17 year old cat with elevated Nitrogen and Creatinine levels

Question
QUESTION: Hello,
Nine months ago my cat was not eating well and I was advised he was in the early stages of kidney disease. I attempted to feed him the k/d diet, but since he has a nose like a bloodhound, he would not touch any food that had any portion of the k/d diet in it. My vet advised me to get him off dry food since it is basically empty calories and I began to feed only wet. Up until one week ago, he was eating three small cans/pouch of food a day of a variety of regular brands. This past week he vomited two days in a row and stopped eating his usual amount. I immediately brought him to the vet to run a blood test and urine test. I also asked the bet to put some fluid under his skin as I didn't want my cat to dehydrate. My cat has been eating some and I've been forcing him to drink water through a syringe......... possibly 6cc's a day which I don't think is enough. I'm trying to find a diet which is low in protein but offers enough fats to keep his weight up. Since tomorrow is a holiday, the local holistic cat food store is closed. My cat won't drop dead overnight, will he? How long will a cat survive not getting the proper nutrition and water? Would you recommend me bringing him back to the vet for more water under the skin? I'm probably making myself crazy for nothing, but I thought I'd write for your opinion.

ANSWER: Julie,

A 17 yr old cat in kidney failure is way past any early stages. It takes 80% of kidney function to be gone before it shows up on tests. That means your cat is probably working with way less then 20% functioning kidneys.

Let me tell you what I went through with my 19 yr old cat when he developed kidney failure a few days after he turned 19. He was raised on Hills foods and for the last 10 yrs of his life he lived on K/D dry as a preventative measure. I owe the fact that he lived to be 19 because of that. Any vet that says dry food is empty calories knows NOTHING about nutrition, especially proper nutrition.

You said you gave him dry but didn't try the canned k/d. There is a canned version. K/D is a diet that has the proper amounts of protein for a cat but it is made more bioavailable to the body and thus the amounts can be lower than normal adults diets. There is an increased amount of fat for energy and brain function. The diets you are feeding from the stores are too high in protein, which causes more urea to be excreted into the blood since the kidneys and then the liver cannot filter it out- so then the ammonia levels raise in the blood which makes the cat sick and then they vomit.

Getting an organic food or whatever isn't going to fix the problem. The cat HAS to be on a lower protein/phosphorus diet and you will NOT find that in a store. Only therapeutic diets such as K/D will provide that. Now there are other brands of these prescription diets such as the novel diets that Waltham makes. You have to get them at a vets.

The bottom line is this: You are fighting a losing battle. You cannot turn around end-stage renal failure and at 17, your cat has outlived most of them. I had to prepare myself for the worst with my cat. I did place him on IV fluids for a few weeks to keep him comfortable, but when he started to lose the fluid in his eyes I refused to let him suffer so I had him put down at my house. He never suffered and he was peaceful and ready to go. I was able to deal with it better because I did what I could for him, just as you are.
Floyd wouldn't eat the last week either and I tried to force feed him but it was hard and he was upset by it. He went about three days without eating but he was getting fluids. Dehydration is more painful to them then anything else, so fluids are important.

6 ccs is not enough and he will start to be really uncomfortable if you don't get more into him. Ask the vet if you can take home a bag of fluids and have them show you how to give them subQ. He should get about 50-75 Mls, twice a day or what ever the vet says.

But prepare yourself Julie, for letting him go. I know how hard it is but don't let him linger. The main thing you need to ask yourself is:

What is his quality of life? Is he happy, active, eating? Does he have more bad days then good days? Is he sleeping all day or moving around and bright and alert?

Only you can answer these questions. When you know the true answer you will do the right thing. I hope you can get him onto a diet that he will eat that is low in protein.

Please let me know how he and you are doing soon.
take care.

p.s. here are some links to other diets made for renal failure if he won't eat the K/D canned. It is the best but at this point, anything is better than nothing.

http://www.walthamusa.com/Learning%20Center/LP21.html

This one is a link to a page that helps with tips on how to get your cat to eat and some other renal diets are mentioned.
http://www.felinecrf.org/which_foods.htm#introducing_prescription_food

Please keep in contact. We have the same last name!



---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Connell,

WOW, I should have gone to school longer because that looks really good in print!

Anyway, I wanted to let you know that my fiesty 17 year old cat who turns 18 this month has bounced back. We purchased the one food I didn't have to have a script for and sure enough I put maybe a tablespoon into his regular food and he wouldn't touch it. The cat has a nose like a bloodhound. He likes Sugar Daddy pops.......... yes I know that is bad for him, but I let him lick a little because for some reason he has a sweet tooth for sugar.... never chocolate mind you, but he will eat an entire sugar cookie by himself.... but his nose works overtime. I've given him back his kibble with what you said in your previous email, so he is back to eating for me and pooping on the carpet which I don't even care about anymore, so long as I see that he is going. I think "who cares, so long as everything is working"............ :-)

So, thank you again for your informative email. I think I am better prepared for the next time he goes downhill and I will probably take him right in and put him to sleep. My face was all broken out this past week from worry and we put a stray down today that we had been feeding for the last three years, and it was so much better because I know she will never be cold or wet or scared again.

Anyway, thanks for listening and I'll keep you posted, ok?

Julie

Answer
Hi Julie,
I am glad to hear that he is doing better and is now eating. I know it won't be easy for you to let him go but you know you will be giving him a gift. You gave the stray the same gift and you are right, she won't be cold or hungry or die a terrible death by car or by being mauled by dogs.
You might want to put a throw rug or some pads down for him to poop on- it will be  easier to clean up for you. I know exactly what you mean about not caring at this age too. Or stage even.
Thanks for letting me know and yes, please keep me informed.
Best to you both and give him a B-Day kiss for me.