Treatments

Herbs

The only herb that has been studied and shown to help lower creatinine level is Stinging Nettle seed (not leaf, though if one cannot find seed, use the whole plant as a 2nd choice), as reported by herbalists David Winston, Alan Tillotson) and Johnathan Treasure. The amount and formulation would need to be customized for a kitty.

A chinese herbal formula for which there is some anecdotal support is Rehmannia 6 a.k.a. Six Flavor tea pills a.k.a. Liu Wei Di Huang Wan : 1-2 pills a day. Look for a brand that is GMP-certified.

For nausea, hyperacidity, and other symptoms of metabolic acidosis - Slippery Elm Bark (SEB): maintenance dose of 5cc (1 tsp) of slippery elm bark (SEB) gruel once a day. Many members have given up to 5 tsp a day if needed; it works as well as Pepcid AC without the horrid side-effects.

I make SEB like any tea infusion – add 1/4 tsp of the bulk powder to 2Tbsp of boiled water. It'll thicken as it sits. Powder from capsules isn't as strong, so if you are using that, add ½ tsp to 2 Tbsp of water.

Note: like other things high in mucilaginous fiber, SEB might inhibit absorption of other stuff given along with it, so give at least 30 – 60 minutes away from food to be on the safe side. Some cats actually like the taste of SEB slurry, and will lick it up when mixed with some treat e.g. yogurt or even alone.

If at all possible, use Marshmallow Root (MR) in place of SEB since they are similar in action and because SEB is endangered from over harvesting and Dutch Elm disease. Some cats do just as well on MR and for others nothing but SEB does the trick. Since there are so few safe options for cats, and SEB is one of those precious few, each of us has to decide if and when to use this herb.

Cautions

  • Do not use Uva Ursi, also known as Bearberry on a cat with CRF because it has a strong astringent effect, and in any case, is only indicated for short-term use in confirmed alkaline urine, like with a bout of cystitis.
  • Also do not give a CRF cat the herb Juniper Berries because it can irritate the kidneys.
  • Cats with CRF are prone to high blood pressure so stay away from Licorice and Horsetail as well.

Subcutaneous (subq) Fluids

In order of preference, on my list, we've had best results with Lactated Ringers solution. If a cat's Calcium levels are elevated (please confirm with an ionized calcium test), then one can switch to Normosol-R. Last choice, and the one that has caused problems for cats is saline solution (0.9% sodium chloride), yet many of our cats' vets have rx'ed this for some reason:(

If you need to educate yourself about types of solution, check this link. Subq fluids use the same solution as they list here for IV, just different delivery method: http://internationalwin.com/tech4.html
[Tasha who we lost in 1997 to ARF following surgery]

As they list in the above link, 0.9% sodium chloride has a much lower than ideal target pH (5.5) vs LRS and Normosol-R so the latter two are almost always better. The only exception would be if a cat for some unusual reason e.g. such severe vomiting for such a long period of time that the pH goes up, has metabolic alkalosis (in which case s/he needs immediate veterinary help).

Amount of fluids - As per Washington State Univ college of veterinary medicine, cats should get 5-10ml of subq daily per lb of body weight. I would be very careful going above this because we have had cats on my list develop fluids in the lungs. Many cats with undiagnosed heart disease can have complications from fluids. If you know your cat has heart disease, you can do what I did, and instead of subq, give fluids orally using a plastic syringe.

As an alternative to sub-Q fluids, I used either a 5cc pediatric syringe or an eye dropper to syringe spring water by mouth. Boo Boo was between 8 and 9 lbs so I aimed for 50-100mls total per day including what he got from raw food. He ate 3-4oz of raw mix per day, and since I syringed it into him, I was able to add 10ml of water per feeding.

The maximum he ever got - around 15cc (3 dropperfuls)- in one sitting was when he got just his herbal brews. Since cats aren't used to drinking much water I figured keep it a small amt like 1 or 2 5cc pediatric syringes. Boo Boo seemed to tolerate it very well, and always remained well-hydrated. If his heart hadn't given out first, I feel he could have lived on for years with a good quality of life with CRF.

Supplements

  • Potassium: Although a small % of cats with CRF can have elevated potassium (K) levels, they are generally more likely to have lower than normal blood potassium levels. It is possible for a cat to have normal potassium readings on a blood test, and still have low potassium levels in the tissues. So rather than wait till K level is down to 4 mEq/L, it's best to try and keep K around 4.5 - 5mEq/L through dietary choices or failing that, through supplementation.
  • The best choices for this are - potassium gluconate or potassium citrate @ 2 to 6mEq i.e 78mg - 234mg of elemental potassium, that is, between 468 mg and 1,404mg potassium gluconate/citrate (as stated on the label) daily
  • If your cat has metabolic acidosis, then Citrate is a better choice than Gluconate, but in early to mid-stage CRF, gluconate is a good choice. Avoid K Chloride which is indicated for metabolic alkalosis, as it can make your cat's problems worse.
  • Vitamins and trace minerals: Be aggressive with supplementation of water-soluble vitamins - C, and B-Complex as well as trace minerals. Be more cautious with fat-soluble vitamins such as A, D, E, and K which are stored in the liver.
  • Fish Body (not liver) Oils e.g. salmon, sardine, anchovy, or krill oil: 1-2 1,000mg softgels (depending on omega-3 in diet, adjust up/downward) with at least 180mg EPA and 120mg DHA e.g. Carlson's and Nordic Naturals brands. NOW brand krill oil is reasonably-priced and easy to squirt into food plus many cats actually like the taste.
  • L- taurine powder or capsule: 500 - 1,000mg NOW/Source Naturals/LEF brands
  • Coenzyme Q10 a.k.a. CoQ10: 30 - 60 mg e.g. Doctor's Best, NSI; get capsules so you can avoid plant-based oils (cats hate 'em anyway)
  • Glandulars or PMG products: Over the last 11 years, these products have been shown to greatly benefit our list cats with compromised kidneys. They have been helpful not only in keeping BUN and Creatinine levels in check, but other non-kidney glandulars can help with anemia as well. Use the ones marketed for humans e.g. Standard Process' Renatrophin and Renafood because they contain more meat and a lot fewer oddball ingredients than the "feline" formulas. These would have to be customized for your cat in terms of which type, exact amounts, and for how long.
  • Phosphate binder: Using aluminum as an oral phosphate binder (OPB) is not something I feel comfortable with. Medscape is replete with information on negative aspects of aluminum hydroxide e.g. just one of many examples: http://www.medscape.com/viewarticle/545034
  • "Of the commonly used phosphate binders, aluminum hydroxide is associated with aluminum toxicity and calcium carbonate is associated with hypercalcemia." 'Nuff said.
  • As a safer alternate OPB, I have been using eggshell powder (ESP) which is a natural source of calcium carbonate (e.g. Epakitin, which also contains chitosan). In the paper by Brown et al, linked and referenced below, Epakitin was found to not increase calcium levels (risk for CRF cats), in fact both PTH and Calcium decreased, as did serum Phosphorous level.
  • I prefer ESP which has the added benefit of being cheap, and easy to prepare at home. I have used ESP as an OPB to good effect. I use Dr. Nagode's guidelines (FWIW, his are for aluminum binders, not ESP) where a 5kg/11lb would need 300-500mg (~ 1/7 - 1/4 tsp) of ESP per day if Phosphorous level is between 6 and 8mg/dl, increasing ESP with higher Phosphorous levels even up to twice those amounts as Phos gets in the 7-8 range In comparison Brown et al, gave 1g twice a day for cats weighing under 5kg.
  • Probiotics: There is limited research support for a formula - Azodyl - containing the following strains of beneficial bacteria - Streptococcus thermophilus, Lactobacillus acidophilus, and Bifiodobacterium longum. The former 2 are in yogurt, but to get high enough numbers, one can get a product such as Source Naturals Life Flora. One can even mix 1/8 or 1/16 tsp of this powder into yogurt or another treat your cat likes.
  • Psyllium husk and/or cooked squash/pumpkin: There are no cat studies on psyllium, and as far as we know at this point, it is less fermentable than pumpkin or rice bran both of which are moderately fermentable, hence ideal for cats as these fiber feed gut bacteria. Probiotics together with fermentable fiber (which functions as a pre-biotic) trap some of the nitrogen, and instead of it being processed by the kidneys (BUN), it is excreted via stool thus keeping it from building up in the system.

All the cats I have helped now have lowered BUN and Creatinine levels from doing all of the above plus a homeopathic remedy that fits the kitty's total symptom picture. A customized raw diet with some tweaks e.g. fiber source, type of meat, ESP, etc. also play a huge role in keeping cats with kidney failure in good shape.

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