Cat - Stage 2 Renal Failure. Calcitriol? No, new diet and new vet.

[Peggy]

My 16 y.o. female cat has been diagnosed with Stage 2 Renal Failure based on blood and urine work. Numbers for BUN/Creatinine/Urine Specific Gravity are 39/2.1/1.028. Six months ago the numbers were 41/1.8/1.037. Of the symptoms given, she may be throwing up more (though that stopped recently with the introduction of New Cat to the household) and drinking more water.

Based on this website which uses creatinine values she on the low end of Stage 2.

Vet wants to put her on Calcitriol, a vitamin D derivative that will help to (from what I understand) slow the progress and make her more comfortable. It is a liquid, not a pill. You then check the blood at 2 weeks and 4 weeks and then every six months to make sure that the calcium levels haven’t gone whacko.

Any advice from those who have been down this road? Or any random people who feel like commenting? Anyone have experience with Calcitrol specifically?

[Chall]

My vet has never mentioned that, but I have to push things with him. I give subcutaneous water to my cat and it gives immediate results of looking feeling better. It’s funny, but after the subq, she then goes to drink from her bowl, so she it seems to remind her to drink.
Her hyperthyroidism is the more immediate problem, at top dosage she is still extremely thin. She is 19.

[oliverreed]

I have lost two kitties to renal failure and I have not heard of calcitrol. I used subQ lactated ringers, which helped greatly with the first cat and not much with the second. I think there was something else going on with my second guy, though. Good luck and please keep us posted. I have a special place in my heart for people going through this particular, unfortunately fairly common, ordeal.

[Peggy]

Chall - this cat was diagnosed with and got radioactive iodine therapy for hyperthyroidism five years ago (well worth the money not to shove pills down this particular cat’s throat, but she was “only” 11 at the time). When I got the kidney diagnosis I wondered if there was a connection but haven’t asked the vet. Probably just getting old:sigh:.

[Lifting_Chickk]

I have a 15 year old hyperthyroid cat on methimazole. She’s on 10mg/day and although she’s gained back a good deal of weight, she’s still thinner than she was when she was younger. Drinks more than what is normal, but is otherwise seemingly comfortable and happy.

I’ve been told hyperthyroidism can mask an underlying kidney problem so when the thyroid is treated, the kidney disease is revealed.

I won’t go through great lengths to keep Cinder around for “as long as possible”. She gets the Meth and when that fails to keep her feeling well she’ll cross the Rainbow Bridge.

It’s sad, but they can’t live forever. (although I wish this particular cat could!)

[rmh_rider]

My heart dog died of this.

At some point, you must decide when you are ready to let them go.

Hardest but most kindest decision you can make.

It has been since 2004, and I still have tears in my eyes. Now as I type this. I cried for so long. Now more tears.

I did have my loving dog cremated. She is now on my dresser in my bedroom.

[arabiansrock]

Peggy
My chihuahua/terrier cross dog (now approx 11 yrs) has been on calcitriol since he was about 2 (hes a rescue so don’t know exact age). He has hypoparathyroidism and gets the calcitriol to keep his blood calcium levels up, otherwise he goes into seizures. I just squirt his dose (1.4 ml) into his mouth every night with a syringe. They can make the liquid to any concentration you need to minimize how much you have to give your cat.

That said, I have not heard of it being used for kidney disease, but if her blood ca+ levels are low, then it would make sense.

You will have to do periodic blood work just as you described, but you will probably need that to keep check on her kidneys anyway.

the calcitriol has literally been a lifesaver for my dog and well worth it (and off to phone in refill on his prescription while I am thinking about it ).

Good luck
arabsrock (another Peggy)

[lilitiger2]

i have been down this road several times and so sorry you are on this journey now! I have never heard of that drug at all, but have a) done the subq fluids, sometimes weekly, eventually daily, with potassium added (by vet), b) used an appetite stimulant (cyroheptadine) which was very helpful and c) CERENIA, huge huge huge help with nausea and overall feeling better. If they eat KD, great. One of my cats did and it seemed to help (eventually he got whatever he wanted, liver and rice, as I remember). The others, no. NF is also a good option as others here have mentioned, forgot about that and another of my cats did eat it. This last one ate Fancy Feast, and ONLY a FRESH can and only with LIQUID. One of my cats was a candidate for epogen, and we actually got it, but he was declining so fast we never really got to use it.

Good luck and prayers for you and your girl!!

[SquishTheBunny]

Cats deal SO MUCH better with renal issues than dogs do. Those values are not significantly elevated, and sound chronic (which again, is far better than acute). Wet kittys food down with extra water if possibe. To be honest I often see differences with foods such as KD, NF etc. but some people believe grains in these foods cause other issues. Personally I had a cat live for 8 years on dry KD only (he refused tin food).

Chronic is fairly easy to manage. Lots of fluids, and occasional trip to the vet for IV fluid support (this often kick starts the kidneys again). Subcutaneous fluids are a bit of a grey area, some people feel they really help and others believe it is a placebo effect. IV fluids (once every few months) is generally more effective than daily SQ,but then again you do hear people say their cats DO feel better with it.

Good luck! Keep trending the bloodwork and you will see what works best for your cat. Long term moderately elevated renal values are a good sign, when they suddenly elevate or the SG becomes < 1.008, or you have no urine production then you know the end is near. Otherwise, I managed my cat for 8 years with a renal diet.

[Peggy]

Thanks for all the information and advice. The cat really looks quite good. The first time the vet (new vet to practice) saw her six months ago she noted how great she looked for her age–much better than her own cat. And she’s definitely holding her own against the new cat I imported from the barn.

The only thing the vet said about diet was to try to keep the protein (and phosphorus?) low, probably by using a food designed for older cats. And I’m pretty sure I’ve seen a fairly large display of Hill’s in the waiting room. But then there’s the grain thing, which I’ve had pounded into me by my former horse vet who authors a website dedicated to cats and the proper feeding of them. She doesn’t love wet food, except (of course) for Fancy Feast, AKA Cat Crack and sometimes TikiCat.

It is interesting that no one has heard of using Calcitriol for this. If there’s an OT Day over the 4th maybe I’ll try a post with that specific question, but it will probably get lost amongst the more interesting threads. From what I’ve read online there is some controversy regarding its use and one site noted that there was a fine balance between the Calcitriol, calcium, and phosphorus.

I’m with you Daatje–no heroics.

(meanwhile, barn kitty may or may not have an allergy to some foods so he is eating Natural Balance duck/venison–good thing I have a pet food discount place with a great inventory nearby)

[Zu_Zu]

Jingles & AO for your dear cat ~

Jingles & AO for your dear cat ~

[Peggy]

Photos!

Because what’s a cat thread without photos. Photos were taken last fall, but she doesn’t look any different now and the newer ones are on my phone

[Zu_Zu]

Thanks for sharing her lovely photos ~ Jingles & AO continue ~

She is lovely ! Thanks for sharing her photos ~ don’t mean to snoop but perhaps you would share her name so the Jingles can be personalized ? TIA

@Peggy;6404155

Because what’s a cat thread without photos. Photos were taken last fall, but she doesn’t look any different now and the newer ones are on my phone

[Chall]

Peggy, she is gorgeous and has that happy contented look of a cat that knows she is loved :yes:

[Peggy]

The cat’s name is Loki. Norse god(dess) of chaos, or something like that.

[SquishTheBunny]

Very cute cat! Chronic disease is very well tolerated by cats. Its amazing how well they can do in a “dehydrated” state (not that your cat is).

Im a bigger fan of lower protein /phos (higher fat) for renal patients than I am “grain free”. However, I know there are some people who feel the opposite. Personal choice.

I managed a cat on K/D with increased values for 8 years. His kidneys werent his demise either. He was probably 25 or so when I put him down after he fell down the steps and likely broke his pelvis. Just weeks before, his renal values were the same as they were 8 years prior.

So, best of luck with your kitty - she looks healthy and well loved - im sure she will remain this way for a longtime!

[Sanely_Eccentric]

My 18 year old cat is dealing with renal failure. She does eat the k/d food, so she’s been on that since fall. She drinks well; I actually keep a dish for her on my nightstand that I can monitor easily. My vet put her on Azodyl and it has done wonders (relative). We started with one capsule a day until her symptoms started progressing again. At that point we went to one capsule morning and one in the evening. Two capsules daily is the max dose for my cat’s size. Then the symptoms came back more once again and so I added another capsule and told my vet the following week. We discussed that while it wasn’t wise to bump up past standard dosage the alternative wasn’t good either. So that’s where we’re at and when that’s not enough then we’re done. She’s been an exceptional kitty and I won’t let her suffer.

As for getting the Azodyl into her I empty the capsules into some ice cream (something fatty is best for absorption of Azodyl), mix it, then load it into a 3cc syringe and squirt it into her mouth at a pace that allows swallowing. It’s been a good system for us because she won’t take it any other way more than once.

I wish you and your cat the best as you go through this.

[Zu_Zu]

Thanks ~ Jingles continue for lovely Loki ~

Thank you ~ Jingles & AO continue for lovely Loki ~

@Peggy;6404231

The cat’s name is Loki. Norse god(dess) of chaos, or something like that.

[Peggy]

Came up with a list of questions, including why not try feeding k/d or NF first, based on my internet research. Finally called office to talk to vet, who is one of several in the practice. We play a bit of telephone tag, she’s out of the office for a few days, more telephone tag, and finally today a call back from the office, but it’s a different vet who explains that vet A is no longer with the practice and she has taken over the case. OK.

I ask “why Calcitriol” and she answers (more intelligently than vet A). Then she asks about diet changes and I get the feeling that she thinks vet A and I had already discussed k/d and NF. I explain that she’d had me feed lower protein but not a kidney specific diet.

So, Thursday we go to the office so Loki can have her blood pressure checked and to pick up some food to see what she’ll eat. Vet B said to change over slowly and give it a couple of months.

Turns out her Ca, K, and P are all normal.

Vet was just at a conference and went to a session where it was reported that Calcitriol is definitely beneficial for dogs but that it hasn’t been sufficiently studied (N too small??) in cats.

[JJARAB]

Tanya’s CRF pages are an outstanding resource for cat owners of cats in all stages of renal failure. There is a wealth of information to be had about symptoms, treatments, assisted feeding, etc. I give our cat Lucky, 17, Epakitin in her wet food as she has no interest in the prescription diets, even with gradual introduction and prefers the junk-food type instead. It helps keep the phosphorus levels down. She also really likes the Hill’s Science Diet Senior Age Defying formula. Her other levels are, as of now, normal, so we don’t need to start supplementing with Potassium, B12 etc yet. If they are eating well and have good body condition for their age, you just take it as it comes.