Kidney support for cat that can’t eat renal diet?

[Cammie]

Sorry this is so long! Would love some input from people knowledgable about kidney disease in cats. CJ will be 13 this summer. She started losing weight over the past month or two and went in for an exam and bloodwork. She has a heart murmur and enlarged heart now and the bloodwork showed thyroid issues which is what I suspected going in. She’s started thyroid meds and will have a recheck in a few weeks to see what her levels are.

The bad news from her results is that she tested positive on the RenalTech panel, which indicates that her kidneys have a 95% chance of failing within 24 months. Currently her values are good, but the vet said treating her thyroid could potentially kickstart the kidney decline. The only suggestion I’ve been given so far is to switch her to a renal diet, but she can’t eat any of the renal foods available. She is extremely allergic to chicken, and has intolerances to beef and fish. I’ve spent days looking at ingredients in different products and there doesn’t seem to be any available in the US that she can eat. Royal Canin makes (or made) a hydrolyzed protein dry food but it’s either discontinued or is extremely difficult to find. I’m not thrilled about putting her on a dry food even if I can find that consistently though.

Currently she eats Stella & Chewy’s raw frozen rabbit, and has their freeze-dried rabbit for treats. I have no idea if she can eat pork or venison or any other novel protein if I try to find something lower in protein or phosphorus. Stella’s has 44% Min protein and the phosphorus is 1.75DM. The other “clean” rabbit foods I can find have higher protein and phosphorus so it seems like this one may be the best option if she has to stay on rabbit.

From what I’ve read, I can try supplementing her with B vitamins, fish oil (not sure if this will cause an allergy flare-up or not with her), a phosphorus binder and a pro/prebiotic that helps with kidney function. Epakitin, Renal K+ and Azodyl are the supplements I’ve been researching.

I’m just not sure on when I should start trying these things. Now while her numbers are still good? Or wait until she starts showing a decline in values? I know that too low of phosphorus is problematic along with being too high, so it seems like I shouldn’t start a binder until that value starts to be an issue. But vet is saying to start a renal diet now, which would be low in phosphorus and high in B vitamins so I have no idea. And the info coming from the vet tech is not very helpful, she just keeps saying put her on a renal diet and that her values are fine at the moment and she doesn’t have any input on supplements.

Any thoughts or suggestions would be most appreciated! I’m not expecting any miracles but want to keep her feeling good for as long as possible. Looking to switch her to a cat only vet that hopefully will be more helpful but can’t get an appointment for a few weeks.

[Sdel]

@erinmeri

Any ideas?

[erinmeri]

Thanks, @Sdel! Yes! So many!

I will read through the OP, but as a Kidney Kitty mama with four under my belt, here are a few initial thoughts:

1. RenalTech is, or was as of a few years ago, a largely unproven marketing gimic. That said, I think being conscious of a cat’s renal health at all ages is important. See number 3 below and look at gold standard markers, and see number 4 below to get specific guidance.

2. kidney disease isn’t a death sentence, I have had four kidney kitties, including my current two.

3. check out the ISFM Consensus guidelines. So much good info, a lot of it not known to most vets: https://journals.sagepub.com/doi/pdf/10.1177/1098612x16631234

4. Join TanyaCKD, but understand it’s moderated differently than here. That said, they saved me in times of crisis and there are MANY very knowledgeable people there: https://tanyackd.groups.io/g/support

5. get ALL your lab values from your vet. “WNL” and reference ranges are always IMO suspect, but they really go out the window with CKD. See #3 above!

6. PM me anytime!

7. you’ve got this!! I went from a CKD noob to a pro overnight and had a cat who was blind and very sick and was also ornery, and I handled it okay. I can give SubQs to any cat, pill any cat, and am generally undaunted… and I was not a cat person when my CKD rodeo started. You will be great!!!

[saje]

Quite frankly with my kidney cats (I’ve had many over the years), my approach now is to feed them whatever they will eat happily that won’t affect any allergies or sensitivities. I make sure they stay very well hydrated, doing lots of soupy meals, water bowls everywhere, and subQ fluids IF and only if it doesn’t stress them to the point of affecting quality of life.

Weight loss is a huge factor, and it does no good to feed a renal diet if they hate it and won’t eat. Again, quality of life over quantity. All the body’s systems struggle more when there is significant weight loss, and they need good protein to keep muscle.

My main aim is a happy cat, and I’ve found that a very wet diet that they’ll really eat keeps them healthy and content for a good long while. Could I get a few more months by forcing a diet and doing daily fluids? Possibly. I did try that at one point. I had a sick cat who hated the sight of me, and it was not a happy old age Never again, at least not for a mid-teens cat. I want their lives to be happy first and foremost. If I had a youngish cat with CRF, then yes, I’d pull out all the stops, but probably not for a senior who has lived a long, happy, well-loved life.

It tears my heart out not to be able to help them live forever, but that’s my pain, not theirs.

[OzarksRider]

I’m currently dealing with a 14-year-old cat that was diagnosed with early kidney disease a year ago. He absolutely will not eat any prescription kidney food, so I just feed him non-prescription food with as low a phosphorous as I can find. He likes Royal Canin “Aging,” Weruva “Steak Frites,” and Hill’s “Chicken and Rice Medley.” If your cat is allergic to chicken and beef those won’t work for you, so it’s probably best to just feed her what she can eat. I supplement my cat with vitamin B12 that I drizzle on his food. It won’t hurt, and it might help to keep the appetite and red blood cell count healthy. You can get liquid B12 from Chewy. If your cat’s phosphorous is still within normal limits she doesn’t need a phosphorous binder yet.

Hyperthyroidism can cause cardiomyopathy which often resolves when the hyperthyroidism is cured. Have you considered radioactive iodine treatment? It’s expensive up front, but in the long run it can be cheaper than treating with methimazole because it cures the disease and eliminates the need for ongoing treatment and lab tests to monitor the dose. The American Academy of Feline Practitioners has published guidelines for the treatment of hyperthyroidism in cats. The guidelines include an excellent discussion about the advantages and disadvantages of different treatments and recommendations for treating cats with underlying kidney and heart disease. Here’s a link: https://journals.sagepub.com/doi/full/10.1177/1098612X16643252

[Cammie]

Thanks for the info everyone, I appreciate it. I’m happy to spend money on her to keep her as happy and feeling well as long as possible, but I know she may end up not being an ideal patient. She can be a pretty stubborn and uncooperative tiger so when it comes time for more intensive treatment we may be stopping there because it wouldn’t be fair for her. She is a cat who gets very stressed and frightened at the vet so I’m not going to put her thru endless visits once this progresses too far. But I do want to give her every chance to keep going as long as she wants to. She’s my heart kitty, so if she could stick around for say another oh, 20 or 30 years or so that would be good.

She had almost starved to death as a kitten when I found her, and as a result has always been obsessed with food. She will eat everything and anything you put in front of her, and is constantly scrounging for food when she thinks I’m not looking. Pickiness is not in her vocabulary, which will definitely work in her favor. She gets “soup” for every meal already and licks every crumb and all the water off the plate every time. She doesn’t drink water at all since she gets so much in her food. If she starts drinking extra water or turning her nose up at food those will be very obvious signs that she’s starting to have issues.

I am aware of the radioactive treatment option for her thyroid but will wait to see how she responds to the meds first before looking further into that. She’s eating her thyroid pill right in her food, she scarfs her food so fast she doesn’t even realize it’s there and I don’t have to pill her. I’m hoping her heart issues will improve or resolve with the thyroid meds.

I started delving into the TanyaCKD site already, but haven’t gotten a deep dive yet. I will definitely check out the ISFM and FHT guides as well, thank you both for those!

Other than being thin right now she’s still glossy and shiny and doing wind sprints like a loon so she seems to be feeling pretty good.

[2DogsFarm]

She’s a pretty girl!
My 8yo FIC cat wouldn’t touch the Hill’s RX food - canned or dry.
I settled on Iams Urinary kibble & {KnockWood} a year+ later he’s had no further issues.
I have yet to find a canned food he likes, but he drinks a good amount of water.
The Delectables treat is acceptable now, but that might not last. It comes in flavors other than chicken.

You find something to help your old gal.

[erinmeri]

@Cammie

Epakitin, Renal K+ and Azodyl are the supplements I’ve been researching.

I’m just not sure on when I should start trying these things. Now while her numbers are still good? Or wait until she starts showing a decline in values? I know that too low of phosphorus is problematic along with being too high, so it seems like I shouldn’t start a binder until that value starts to be an issue. But vet is saying to start a renal diet now, which would be low in phosphorus and high in B vitamins so I have no idea. And the info coming from the vet tech is not very helpful, she just keeps saying put her on a renal diet and that her values are fine at the moment and she doesn’t have any input on supplements.

As for supplements, the ISFM guidelines I sent you have good info on Phosphorus levels based on CKD stage that should help you determine when to start a binder if kidney food is out of the question. I am not a big fan of Epakatin personally. I used PhosBind successfully. More here: https://felinecrf.org/phosphorus.htm

I’m not sure if the charts are kept up to date, but this may help you with phosphorus in foods: https://felinecrf.org/canned_food_usa.htm

As for Renal K+, you only want to use if you need to. The potassium levels on blood work should be middle of the reference range - 4.4 is the goal. More here: https://felinecrf.org/potassium.htm

B vitamin supplementation can be done orally or through injections, or both. More info here: https://felinecrf.org/vitamin_b.htm

Azodyl is a bit controversial. Can cause nausea, if I am remembering correctly. I never have used it. If you join the group I sent you earlier, they will have a lot of input. Be forewarned that they will ask you for all labs.

Hope this helps,
Erin

[erinmeri]

@Cammie

I am aware of the radioactive treatment option for her thyroid but will wait to see how she responds to the meds first before looking further into that. She’s eating her thyroid pill right in her food, she scarfs her food so fast she doesn’t even realize it’s there and I don’t have to pill her. I’m hoping her heart issues will improve or resolve with the thyroid meds.

I missed the part about thyroid. Hyper T will mask CKD. So, once that is sorted, you’ll want to re-run the kidney values. There are many on the TanyaCKD group with experience with both HyperT and CKD.

[Cammie]

Thank you for the info on the supplements. I’ve put in a request to join the Tanya group and will look for more info there.

I looked at the wet food list but I don’t think she can eat anything on there on the good end of the spectrum. Her chicken allergy is so bad I haven’t tried her on duck or turkey, although it may be possible she would be able to eat those. Since she does so well on rabbit I haven’t wanted to mess around with her diet. But in looking at the food list, the duck and turkey options are for supplemental feeding only so they wouldn’t work long term. If she has chicken or eggs she scratches at her throat so badly she draws blood and has to go on steroids to calm her system down. Fish and beef bring on ear infections. She’s also allergic to scented laundry detergent, carpet, dust, the world in general just to give you an idea of her limitations…

In looking at the bloodwork, her values all seem pretty good currently. Potassium is 4.5 right now. She goes back in a few weeks to check her thyroid level and to see if treating the thyroid has impacted her kidney values.

[Bogie]

Sadly, I have a cat in Stage 4 kidney disease. He was diagnosed a few years ago and we’ve kept him going with lower phos foods – he likes the Weruva Steak Frites – but he’s a bit of a picky eater. I also have a cat that is allergic to chicken and fish so I know how hard it is sometimes to find something they can/will eat. My previous CKD kitty did really well on Stella and Chewy’s Chick Chick Chicken which isn’t an option for you, but my conclusion is that you need to find something they will eat and that you can lower phosphorous levels by using a binder. Many of the low phos foods are unpalatable. The bottom line is they need to eat. My vet also gave me an appetite stimulant to encourage him to eat. I will occasionally do Sub Q fluids but it requires wrestling my cat into submission (He’s surprisingly strong) and the stress levels all around are not helping (I’m also dealing with a father going into hospice care, so don’t have as much emotional energy).

For my allergic kitty I’ve had the most success with Farmina’s N&D wet food. Many of them also have pumpkin which helps keep his digestive tract happier. He does very well on Wild Boar w/pumpkin and Lamb w/blueberries. There are also some good venison options out there.

[erinmeri]

@2DogsFarm

The Delectables treat is acceptable now, but that might not last. It comes in flavors other than chicken.

This was my absolute go-to for giving meds and supplements! It’s like kitty crack!

[Cammie]

@Bogie

For my allergic kitty I’ve had the most success with Farmina’s N&D wet food. Many of them also have pumpkin which helps keep his digestive tract happier. He does very well on Wild Boar w/pumpkin and Lamb w/blueberries. There are also some good venison options out there.

Sorry about your kitty. It’s so stressful when an animal won’t cooperate when you’re trying to do everything to help them.

Thanks for the recommendation on the food. I know I tried her on lamb as a kitten and she threw up on it so I’m assuming that’s a no-go. I haven’t tried her on pork or venison, will have to look at the nutrition vs rabbit to see if it’s worth trying to switch. I’m always leery of the cat foods that put in things like blueberries, but if CJ can handle the switch and the food is overall better for her kidneys I’m happy to give it a go.

[Bogie]

@Cammie

I’m always leery of the cat foods that put in things like blueberries, but if CJ can handle the switch and the food is overall better for her kidneys I’m happy to give it a go.

Farmina is a very high quality food. It’s cooked in the can to retain nutrients and the company is committed to keeping it fairly fresh. It can be difficult to find as it’s imported from Italy (only my cat would hold out for authentic Italian food!) and Loyal Companion which was their main distributor, just went bankrupt. However, it saved my cat who before that had almost constant diarrhea and stomach pains. And it’s less expensive than prescription food.