ??? He doesn't eat enough food... assume this is because of nausea. The Mirtazapine works for a couple of hours but wears off. I'm so afraid that he'll lose more weight. He is also getting 100 ml of sub-Q fluids twice a week.

I find the information on this forum is important to me and the two vets seem to differ in diagnosis. i welcome any advice and/or details about your experience with your cats.
Thanks in advance.

 

[Antonio65]

Hi, I wonder if your vets have ever run any scans or tests to say that Jengo has IBD.
My cat had it, and was put on a different diet, something that wasn't irritating her GI tract so much. She never had diarrhea, but she would vomit nearly everyday. The vet gave her Omeprazole and Ranitidine as well, but things went much better when we switched her diet to a monoprotein grain free wet food.
According to the nutritionist vet, her GI tract had been irritated by the grains in the food and also she migt have been intolerant to some protein, so we did a radical change of diet.

My other cat (in my avatar) had CKD, and our approach to counter it was 120 ml sub-Q's every other day, half pill of Fortekor every day, and Renal diet. I also added some probiotics and vitamin B supplement every morning.
The probiotics were added to help her bowels remove some of the toxins. They were a replacement for Azodyl that it wasn't available in my country, and I found the right mix of two different OTC human grade products to "mimic" the Azodyl.
My cat developed CKD at the age of 6, and she left me at 17 years of age but it wasn'tthe CKD that took her away from me.

The Prednisolone doesn't help much in the case of a CKD, but if it's really necessary you can't help it.

 

[FeebysOwner]

Hi. All the treatments/meds that your cat is currently getting are in line with what most CKD cats receive - for their remaining lifetime. However, I would like to ask you to verify the range for the Creatinine level; it seems a bit small in terms of the range I am familiar with. Antech labs, one of the more common labs in the US, use a range of 0.6 - 2.4. However, there is a more general universal-type range for the US of 0.5 - 1.8. Nonetheless, as a basic rule using the IRIS (International Renal Interest Society) guidelines, your cat would probably be at Stage 2.

While all cats are different generally speaking - from what I have learned through Tanya's web site and an affiliated forum, the treatments your cat is getting seems a bit more than I would expect to see at Stage 2 CKD, UNLESS there are other issues at play - such as IBD or even pancreatitis. I am not saying the symptoms you are describing cannot be seen at Stage 2, but usually there are other health factors that accompany the CKD which are attributing to the symptoms.

Contrary to what you said you read, not all IBD cats have diarrhea. One of the most common signs of IBD is thickening of the intestinal wall which can usually be seen via an ultrasound. The ultrasound can also show what the kidneys look like, and sometimes even the pancreas. There are other conditions that can cause inflammation in the GI tract, but many times IBD is part of those conditions.

There is much more I can tell you, but it will all be overwhelming - as most illnesses in our beloved cats can be. Bottom line, if you want to treat your cat as if all he has is CKD, then you are doing about as much as you can to try to slow the progression. There are medicines to help remove toxins from his body that the kidneys cannot remove as well as they once did - things like Phos-Bind, Azodyl, just to name a couple. These types of medicines when they become appropriate are mainly to make a cat feel better and take some stress off of the kidneys.

At Stages 2-3, the goal is to slow progression using the following:

• Management of high phosphorus levels through dietary phosphate restriction or medicines​
• Management of proteinuria (excess protein in the urine)​
• Management of hypokalemia (low potassium levels)​
• Management of hypertension (high blood pressure)​

It would be my layperson's belief that if none of these are particularly out of range, then CKD might not be all that is going.

I think you are going to have to find a way to become educated about your cat's condition so that you can at least discuss alternative/additional conditions/treatments with these vets. And, as much as you probably don't want to hear it, Tanya's web site discusses all that I have talked about is the main reason I know what I know today.

 

[mrsgreenjeens]

I've had three kidney cats and believe Tanya's website is the best source of information out there. Yes, it is definitely overwhelming, but just click on the links either at the top or on the left side to narrow down your search to find things you want to read about. For instance, if you first click on "key issues" from across the top of the page, then you can select "appetite loss, nausea and vomiting" from the left margin. Then start scrolling down and it will discuss those topics, what causes them, etc, and then further down it discusses the treatments. There it lists the medications you have been given, plus some natural remedies, like feeding right before bedtime to prevent the foamy vomit (which normally occurs early in the morning), using slippery elm bark syrup to help coat the stomach, etc.

THIS particular page of their website discusses the stages of kidney disease: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - How Bad Is It? Just scroll down a little bit to find the charge of Creatinine and what the stages are. Towards the bottom of that page it discusses how to treat the cat in each stage.

I agree with FeebysOwner that your furbaby appears to b in Stage 2, which usually means treating as you are doing right now, with the exception of sub-q fluids. Typically those aren't required yet, but you may be giving them due to the IBD? Don't think they can hurt unless your cat also has heart issues.

If you have specific questions, feel free to ask. Oh, and most kidney cats do not eat enough. With my last one, I found feeding her many small meals each day (and night) worked out better than trying to get her to eat regular sized meals. I ended up feeding her 8 - 9 times per day, with maybe 1 tablespoon per meal. I even fed her twice in the middle of the night. That also helped a lot with the morning vomiting.

 

[Sillycat41]

Hi, I wonder if your vets have ever run any scans or tests to say that Jengo has IBD.
My cat had it, and was put on a different diet, something that wasn't irritating her GI tract so much. She never had diarrhea, but she would vomit nearly everyday. The vet gave her Omeprazole and Ranitidine as well, but things went much better when we switched her diet to a monoprotein grain free wet food.
According to the nutritionist vet, her GI tract had been irritated by the grains in the food and also she migt have been intolerant to some protein, so we did a radical change of diet.

My other cat (in my avatar) had CKD, and our approach to counter it was 120 ml sub-Q's every other day, half pill of Fortekor every day, and Renal diet. I also added some probiotics and vitamin B supplement every morning.
The probiotics were added to help her bowels remove some of the toxins. They were a replacement for Azodyl that it wasn't available in my country, and I found the right mix of two different OTC human grade products to "mimic" the Azodyl.
My cat developed CKD at the age of 6, and she left me at 17 years of age but it wasn'tthe CKD that took her away from me.

The Prednisolone doesn't help much in the case of a CKD, but if it's really necessary you can't help it.

Hi, I wonder if your vets have ever run any scans or tests to say that Jengo has IBD.
My cat had it, and was put on a different diet, something that wasn't irritating her GI tract so much. She never had diarrhea, but she would vomit nearly everyday. The vet gave her Omeprazole and Ranitidine as well, but things went much better when we switched her diet to a monoprotein grain free wet food.
According to the nutritionist vet, her GI tract had been irritated by the grains in the food and also she migt have been intolerant to some protein, so we did a radical change of diet.

My other cat (in my avatar) had CKD, and our approach to counter it was 120 ml sub-Q's every other day, half pill of Fortekor every day, and Renal diet. I also added some probiotics and vitamin B supplement every morning.
The probiotics were added to help her bowels remove some of the toxins. They were a replacement for Azodyl that it wasn't available in my country, and I found the right mix of two different OTC human grade products to "mimic" the Azodyl.
My cat developed CKD at the age of 6, and she left me at 17 years of age but it wasn'tthe CKD that took her away from me.

The Prednisolone doesn't help much in the case of a CKD, but if it's really necessary you can't help it.

Thanks for responding! I didn't want to put him thru a byopsy because of his age. The 2nd vet said that she couldn't feel any thickening in his abdomen. I have tried and tried to switch his diet but he refuses to eat the novel proteins. He rarely eats the same flavor of the regular canned foods two meals in a row. I have so many different flavors and have to keep opening cans until I find one that he'll eat. Wonder if I just got him off the ones with grain if that would make a difference.

I bought some expensive probiotics from the vet but whenever I mix it in his food he can tell and won't eat it. The vets have never mention Azodyl or Fortekor but did mention Porus One. Haven't tried it yet though... also supposed to remove toxins. Also give him B12 injection once a month. He's get sub-Q twice a week... 100 ml although the last time he seems to react to that much fluid. Trying to get ahold of the vet to talk to her.

 

[Sillycat41]

Hi. All the treatments/meds that your cat is currently getting are in line with what most CKD cats receive - for their remaining lifetime. However, I would like to ask you to verify the range for the Creatinine level; it seems a bit small in terms of the range I am familiar with. Antech labs, one of the more common labs in the US, use a range of 0.6 - 2.4. However, there is a more general universal-type range for the US of 0.5 - 1.8. Nonetheless, as a basic rule using the IRIS (International Renal Interest Society) guidelines, your cat would probably be at Stage 2.

While all cats are different generally speaking - from what I have learned through Tanya's web site and an affiliated forum, the treatments your cat is getting seems a bit more than I would expect to see at Stage 2 CKD, UNLESS there are other issues at play - such as IBD or even pancreatitis. I am not saying the symptoms you are describing cannot be seen at Stage 2, but usually there are other health factors that accompany the CKD which are attributing to the symptoms.

Contrary to what you said you read, not all IBD cats have diarrhea. One of the most common signs of IBD is thickening of the intestinal wall which can usually be seen via an ultrasound. The ultrasound can also show what the kidneys look like, and sometimes even the pancreas. There are other conditions that can cause inflammation in the GI tract, but many times IBD is part of those conditions.

There is much more I can tell you, but it will all be overwhelming - as most illnesses in our beloved cats can be. Bottom line, if you want to treat your cat as if all he has is CKD, then you are doing about as much as you can to try to slow the progression. There are medicines to help remove toxins from his body that the kidneys cannot remove as well as they once did - things like Phos-Bind, Azodyl, just to name a couple. These types of medicines when they become appropriate are mainly to make a cat feel better and take some stress off of the kidneys.

At Stages 2-3, the goal is to slow progression using the following:

• Management of high phosphorus levels through dietary phosphate restriction or medicines​
• Management of proteinuria (excess protein in the urine)​
• Management of hypokalemia (low potassium levels)​
• Management of hypertension (high blood pressure)​

It would be my layperson's belief that if none of these are particularly out of range, then CKD might not be all that is going.

I think you are going to have to find a way to become educated about your cat's condition so that you can at least discuss alternative/additional conditions/treatments with these vets. And, as much as you probably don't want to hear it, Tanya's web site discusses all that I have talked about is the main reason I know what I know today.

Here's a copy of his recent blood test results. It does show that his Bun and Creatinine are high according to this lab. The 2nd vet said that he doesn't have pancreatitis but she never confirmed the 1st vet's diagnosis of IBD. ??

He hasn't had an ultra-sound and I think we should schedule that to see what is going on. Palipatating probably isn't very accurate. I think he has nausea a lot and tried Reglan... didn't work. Now she wants to try Omeprazole. Does anyone have experience with that? I take it for acid reflux so maybe the nausea is from excess acid???? Who knows? I just feel if I could give him something to fix the nausea that he'd do better all around.

I'll have to get back on Tanya's site and not read too much at one sitting. Otherwise my head is spinning!!

I am a little worried that 100 ml of sub-Q may be too much for a 8 1/2 to 9 lb. cat. They have never mentioned that he has heart issues though but at his age he might.

As for feeding... since he never eats much at one meal, I feed him sometimes 8 small meals a day. I get up at least 3 times during the night to feed him a couple of teaspoons or tablespoon of food. I think that sometimes prevents the vomiting early in the morning.... not always though.

Thanks to all of you for your help and support!! Hugs!

 

[FeebysOwner]

The 2nd vet said that he doesn't have pancreatitis but she never confirmed the 1st vet's diagnosis of IBD. ??

What did the 2nd vet base her 'no pancreatitis' on? IBD is tricky to confirm without at least an ultrasound, and even then it isn't always definitive. The biggest thing is the intestinal wall thickening - if they see that they will typically say it is IBD related.

Now she wants to try Omeprazole. Does anyone have experience with that? I take it for acid reflux so maybe the nausea is from excess acid????

Tbh, many CKD cats seem to be taking an appetite stimulant (typically mirtazapine), anti-nausea (Cerenia or Elura are common), and omeprazole too. It is thought that these cats can have acid build up. And the build up is even more common with cats who aren't eating frequently - although it sounds like you have that covered. I was offered famotidine for my cat (also an acid reducer) before the vet would even consider anti-nausea meds - not saying I agree with it, but I now wonder if that another standard 'go to' for some vets.

Here's a copy of his recent blood test results.

Are the last test results from a different lab? The ranges have changed making it hard to determine if the actual numbers can be compared to previous results. Ask the vet how the numbers can be compared if they are from two different labs. However, I am also curious as to why, in the upper right-hand corner it depicts the word 'Dog' - ask the vet about that too. Are the ranges listed for a dog?

Oh, and about the sub-Q fluids. The standard 'go to' for many vets does seem to be 100ml, but I think you need to ask the vet about lowering it a bit for the size of your cat.

 

[Sillycat41]

What did the 2nd vet base her 'no pancreatitis' on? IBD is tricky to confirm without at least an ultrasound, and even then it isn't always definitive. The biggest thing is the intestinal wall thickening - if they see that they will typically say it is IBD related.

Tbh, many CKD cats seem to be taking an appetite stimulant (typically mirtazapine), anti-nausea (Cerenia or Elura are common), and omeprazole too. It is thought that these cats can have acid build up. And the build up is even more common with cats who aren't eating frequently - although it sounds like you have that covered. I was offered famotidine for my cat (also an acid reducer) before the vet would even consider anti-nausea meds - not saying I agree with it, but I now wonder if that another standard 'go to' for some vets.

Are the last test results from a different lab? The ranges have changed making it hard to determine if the actual numbers can be compared to previous results. Ask the vet how the numbers can be compared if they are from two different labs. However, I am also curious as to why, in the upper right-hand corner it depicts the word 'Dog' - ask the vet about that too. Are the ranges listed for a dog?

Oh, and about the sub-Q fluids. The standard 'go to' for many vets does seem to be 100ml, but I think you need to ask the vet about lowering it a bit for the size of your cat.

The vet ran a complete blood panel and said she doesn't think he has pancreatitis. After reading your comments I did a quick search and found that many cats have normal pancreatic enzyme levels." I'm going to schedule him for another kidney panel and ultra-sound. Have to get more info in order to treat him properly. Hope we can get in soon. The vets here are booked for weeks in advance.

I did try Famotidine several times but he vomited it up right away on two occasions. He also vomited within 6 hours other times. Hard to tell if it reduced the acid. Cerenia does help with the vomiting but she said to only give it to him every other day. Must be hard on the kidneys. Next step is to try the Omeprazole... supposed to reduce acid for 24 hrs.

The vet clinic has an in-house machine to test the blood work. I panicked after you pointed out that it said "Dog ID" on the lab results from April. I just called the vet office and the tech assured me that those were Jengo's lab results.... that the machine acts up sometimes and has to be reset. I told her they should get that fixed!! She said you can tell by the range that it's for a cat. Thanks for pointing that out... I missed that.

I'm waiting for a response from the vet for my last questions... one about reducing the sub-Q to 75 or 50 ml. Jengo is a small 9 lb. cat... 100 seems to much at one time. Thanks for that comment too. Members of this forum are so helpful. Appreciate your feedback!

 

[mrsgreenjeens]

We gave our last kidney cat famotidine via injections and that seemed to work well. No side effects and it was much easier to give. You might try it and see if he still has issues. (the injections are with a very short needle that are given in the scruff so they really don't even feel it. we gave them during loving sessions and I never ever even saw her flinch)

 

[Sillycat41]

We gave our last kidney cat famotidine via injections and that seemed to work well. No side effects and it was much easier to give. You might try it and see if he still has issues. (the injections are with a very short needle that are given in the scruff so they really don't even feel it. we gave them during loving sessions and I never ever even saw her flinch)

I didn't know that famotidine was available in injections!! I do give Jengo B12 injections so I am comfortable doing that. Thanks!