Lili is 13 and has Renal Failure - Cat Forum : Cat Discussion Forums
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post #1 of 4 (permalink) Old 09-29-2018, 05:55 PM Thread Starter
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Location: Baytown, TX
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Lili is 13 and has Renal Failure

Hello everyone,

My 13 year old inherited kitty, Lili, was diagnosed with kidney failure yesterday. The vet said she had a significant case but didn't tell me what stage she's in. Lili also has very bad arthritis and muscles loss in her back hips and legs.

Her kidney related results are:

BUN = 39 (Range = 14-36 mg/dL)
Creatnine = 2.1 (Range = 0.6-2.4 mg/dL)
Phosphorus = 5.4 (Range = 2.4-8.2 mg/dL)

I've already found out about Tanya's Guide to Feline Kidney Disease so I have a lot of reading to do. My vet recommended a diet change to Science Diet K/D, adding kidney boosting / anti-vomiting / pain meds, and subq fluids at home. I'm pretty nervous of about giving her fluids because I have a vision issue so I'm hoping a vet tech can come over to help me out.

She'll be strictly on canned food from now on. Before her diagnosis I was already giving my 4 cats soupy wet food with the addition of kibble (4Health Grain Free Indoor) every few days for dinner. I'd like to know what's the best canned cat food that you feed your kitties with kidney disease? She seems to be allergic to beef so I don't feed her any. I'd personally don't want to use Science Diet unless it's absolutely necessary. Also, do you add any kidney failure supplements to their food or give as treats?

I try to feed as much grain free food as possible but that can get expensive at times as I have 2 dogs as well. The cats have been eating the following canned food:

Friskies Classic pate
- Salmon =
- Mixed Grill =
- Turkey & Giblets =

- Indoor Chicken =
- Weight Management =
- Chicken =

4Health Grain Free:
- Turkey & Giblets =
- Chicken & Whitfish =

Are any of these foods bad for Lili? I've read that I need to watch her protein intake. All the 4health food have min of 9% ad the Friskies has a min of 10%

I'd appreciate any and all suggestions or tips to help her through this. Thank you all!
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post #2 of 4 (permalink) Old 10-01-2018, 03:46 PM
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Hi JBerotte,

I'm really sorry about Lili's diagnosis. I lost my Celia to CKD a few months ago. She was over 17.5 years old and went very quickly from "maybe very early loss of kidney function" to stage 3 in 6 months.

Lili has many advantages over Celia though: she's early stage 2, you've already found Tanya's site, and your vet seems more up-to-date with current treatments than many others, who recommend only the standard fluids and rx diet. With the proper treatments, stage 2 CKD kitties can be stable for years.

The only thing you want to try to get down is that phosphorus level, which is a bit high for stage 2, where the phosphorus should be under 4.5, and ideally closer to 3. Keeping phosphorus low is crucial, and prescription kidney diets have just about the lowest phos levels possible.

However, they are also low in protein, and there isn't agreement on what's best. Most experts have settled on not too much, not too little. It's true that protein is hard on the kidneys; on the other hand, CKD kitties suffer muscle wasting as the disease progresses, and you say Lili already has muscle wasting from the arthritis, so personally I'd probably wait a bit to go to an rx diet, or at least not feed it exclusively. The Friskies salmon pate is actually about 45%, and the 4Health turkey around 41% (I won't get into the calculations here). Those are on the high side, but again, I'm not sure that's a bad thing in Lili's case.

An alternative to giving money to Hill's (or giving any other rx renal food) is to get the lowest phosphorus commercial foods and to add a phosphate binder to lower absorption. If you do this, ask your vet about adding a binder. On Tanya's site, there are food tables (and info on how to use them) that give phosphorus and protein content for zillions of foods:

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - How to Use the Cat Food Data Tables
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease- Canned Food Data USA

Unfortunately, the two brands you're feeding aren't listed - for Friskies, apparently the company just will not supply the data. You can try contacting both companies to ask for phosphorus content *on a dry matter basis* and not the "as fed" number in the nutritional info. I've done that with other companies.

Do you know what Lili's potassium (K) result was? If it's under 4, then you may want to supplement it. Otherwise, giving vitamin B12 may be helpful. Some people really like Aventi Kidney Support, though personally I'm not convinced.

Is Lili getting any treatment for her arthritis? Celia got Cosequin, as well as cold laser therapy, chiropractic adjustments (yes, they exist for kitties!), and acupuncture.

I would strongly encourage you to join the support group affiliated with Tanya's site. I did and got great advice from many other people who have already been through the CKD journey with their kitties.

Hope something in all of this is helpful!
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post #3 of 4 (permalink) Old 10-05-2018, 03:17 PM Thread Starter
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Hi spirite,

Thank you so much for all the helpful info and I'm so sorry about your beloved Celia. I did join Tanya's support grough and a few on Facebook. The vet said Lili is in very early stage 3 failure...she said 0.1 above a stage 2. The vet wants her to be on Hill's K/D + Mobility but it's super expensive....3 2.8 oz cants for $7.79 with my vet supplied discount. The vet told me that she does not believe supplements work and I knew she was going to push for a diet change to Hill's only. I normally don't use her for that reason but I wanted the best vet there that dealt with cats. I ususally use one of the practice's 2 owners. I did buy the Aventi KS on Amazon and started giving it to her last night. It had great reviews so hopefully it'll work for her.

Her potassium was 4.6 (Range = 3.4-5.6 mEq/L) and the vet did not say anything about a phosphorus binder.

Lili was prescribed Tramadol for the arthritis, Cerenia for vomiting, and Amlodipine Bylate. She gave me a 2 week supply of all 3 and then reevaluate how she's doing. Lili had her first sub q fluid treatment last week of 150 ml and we need to do it every 2 weeks. Her mobility improve for a few days but now she's back to just sitting around. I've tried various ways to give her the pills and sometimes they work and other times not. It's a hit or miss with her. I put an empty salmon pill pocket and a balled up Whisker Lickins treat (vet recommended for giving pills) and she didn't eat either.

When I try to put the pill in her mouth with pill pocket, treat, or alone she immediately tries to spit it out and turns her head left and right. I can't even close her mouth fast enough to get her to swallow it. I may have to crush the pills but she doesn't like to be syringe feed either. Tried that this afternoon with the leftovers from her morning meal (wet food mixed with a little pure pumpkin and 1/2 dose of Aveni KS). For the last 2 days she's only been eating half of her normal portion at a time. So I'm getting a little worried about her not eating enough.

I'm definitely going to have to do more food research. I rotate brands ad flavors at each meal. Do you have any suggestions on how to get a stubborn cat to eat willingly? Before her prescribed meds she would vomit very easily before or after a meal...just picking her up or getting her walk 6 feet to her food spot would cause her to vomit. I need to talk to the vet next week about anti-vomiting meds because I gave the final dose last night. I'll see how she does over the weekend.

Thanks again!!!
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post #4 of 4 (permalink) Old 10-05-2018, 09:42 PM
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Hi JBerotte,

Hmm, you might ask the vet about switching to buprenorphine. A lot of people find that their kitties respond to it better than to Tramadol or gabapentin.

Is the amlodipine being given to try to slow disease progression, or for high blood pressure? (And if she hasn't had her BP tested, she should.)

The potassium looks good; the vet likely didn't say anything about binders because she recommended the renal diet. Take a look at the food table on Tanya's site and see if Lili will eat any of them.

I'd call the vet and try to get more Cerenia as soon as you can, because it works best when given consistently, and it's clearly helping. What is the dose she's getting? When given by injection, the dose is 1 mg/kg, but when given orally, it's 2 mg/kg, or approx. 1 mg/lb. Many vets prescribe the injection dose for the oral Cerenia as well. If Lili's underdosed, you can show your vet the ISFM Consensus Guidelines on treating CKD: SAGE Journals: Your gateway to world-class journal research

The dosing is in table 9, p. 232.

For pilling, try putting the pill in one treat or Pill Pocket and then putting it, along with some plain treats as decoys, on a plate. That way she won't feel like you're doing something to her that she doesn't want done. Celia resisted any treatments ferociously, but when I put them down like treats, then it was her choice to eat them (you know how cat are...). She didn't like Pill Pockets, so we used cheese. She was so incredibly suspicious, but the key was to use just enough to completely cover the pill. If it's too big, you risk having Lili chomp into it, and then she'll forever be turned off by that treat.

I'd also try adding Cosequin. It's a chicken-flavored powder that Celia would usually take if I mixed it into her food.

If Lili is already a fussy eater, she may not like the k/d anyway - most kitties don't. If you don't want to feed it, then as far as the vet knows, Lili doesn't like it...This may not be a lie anyway.

As for how to encourage Lili to eat - that depends a bit on whether the nausea/vomiting are controlled. If they are, and she just doesn't have much appetite, there are plenty of things you can try but a few easy ones are sprinkling some Fortiflora, or dried bonito flakes, or crumbling some dehydrated chicken or salmon or whatever, onto her food or mixing in a bit of plain meat (nothing added) baby food. Celia liked roast chicken, and I'd also boil a chicken thigh and give her bits of chicken in some of the boiling liquid. That's also a great way to get more water into a kitty.

Is she vomiting any white foam? That would be a sign of stomach acid, in which case famotidine (Pepcid) or ranitidine (Zantac) would help.

I hope you find some super yummy things that entice Lili!
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