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Discussion Starter #1
Hi everyone! I was hoping I could get some advice from fellow kitty lovers on food choices for my 3 kitties.

Bitsy is a 15 yr old female short hair domestic kitty and has kidney failure (diagnosed last Nov and have been giving her sub-q fluids 3 times a week) but is currently doing fine.

Oliver is a 12 yr old male flame-tip siamese kitty and other than eye drops for conjunctivitis he's a healthy boy (thank the Lord!).

Munchie is a 12 yr old male short hair domestic/part manx (stumpy tail) and he's been dealing with bladder infection/stone issues since May. His x-ray from 6 weeks ago showed a stone, so my vet put him on Hill's S/O diet. The x-ray yesterday showed that it had grown, so he must have the oxalate type of stone that won't dissolve from diet. So, he's going to have to have surgery.

Prior to Bitsy's kidney diagnosis, I had been feeding the cats Hill's M/D dry (advised by vet for weight control - which vet said was fine for all the cats) along with wet Science Diet turkey (or chicken) for mature cats. After Bitsy was diagnosed, the vet said that all kitties could be on her diet, which was to be Hill's K/D (Oli & Munchie were still fed the Science Diet wet). Then Munchie's bladder problems started happening. Munchie's been on the S/O for the past 6 weeks while Bitsy & Oli have been on the k/d.

With Munchie about to have surgery to remove his stones, I don't need to feed him the S/O any longer and am looking for good choices for him to reduce the occurance of future stone development but also hoping for something that would work for all the cats (I understand that's probably not going to happen with Bitsy needing a special diet for her kidneys).

I'd been taking the advice of my vet this whole time and hadn't thought to look up food alternatives online before now. And I guess I'm questioning it now because it seems that Munchie started developing all of his problems after being switched to the Hill's K/D diet last Nov (despite being told that it was fine).

I do not want to feed a raw diet - but food I can purchase already made.
I appreciate any thoughts. Thanks! :daisy

p.s. here are my kitties (from top left clockwise - Munchie, Oliver & Bitsy)
 

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Hannah had urinary problems, vomiting issues and bladder stones, the vet recommended foods did not help. I ended up feeding her chicken baby food as it was all she could keep down. Switching her to an all wet grain free, high protein/low carb diet (Wellness core, EVO, ziwipeak, Halo grain free pate) has completely eliminated her symptoms. I also bought a water fountain to encourage her to drink more water. She is 13 and eating dry foods made with corn and by products for years caught up to her.
 

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Canned food is much healthier for your cats than kibble. This is especially true for Bitsy and Munchie. Cats in renal failure are easily dehydrated and require extra water in their food in order to help maintain adequate hydration. Since kibble contains only about 8% moisture and actually absorbs moisture out of the GI tract, it is the worst possible dietary option for a renal cat. The ONLY time that kibble should be fed to a renal cat is if it is the ONLY food that the cat will eat. Canned foods contain about 80% moisture, and they can (and should) be mixed with extra water to improve hydration even further.

The following link will provide you with a lot of information regarding dietary issues related to feline kidney disease:

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Nutritional Requirements of CKD Cats

Cats who develop urinary crystals or stones also require extra moisture in their diets. Extra moisture=increased urine production, and more urine helps keep crystals flushed out of the cat's urinary tract before they have a chance to clump together and form stones and/or blockages. Again, kibble should not be fed to a cat AT ALL with a history of crystal/stone formation UNLESS kibble is the ONLY food that the cat will eat.

NO CAT WHO IS NOT IN RENAL FAILURE SHOULD BE FED A PRESCRIPTION RENAL DIET! Prescription renal diets are low protein (which, in itself, is controversial for renal cats). Low protein can seriously weaken a cat and cause muscle wasting. While prescription renal diets also provide other dietary modifications that may benefit a renal cat, esp. in later stages of the disease, none of those modifications are necessary or beneficial to healthy cats. Oliver and Munchie should NOT be eating a renal diet. They should be eating a high quality canned diet, preferably mixed with warm water to increase hydration (esp. in Munchie's case).

Laurie
 

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Discussion Starter #5
I appreciate all of your responses SO SO much!! I feel badly that I've not researched this before now. I will stop with the Hill's K/D food. I bought some Wellness Core food today and will see how they all like it tonight. And all these years I've fed them both wet & dry (dry always sitting out so that they can munch as they want - which of course they've gotten used to). Taking up the dry is going to take some getting used to for them - but I want them all healthier, so I'm going to do it.

Laurie - I appreciate your tips so much. It's been confusing on the diet thing, because I do remember researching some about diet after Bitsy's renal failure diagnosis, but I saw contradictory info because I'd been told by the vet & read online that a low-protein diet was the best. :( But she has been getting worse since then (weight, bun/creatinine & energy - she sways alot, so I know she's lost muscle mass) - so hopefully her tummy can handle a diet change fine and maybe she'll turn a better corner.

Elizabeth - I'll take a look at the link you gave here in a bit, thanks for that.

So...a grainless diet for cats - is that for all cats in general, or best for cats with stones? Also, I'm reading that cats shouldn't eat fish either? Is that correct?

I appreciate y'all!
 

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Discussion Starter #6
oh and yes, Elizabeth, ever since Bitsy's renal failure diagnosis, she's been getting sub-q fluids at home. At first twice a week, and now 3 times a week.
 

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Cats shouldn't be eating grains at all regardless of health. Fish is okay but in moderation for healthy cats. I'm not sure for cats in renal failure.

Here are some good wet foods you can feed:
Wellness CORE/Grain-Free Varieties
Merrick
Weruva
EVO 95%
Tiki Cat (Not Fish on Rice though)
Petcurean Go! (Look for Grain-free on label)
Nature's Variety Instinct

Some of these foods are high protein. You might want to add warm water to the thicker foods to increase fluid intake.

There are a lot of good wet foods. You just want to make sure it doesn't contain any grains, unnamed "meat", and by-products.
 

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Discussion Starter #8 (Edited)
Thanks Scottd!

Hallelujah! I fed them the Wellness Core chicken + turkey + chliver tonight and they all devoured it! It was thick, so I added water to make it more soupy (which is how they like their wet anyhow). They never eat a big can (shared between all 3) in one sitting. Munchie, who hasn't been eating well since on his s/d diet, ate alot and is very contentedly sleeping right now. Hopefully this will continue and they'll all love the same food and it'll help health issues.

Munchie also has allergy problems (he's got alot of fur missing from all of his legs, luckily no open sores right now), so at some point I'm going to see if they'll like other flavors other than the chicken and see if that's what he's been allergic to all these years.

It's such a relief to have them all on one food again and not having to feed separately. Now to gear myself up for a coned kitty after surgery.

Thanks again y'all! :)
 

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Do you have copies of Bitsy's most current bloodwork that you could post here so that we could take a look? It would be very helpful to see where her blood values are in order to make the best dietary recommendations for her. If you don't have copies of her labs, I strongly recommend you go to your vet and acquire them. You should ALWAYS obtain copies of ALL lab reports run on your animals to maintain at home. If you do post her labs here, please be sure to include the reference ranges like so:

BUN 44 (18-36)
creatinine 2.7 (0.6-2.0)
phosphorus 4.8 (2.7-7.5)
potassium 3.6 (3.3-5.4)
etc.

It's important to include the reference ranges, because each lab's reference ranges will vary a bit depending on testing equipment and methods used. It's also important to post ALL blood values, not just the ones out of normal reference range. Bitsy's weakness and "swaying" may not have anything to do with the reduced protein in the renal diet. Weakness can have a number of causes, including anemia, low potassium, high blood pressure, and others.

Laurie
 

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sure, here you go:

8/24/12
weight 11.4 lbs
BUN 59 (15-34) high
Creatinine 4.3 (.8-2.3) high
Phosphorus 4.3 (3.0-7.0) normal
Potassium 4.9 (3.9-5.3) normal
WBC 16 (4.2-15.6) high
RBC 6.79 (6.0-10.0)
HGB 11.0 (9.5-15)
HCT 37 (29-45%)
MCV 55 (41-58 )
MCH 16.2 (11.0-17.5)
MCHC 29.7 (29-36)
Neutrophil 81 (35-75%) high
Lymphocytes 10 (20-55%) low
Monocytes 7 (1-4%) high
Eosinophil 2 (2-12)
Basohil 0 (0-1)
auto platelet 526 (170-600)
urine and the rest was normal

5/15/12
weight 12.4 lbs
BUN 46 (15-34) high
Creatinine 3.6 (.8-2.3) high
don't have the rest of the numbers (could get though)

10/10/11 (diagnosis of kidney disease)
weight 11.5 lbs
BUN 110 (15-34) very high
Creatinine 6.7 (.8-2.3) high
Phosphorus 6.8 (3.0-7.0) normal
TCO2 10 (13-25) low
Potassium 4.1 (3.9-5.3) normal
Sodium 145 (147-156) low
Neutrophil 78 (35-75%) high
Lymphocytes 14 (20-55%) low
Monocytes 6 (1-4%) high
Urine 3+blood, RBC 6-10 (0-5 range)

I have other BUN & Creatinine numbers between Oct & May, but not the rest of the numbers (I could get if needed). Her highest BUN has been 110 & 74 for Creatinine.
 

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Do you have her Total Protein on any or all of those dates?

What meds and supplements does she get regularly, and in what doses?
 

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Discussion Starter #12
8/24/12
Total protein 7.7 (5.9-8.5)
Calcium 10.3 (8.2-11.8 )

10/20/11
total protein 8.1 (5.9-8.5)
Calcium 9.3 (8.2-11.8 )

She receives sub-q fluids 3 times a week (200ml each time). That's it.
 

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OK, here's what I've observed in Bitsy's bloodwork. Since diagnosis, her phosphorus has lowered to the bottom half of the reference range, and her potassium has risen to the upper half of the reference range. These are both very good improvements, and since you aren't giving any meds or supplements that would account for those improvements, I have to assume that they resulted from the renal diet.

Now, her apparently increasing weakness (swaying) may (or may not) be attributable to the restricted protein in the renal diet, but I don't recognize anything else in her bloodwork that would account for it. So, it may be a good news/bad news thing with the renal diet. The renal diet probably also provided extra B vitamins, which would help counteract the B vits lost in her increased urine output, and help prevent a vit B deficiency.

You could, of course, add supplemental potassium gluconate to regular canned food, and you could provide injectible B vits during fluid admins. Maintaining low phosphorus is a bit more complicated, because the most effective phos binder, aluminum hydroxide, is very constipating, so you'd likely have to start regularly mixing a stool softener into her food, as well. Also, there is a remote possibility of aluminum toxicity with prolonged use of aluminum hydroxide.

If Bitsy was eating well and maintaining weight on the renal diet, it might be best to keep her on that food (assuming it was canned food). But if she was eating poorly and losing weight on the renal diet, then switching her to a regular food that she'll eat more enthusiastically, and adding any necessary supplements/meds might be the better option. You need to weigh the risks and benefits of both and see which seems the wiser choice for Bitsy. If you do decide to switch her to non-renal foods, you should choose those containing the lowest levels of phosphorus. You can find food charts with the necessary information here:

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease- Canned Food Data USA

You should also have another full blood chemistry run 3 mos after switching her diet to see how the change is affecting her blood values. This will tell you if you need to add any meds or supplements to keep her electrolytes in proper check.

Two more recommendations ...

Fluids - It would be best if you could admin 100ml every day rather than 200ml every other day. Since most cats process subQ fluids within 12-24 hrs, the every other day admins are leaving Bitsy's body thirsty every other day. By giving 100ml daily, you would keep her much more evenly and consistently hydrated, which may help with her appetite and her overall physical comfort. It may even bring down her creat a bit.

Calcitriol - If your vet hasn't mentioned Calcitriol, and you haven't come across it in your own research, I recommend you read up on it at the following link and discuss it with your vet. I give it to two of my CRF cats, and I believe it helps keep their disease stable.

Calcitriol Reference Page

Laurie
 

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Discussion Starter #14
Thanks so much for the time you've taken to give me this advice Laurie! I'll look into those links.
 

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Discussion Starter #15 (Edited)
After looking at the food chart link, it looks like the canned food she was on (Hill's K/d) has the lowest of phosphorus levels.


Why is phosphorus important with her disease? (edit - I found a page regarding this...nm)


Since she's been on the k/d this whole time - you mentioned that low phosphorus can cause constipation - which I've not seen in her. Her stools are fine. She wouldn't eat the k/d enthusiastically, however I've fed them 3 different flavors of the Wellness Core canned since yesterday and she's in love (just like the other 2). If they don't have throw-up or stool problems on this wellness, I may try it for a while and like you mentioned, get her bloodwork done to see how she's doing.
 
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