Chronic Renal Failure

This forum is for cat lovers seeking everyday advice and suggestions on health-related issues. Remember, however, that advice on a public forum simply can't be a substitute for proper medical attention. Only your vet can say assuredly what is best for your cat.

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Joey (In- Memory)

I'm big, I'm- bad, but I am a- real mush!
Purred: Tue Apr 2, '13 10:17am PST 
Okay many of you may know me for being able to give advice to other pawparents but I am stuck and I am now in need of help.

Joey was just diagnosed with Chronic Renal Failure. I am devastated. I lost a cat to Acute Renal Failure and I can't get past that experience. Joey is 14 - 14 lbs. (was 22 lbs.) had a bout of bladder stones in 2006 - struvite stones, had surgery and no reoccurrence. He is on an all wet food diet of Fancy Feast because that is all he will eat. He gets 1/2 tsp. of MiraLax to combat chronic constipation daily. He gets crunchy cookies every day for his dental health. Currently the doctor has him on an antiemetic to stop the vomiting and it has helped. I have another cat in the house (Phoebe) and they co-feed so I know that will most likely need to change as she is healthy and only 5 years old.

I am desperate for all the information you can provide - what to look out for - what to ask - how to be prepared - diets, etc.!!! For example a friend just told me to get him off the tap water - I have hard water - and offer him distilled instead - is this something I should do?

The vet told me to take a few days and think about things before we speak again and come up with a care plan. Any and all advice is welcome!!!


World's Best- Kitten- Socializer
Purred: Tue Apr 2, '13 1:20pm PST 
My response is somewhat dependent on the condition of the cat. Are there behavior indicators that he is going downhill quickly (not eating, drooling, hiding, etc)? Or does he mostly seem to be himself? The other consideration is what you feel comfortable doing both from a treatment perspective and from a financial perspective? If the cat requires daily saline injections to help flush out toxins, are you comfortable with that or not? When does cost become an issue? I also lost a cat to acute renal failure after 4 years of chronic kidney disease. I don't have the answers, but these are some of the things you need to think about both before you meet with your vet and in a few days when you do meet with your vet. I know how hard it is and I hope that whatever treatment plan you come up with is what's best for you and your cat.

Joey (In- Memory)

I'm big, I'm- bad, but I am a- real mush!
Purred: Tue Apr 2, '13 2:05pm PST 
Hi Iba thank you for your response!

Joey is acting just fine - he is energetic, playful, seeking out affection - what prompted me to see the vet is that he was vomiting nightly for about a week - no food or hair - just bile - and he started drinking out of the toilet again. So because of his history of bladder stones and the fact that he is on an all wet diet I became concerned that he was increasing his water intake. The vet did blood and urine and the specific gravity was 1.015 - with elevated kidney values however the phosphorus was normal. After we got the antiemetic on board his appetite came back with vengeance - so he is eating normally - just an heightened thirst drive. I am realistic - he is 14 - I certainly don't want to create more harm by putting him through an ordeal only to have him spend his remaining time with us in misery - but I am willing to do what I can. Any advice on the diet specifically would be helpful - I am not a fan of the vet endorsed brands so if there are better options please let me know. I will talk to the vet about sub Q fluids - when they are necessary - and see if we can do it. He is my baby and I don't want to lose him - but I realize he is an old kitty so I think I am just going to take it day by day.

Thank you for your help!!!


Butt-kicker of- all other cats
Purred: Tue Apr 2, '13 8:56pm PST 
I'm so sorry about your kitty. I don't really know much about this, and I also am not a fan of the foods the vets sell. I would feed your kitty a good quality canned cat food. I am not an expert, maybe there is one that is better for cats with renal failure...I'm not aware of which one, and hopefully someone that knows will chime in and can tell you, but I would just give my cat a decent food. I have a super picky 10 year old cat who was a former kibble addict, and she is quite happy with Wellness canned food, chicken or turkey. I mix a ilttle warm water in with the food. She does not eat much of it, 1/3 in the morning and another 1/3 in the evenings, and that's it. I think when you feed them a decent food, they are not screaming for food all the time, at least this has been the case for me and my cats. I would give her what she wants, I would avoid all dry food if it were me, I know she is used to it, but if she will eat canned, I would do that for her. Hopefully someone who has more experience with this issue can give you better advice. I'm so sorry to hear this about your kitty frown

Joey (In- Memory)

I'm big, I'm- bad, but I am a- real mush!
Purred: Wed Apr 3, '13 6:59am PST 
Thank you Beep - I appreciate your response. I just don't want to do the wrong thing here so any information is helpful. I have learned that a diet low in protein and low in phosphorus is what is recommended - but there are two schools of thought - some feel better quality protein is needed not less protein. It's very confusing. He is a wet food eater already (both of my cats are all wet food). More research to do! If anyone else has any info or advice I would appreciate it! smile

Kaci- Sunshine - Beloved- Angel

Sugar 'n Spice
Purred: Wed Apr 3, '13 2:31pm PST 
I'm so sorry Joey has chronic renal failure. Kaci was diagnosed with chronic renal failure (aka chronic kidney disease) in October 2010. CKD can be managed and cats definitely can have a good quality of life living with CKD. There are ups and downs with this disease, esp. when the cat has other diseases that complicate matters like Kaci does.

There are prescription canned foods you can get from your vet made esp. for cats with kidney disease. The companies who make this food are Hills, Iams, Purina and Royal Canin. If you want to try them, maybe your vet can give you a sample pack so that Joey can try each one (my vet did). Yes, there's controversy about these foods and I don't have access to any official statistics or studies proving these foods are better or worse for cats with kidney disease. I know of cats who started eating the prescription foods when first diagnosed and have done very well on them. When my cat Jennifer was first diagnosed with CKD, she started eating Hills canned k/d food and also getting subq fluids 3 times a week and lived for 3-1/2 years after diagnosis.

Kaci absolutely refuses to eat any of the prescription foods and eats commercial grain-free canned cat food only. I feed her an assortment of brands: Fancy Feast (only the *classic* grain-free flavors), Nature's Variety Instincts (chicken), Wellness (salmon & turkey and chicken), Performatin (lamb and turkey), GO! (chicken, turkey & duck), Great Advantage (chicken) and a few others. Her CKD often makes her tummy upset and her appetite go off and she often needs to take an appetite stimulant to get her to eat but other than that, she's done well eating those foods.

There's no one-size-fits-all treatment plan for CKD cats and your vet will help in that area. E.g., some cats won't need subq fluids, at least in the beginning, and others need them. Some cats need phosphorus binders and others don't (Kaci doesn't). Some cats have problems with their potassium levels. CKD can cause high blood pressure and blood pressure should be checked and monitored. There are meds for high blood pressure. Other common CKD issues are appetite loss a(n appetite stimulant can help), weight loss, constipation and vomiting.

Kaci stopped eating a few weeks after diagnosis and was hospitalized because her kidneys started crashing from a suspected kidney infection. Afterwards, she started getting 150 cc's of lactated ringer's solution every 3 days for several months. Over a year and a half ago, I started giving her 100 cc's every day. She's lost a lot of weight over the past year and now gets between 60 and 80 cc's daily. If I miss a day or cut the fluids below 60 cc's, she gets dehydrated and constipated, starts drinking tons of water and ends up getting sick. Without the lactated ringer's solution, she wouldn't have made it as long as she has.

I know you must be doing lots of research and reading about this disease. If you haven't come across these excellent websites yet, you should check them out:

Feline CRF Information Center: www.felinecrf.com

Tanya's CRF website (very comprehensive!) I don't have the url but it's easy to find by googling.

Good luck! If you have more questions, send me a pawmail and I'll do my best to help.

Joey (In- Memory)

I'm big, I'm- bad, but I am a- real mush!
Purred: Thu Apr 4, '13 8:40am PST 
Hi Kaci - thank you for your response. I am sorry to hear you have CRF as well.

Thank you for the links - I have been to both sites and you are right they have tons of great information. Joey tried the Purina NF last night and again for breakfast and he ate some - he didn't reject it outright. I have another cat in the house - and both Phoebe and Joey are grazers - they don't eat their whole meal at a given time - so feeding them separate foods now is proving to be a challenge. I can't lock them up in separate rooms all day - so I am looking for a way to encourage them to eat their food in one sitting so I can pick up the dishes and not worry that Joey is eating the Fancy Feast and Phoebe is eating the Purina NF - I know it won't hurt her but it's not nutritionally complete for a healthy 5 year old. Any advice on that would be great! Other than the CRF Joey's vet does not believe he has any complications - no high blood pressure - his phosphorus is normal - and no anemia. Also, given his temperament he said we would wait for the next round of bloodwork before we approach sub Q fluids. I am so grateful for all the advice and support - it's a helpless feeling - but I am over the initial shock now and focused on quality of life.

Thanks again!

Merlin- >PAWS<- [In Loving

Purred: Thu Apr 4, '13 9:39am PST 
Been there with CRD, but it was many years ago, and I know things have evolved since then. The sub-q fluids are scary to think about, but they're really easy to give once your vet or vet tech shows you how, so don't be scared of them. I will give you these tips for when you do start with sub-q's: First, warm the bag before giving the fluid; imagine a cold fluid going in under your skin, and you can understand the wisdom of this. I used to keep Merlin's bad on a heating pad set to Low and covered with a small hand towel. Secondly, do NOT use one of your cat's favorite places to inject the fluid; otherwise, in short order, it will no longer be a favorite place and you will have denied him a pleasure. I used to put Merlin on a table under the window, and then hang the bag from the curtain rod - and I'd read poetry to him while the fluid was going in.

The food situation has probably improved since 2001, but my vet's advice was to "feed him what he'll eat." Pointless to save the cat's kidneys if he's being malnourished in the process.

Unfortunately, this condition cannot be cured, only managed; how long it can be managed varies. Personally, I think genetics has as much to do with it as anything. I have a friend whose cat lived an addtional two years after diagnosis, so it is possible.

I wish you the very best of luck, for I know the pain and the fear involved.

Joey (In- Memory)

I'm big, I'm- bad, but I am a- real mush!
Purred: Thu Apr 4, '13 11:39am PST 
Thank you Merlin - appreciate your insight with the sub Q fluids! Joey's temperament is difficult at best - he is a very aggressive cat with feral tendencies - I have raised him from 7 weeks old and I am pretty much the only person he has ever trusted - and he has bitten me severely on many occasions (in fact he bit me at the vet on Friday when I took him in) – and he bit me so badly at the vet once when he was young the vet actually told me to put him down. Over the years I have learned to avoid his triggers, create a sanctuary for him and love the big, bad, biter for who he is. He is difficult for two vet techs to handle let alone just myself at home - when I clip his nails he creates quite the fuss but he does let me get through it - he does not like to be handled or confined. All that being said I am concerned that doing the sub Q fluids at home will create trauma for both of us - I know getting them on board early is key to successful quality long-term care for kidney failure - I want to do it - but I am hesitant. I will muster the courage to try - but if he responds so poorly to it I don't know if I want to torture him - his home is where he feels safe. Phoebe is another personality entirely - and if it were her there would be no issue. Do you know of anyone who tried sub Q therapy at home with an aggressive kitty?

Thank you for all of your support!

Delyte, Dark- Angel, at- Bridge

Me and my- person, together- against all
Purred: Thu Apr 4, '13 12:28pm PST 
This is Delyte. I am nearly 18, have hyperthyroid and CRF. The diseases are progressing slowly for me, and I have had them for over 4 years. My person has made the decision not to do any extensive treatments on me now because I am old and frail and possibly in some pain from arthritis. I have very severe gastrointestinal weakening due to surgery I had for a tumor so I cannot take most medications orally.

I am usually well behaved at the vet although I am a demon at home to my person if she is trying to do anything to me. She had to force feed me for 10 days after my surgery 8 years ago and still has scars. Are you sure that you won't let the vet tech do things in their skillful ways that you might not allow your person to do?

Getting the subq fluids really does help with the way you feel and it is worth the effort to get it done.

I eat the classic Fancy Feast and am doing pretty well. The diets for CRF and hypertyroid are opposite, so I can't follow both. However, my person's previous cat, Peri, had CRF formany years, and the Purina NF helped her tremendously. It seemed to extend her life for about three years. It's the only one of those prescription diets that we would in any way recommend.

Our male person has CRF and was on dialysis for 5 years and managed to get off by getting healthy and eating well and using a phosphorus binder after meals. We've never done that for cats but it might be worth trying.

Good luck and giant old purrs to you! cat on moon

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