Treatments

Herbs

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

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.