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Cat Forum / Health and Behavior / January 2006Tiger's kidneys
Tiger went to the vet on Sunday. She had peed in several places that were not her litterbox, and her skanky ears were bothering her again. I called just now to see if her test results were back. The vet said the urine culture wasn't done, so I don't know about that yet. She said that her urine had a low concentration(?) and that her creatinine was slightly elevated. She said the normal range is .8 - 2.3 and Tiger's was 2.4. On Sunday, she said that her left kidney felt really small. So, it looks like Tiger is heading for kidney failure. The vet suggested giving her extra fluids 2-3 times a week, so I'm going to bring her in next week to learn how to do that. She also suggested putting her on a prescription diet. She said they carry Eukanuba and Science Diet prescription foods for kidney problems. Does anyone have an opinion about them, which is better? Tiger has been eating only canned food for the last couple of years and I'd like to stay with that. Also, I have another cat and forgot to ask if he would be able to eat the prescription food as well. I know that no matter how hard I try, they will end up getting into each other's bowls. Currently Tiger is eating & drinking well. She actually seems to be eating more, or at least cleaning her bowl faster. She's always been a good drinker. I had her shut in the bathroom for a couple of days before her appointment while I was at work, and had a bowl of water in there for her. One day after I let her out I forgot to remove the bowl, and she kept making special trips into the bathroom to drink from it, as well as the Drinkwell in the kitchen. I'm hoping that we caught this early and Tiger will be around for awhile, but she is already 15 1/2 years old. She had a tumor removed last year. Other than that, she's been a healthy cat except for the skanky, waxy buildup that tends to form in her ears. I have some medication for that from the new vet. -- Liz Is the skanky stuff fungal? My cat that passed away recently had a fungal problem with his ears. Brown waxy stuff - the vet had him on a medicine in a tube,,, sorry but the name escapes me. > Is the skanky stuff fungal? My cat that passed away recently had a > fungal problem with his ears. Brown waxy stuff - the vet had him on a > medicine in a tube,,, sorry but the name escapes me. I'm not sure. I know it's been tested for various things in the past but I don't know what. I was just always told that it's "nothing". It's thick, brown & waxy and drives her crazy. When pressed, a couple of vets had given me medication in the past (Animax? and something else) but the stuff always returned. I have to say that after the last deep cleaning (October 2004) until now, her ears have stayed cleanest the longest. The stuff still came back but not as much, and one ear stayed almost completely clear until just recently, when she began scratching it again. The medication this new vet gave me is for mites, I think - Tresaderm. -- Liz > Tiger went to the vet on Sunday. She had peed in several places that > were not her litterbox, and her skanky ears were bothering her again. > > I called just now to see if her test results were back. The vet said > the urine culture wasn't done, so I don't know about that yet. It was a wise decision for your vet to run a urine culture. Cats with kidney disease are more predisposed to urinary tract infections and if the infection spreads to the kidneys it can accelerate progression of kidney disease. She > said that her urine had a low concentration(?) and that her creatinine > was slightly elevated. She said the normal range is .8 - 2.3 and > Tiger's was 2.4. On Sunday, she said that her left kidney felt really > small. So, it looks like Tiger is heading for kidney failure. She is just in the early stages of kidney disease, she could still have years of life left. > The vet suggested giving her extra fluids 2-3 times a week, so I'm > going to bring her in next week to learn how to do that. Seems like fairly aggressive treatment for early kidney disease. The purpose of subcutaneous fluids is to ensure she is taking in enough fluids to compensate for extra fluid loss in her urine. Thus SQ fluids are important for cats that are not taking in enough fluids from eating and drinking. I recommend adding extra water to canned food to increase fluid intake and make sure you have multiple large water bowls with fresh water available throughout the house. The drinkwell water fountain is a great idea too. She also > suggested putting her on a prescription diet. She said they carry > Eukanuba and Science Diet prescription foods for kidney problems. Does > anyone have an opinion about them, which is better? Science diet G/D is a good food for this stage of kidney disease. Most premium senior diets would be appropriate as well. Diets specifically designed for kidney disease (e.g. K/D or Euk Multistage Renal) are too protein restricted for cats with early kidney disease. I usually don't recommend them until BUN values are significantly elevated. Tiger has been > eating only canned food for the last couple of years and I'd like to > stay with that. Good idea Also, I have another cat and forgot to ask if he would > be able to eat the prescription food as well. Your other cat shouldn't be fed a kidney diet, but neither should Tiger at this point. Ask if her blood potassium level was tested. Potassium supplementation should be started if potassium levels are in the low end of normal range. There is evidence that potassium supplementation at this stage will prolong kidney function. I find the powdered potassium supplements are the easiest to give. J. dvm >> Tiger went to the vet on Sunday. She had peed in several places that >> were not her litterbox, and her skanky ears were bothering her again. [quoted text clipped - 6 lines] > infection spreads to the kidneys it can accelerate progression of kidney > disease. She said that there doesn't seem to any infection but I guess I'll find out for sure when the culture is completed. I forgot to ask when that would be. When she had urination problems in the past (starting when she was young) I was always told she didn't have an infection. >> The vet suggested giving her extra fluids 2-3 times a week, so I'm >> going to bring her in next week to learn how to do that. [quoted text clipped - 7 lines] > available throughout the house. The drinkwell water fountain is a great > idea too. The vet said it was up to me. She said that Tiger's skin was "tenting" when I had her in. When they pull up on the skin, it remians that way for a few seconds before returning to normal. I just pulled her skin myself, and it doesn't stay that way for more than a second or so. I'm still going to bring her in on Tuesday to learn how to give her fluids, because I'm sure I will eventually need to know and I might as well learn now. It will be up to me to decide if I want to give them to her or not. I have a feeling I will put it off for now. Tiger does get plenty of fluids. She *loves* to drink and she eats wet food. I'm going to put a bowl of water back in the bathroom, since she was also going in there to drink when I left it down. I think my other cat, Otto, prefers a bowl over the Drinkwell. I rarely see him drinking. Before I got the fountain, I'd see a lot of fur at the bottom of the water bowls because he would stick his paw in and then lick the water off his paw. When I open a can of food in the morning, I leave it in the sink full of water because he likes drinking water out of the dirty dishes in the sink. But I have never had to worry about Tiger getting enough. Recently, even before she began peeing outside the box, I've noticed the reservoir in the fountain was emptying faster. > She also >> suggested putting her on a prescription diet. She said they carry [quoted text clipped - 6 lines] > protein restricted for cats with early kidney disease. I usually don't > recommend them until BUN values are significantly elevated. Right now she's eating regular (adult, not senior) Wellness, Petguard & Science Diet. Chicken, turkey, beef combinations mostly. She's never been a picky eater and as long as the canned food is pate style, she's eaten it. She's also become a treat fanatic, running over every time she hears a bag, or what she thinks is a bag or treats getting rattled. Tonight she came running as I was testing my blood sugar, because she thought the vial of strips sounded like treats. She's always liked treats but has never been pushy about it. Is her increased appetite related to her kidneys? She's even eating more at regular mealtimes. > Also, I have another cat and forgot to ask if he would >> be able to eat the prescription food as well. [quoted text clipped - 9 lines] > > J. dvm I can put her in the bedroom or bathroom at mealtime. I had her in the bathroom for several days last week and that's when I realized how quickly she emptied her bowl. I'll ask about the rest of her blood test results when I go next week, and will also ask about her potassium levels. -- Liz >>> Tiger went to the vet on Sunday. She had peed in several places that >>> were not her litterbox, and her skanky ears were bothering her again. [quoted text clipped - 10 lines] > out for sure when the culture is completed. I forgot to ask when that > would be. Results usually take about 3 days. >SNIP> > pushy about it. Is her increased appetite related to her kidneys? No, appetite decreases as kidney disease advances, so a good appetite is a good sign. > The vet said it was up to me. She said that Tiger's skin was "tenting" when > I had her in. When they pull up on the skin, it remians that way for a few > seconds before returning to normal. She's a 15 year-old cat! What does he expect? Older cats often have reduced skin turgor and delayed skin return even without dehydration because their skin losses elasticity with age. A 15-year-old cat is physiologically equivalent to a 76-year-old person. Hasn't he ever noticed the flaccid "chicken skin" on elderly people? Its like Silly Putty. Same principal applies to elderly cats. Fluid therapy should only be used to prevent dehydration in cats that aren't getting enough water from food and drinking to keep up their urinary losses, or on a *short-term* basis to promote diuresis to lower uremic toxins in the blood during acute decompensation. Chronic fluid therapy actually promotes the progression of CRF because it makes the kidneys work harder and also increases single-nephron GFR and promotes glomerular hyperfiltration- which can also promote progression. If she's eating canned food, she's meeting almost her entire daily water requirement from her food and only needs to drink a little extra water. > > She also > >> suggested putting her on a prescription diet. She said they carry > >> Eukanuba and Science Diet prescription foods for kidney problems. Does > >> anyone have an opinion about them, which is better? Her kidney values are *far* too low to begin protein restriction. All she needs right now is a canned senior diet that's low in phosphorus and a potassium and an omega-3 supplement. Protein restriction shouldn't begin until her BUN is at least 60-80 mg/dl or if she develops clinical signs of uremia. Between premature protein restriction and unnecessary fluid therapy, some vets are actually hastening CRF cats' premature demise. How's Harriet? Phil > Fluid therapy should only be used to prevent dehydration in cats that > aren't [quoted text clipped - 8 lines] > If she's eating canned food, she's meeting almost her entire daily water > requirement from her food and only needs to drink a little extra water. I'm still going to bring her in next week to learn how to give her fluids, but won't actually start doing so until she needs it. She always has liked water so I was surprised when they said she was a little dehydrated. Like you said, it's probably not dehydration but just normal aging. >> > She also >> >> suggested putting her on a prescription diet. She said they carry [quoted text clipped - 7 lines] > until her BUN is at least 60-80 mg/dl or if she develops clinical signs of > uremia. I started buying some senior cat food for her before Otto showed up, probably when she was around 9 years old. She began to lose weight rapidly with it, so I put her back on her regular foods. I'm willing to try it again. Any brand(s) you recommend? Right now she's getting adult Petguard, Wellness & Science Diet. > How's Harriet? > > Phil Harriet is doing much better, although today I caught her in one of the rooms burying something. I found a couple of turds on the floor but don't know how long they had been there. They weren't fresh. She has been going regularly in the box, is eating better and hasn't been attacking anyone for several weeks. -- Liz Try the Science Diet Senior canned foods. My 16 year old is about the same as your cat....kidneys starting to decline even though his BUN and creatinine are within normal but USG in the low range. I've been feeding him the Science Diet Senior foods, turkey and chicken mostly. He also likes the Nutro Senior canned food too. >> Fluid therapy should only be used to prevent dehydration in cats that >> aren't [quoted text clipped - 46 lines] > -- > Liz > Ask if her blood potassium level was tested. Potassium supplementation > should be started if potassium levels are in the low end of normal range. > There is evidence that potassium supplementation at this stage will prolong > kidney function. I find the powdered potassium supplements are the easiest > to give. Hi Doc, I'm glad to see you back! You've been sorely missed. I have an excellent paper by Drs. Steven Dow and Martin Fettman on the benefits of potassium supplementation in renal cats: "RENAL DISEASE IN CATS: THE POTASSIUM CONNECTION". I'd be happy to send it to you if you'd like to read it. Phil >> Ask if her blood potassium level was tested. Potassium supplementation >> should be started if potassium levels are in the low end of normal range. [quoted text clipped - 16 lines] > > Phil Thanks Phil, I'd like to read that. I'll send you my email address privately > She also > > suggested putting her on a prescription diet. She said they carry [quoted text clipped - 6 lines] > protein restricted for cats with early kidney disease. I usually don't > recommend them until BUN values are significantly elevated. Dr. Martin - I would have to disagree, the recent studies have been pretty overwhelming that the sooner k/d is started, the better the results. k/d contains more than enough protein for a normal healthy cat, let alone a renal failure cat. This below from Dr. Joe Bartges on the AAVN Listserver today: "based on the cat study by Barber and Elliot (and the dog study by Jacobs, et al) - I place dogs and cats on "renal failure" diets when they are diagnosed with azotemic renal failure - regardless of degree of azotemia, hyperphosphatemia, acidosis, etc." joe Joe Bartges, BS, DVM, PhD, DiplACVIM, DiplACVN Professor of Medicine and Nutrition The Acree Chair of Small Animal Research Department of Small Animal Clinical Sciences C247 Veterinary Teaching Hospital College of Veterinary Medicine The University of Tennessee > Also, I have another cat and forgot to ask if he would > > be able to eat the prescription food as well. [quoted text clipped - 7 lines] > kidney function. I find the powdered potassium supplements are the easiest > to give. Which are already contained in the k/d diet...... >> She also >> > suggested putting her on a prescription diet. She said they carry [quoted text clipped - 11 lines] > results. k/d contains more than enough protein for a normal healthy > cat, let alone a renal failure cat > This below from Dr. Joe Bartges on the AAVN Listserver today: > [quoted text clipped - 14 lines] > College of Veterinary Medicine > The University of Tennessee It definitely is a controversial issue. Yes, there is no question that Dr Bartges is a believer in protein restriction for early CRF yet other equally reputable veterinarians advocate delaying protein restriction. If studies overwhelmingly proved the benefits of early protein restriction then there would be no controversy. I would be interested in reading these studies to which you referred. Can you post some abstracts or summaries? J. >>> She also >>> > suggested putting her on a prescription diet. She said they carry [quoted text clipped - 41 lines] > > J. What do you consider "restricted" protein? I looked at the K/D cans and bag and they do have the AAFCO statement for adult maintenance, so is that considered "restricted" or just low protein? I've been sticking with the canned K/D for my cat because of the very low phosphorus and no one seems to disagree with the need for low phosphorus, if it's not really enough protein for her I was thinking about adding some chopped egg whites to it. She does get some pieces of T/D as a dental treat every day. > What do you consider "restricted" protein? I looked at the K/D cans and > bag and they do have the AAFCO statement for adult maintenance, so is > that considered "restricted" or just low protein? I use the terms interchangeably. I would refer to K/D as either a restricted protein diet or a low protein diet. > I've been sticking with the canned K/D for my cat because of the very low > phosphorus and no one seems to disagree with the need for low phosphorus, > if it's not really enough protein for her I was thinking about adding > some chopped egg whites to it. She does get some pieces of T/D as a > dental treat every day. I would not recommend adding egg white to supplement protein. Proper nutrient and mineral ratios in diets are important (particularly calcium and phosphorus) and supplementing with single ingredients could throw off those ratios. I hope my comments have not been interpreted as a condemnation of K/D cat food. The folks at Hills did the cat world a great favour when they introduced K/D. It is an excellent diet when used appropriately and has improved the quality and quantity of lives of countless cats with renal disease. In addition I too sometimes prescribe K/D or similar 'renal diets' for cats with early renal disease. If I expect a client to be unlikely to pursue regular follow up lab testing (for financial or other reasons) in order to determine when best to change to a renal diet I believe their cats are best served by changing to a renal diet earlier rather than never. J. "J. Martin" <jmartin@false.address> wrote : > I hope my comments have not been interpreted as a condemnation of K/D cat > food. The folks at Hills did the cat world a great favour when they [quoted text clipped - 5 lines] > order to determine when best to change to a renal diet I believe their cats > are best served by changing to a renal diet earlier rather than never. It's great to have your measured and intelligent input on the controversial topic of food. So many factors must be weighed when choosing a food for a particular cat (particularly one with medical conditions) it seems to me that no reasonable person would take your comments as a blanket condemnation of K/D. The only problem that I have with K/D is that my cat doesn't want to eat it! Even the chicken K/D. And my cat is usually not a picky eater. I wish they would develop a prescription diet food that cats like (or at least my cat liked). Sue > "J. Martin" <jmartin@false.address> wrote : >> [quoted text clipped - 18 lines] > me that no reasonable person would take your comments as a blanket > condemnation of K/D. > What do you consider "restricted" protein? I looked at the K/D cans and > bag and they do have the AAFCO statement for adult maintenance, so is [quoted text clipped - 5 lines] > some chopped egg whites to it. She does get some pieces of T/D as a > dental treat every day. I would nix the idea of adding egg whites. A cup of egg whites would add 32 mgs of phosphorus to the diet while adding 25 grams of protein. Fairly low phos, and perhaps not greatly problematic, but then you have altered the intake of many other nutrients at the same time. Replacing calories with egg white necessarily means the number of calories ingested from the food declines, and so too does the amount of Omega 3 fatty acids and antioxidant vitamins which are key nutrients in a renal failure diet. Some caution on adding the t/d kibbles - a quarter cup of t/d would add 140 mgs of phosphorus to the diet. I'm not sure what "some pieces of t/d" equals and perhaps it's far less than 1/4 cup and there isn't any problem. > Some caution on adding the t/d kibbles - a quarter cup of t/d would > add 140 mgs of phosphorus to the diet. I'm not sure what "some pieces > of t/d" equals and perhaps it's far less than 1/4 cup and there isn't > any problem. Just 10 or 12 pieces of T/D, less than 1/8 cup. Just something for a mid- day snack. She doesn't want K/D dry anymore, she only want the wet K/D now that the main meals have been changed to canned. I believe this is scheduled for full publication mid 2006. It's important to note that creatinine concentration is particularly insensitive indicator of GFR in early CKD. For example a 50% reduction in GFR results in an increase in serum creatinine from 1.0 mg/dl to 2.0 mgs/dl. A further 50% reduction drives the values up to 4.0 mgs/dl. ACVIM Proceedings 2005 Clinical Evaluation of Effects of Dietary Modification in Cats with Spontaneous Chronic Renal Failure S. Ross1; C. Osborne1; D. Polzin1; S. Lowry2; C. Kirk3; L. Koehler1 1College of Veterinary Medicine, University of Minnesota, St. Paul, MN;2Hill's Science and Technology Center, Topeka, KS; 3 College of Veterinary Medicine, The University of Tennessee, Knoxville, TN A double-masked, controlled, randomized, clinical trial was designed to determine if a renal diet (modified in protein, phosphorous, sodium, and lipid composition) was superior to an adult maintenance diet in minimizing uremic episodes and mortality rate in cats with mild to moderate chronic renal failure. Cats were chosen based on a criteria of having creatinine concentrations equal to or greater than 2.1 mg/dl. Forty-five client owned cats were randomly assigned to a maintenance diet or a renal diet and evaluated tri-monthly for up to 24 months. Kaplan-Meier survival analyses were used to evaluate efficacy of the renal diet compared to the maintenance diet in minimizing uremia, renal-related mortality, and all causes of mortality. Rec Events Renal diet (%) Maintenance diet (%) P-value Uremic crises 0/22 (0) 5/23 (22) 0.02 Renal cause mortality 0/22 (0) 4/23 (17) 0.03 All causes of mortality 3/22 (14) 9/23 (39) 0.06 Serum urea nitrogen concentrations were significantly lower and blood bicarbonate concentrations were significantly higher in the group fed the renal diet at baseline and during the 12- and 24-month intervals. Cats fed the maintenance diet had a significantly greater number of uremic episodes (22%) compared to cats fed the renal diet (0%). A significant reduction in renal-related mortality was observed in cats fed the renal diet. The renal diet evaluated in this study was superior to an adult maintenance diet in minimizing uremic episodes and mortality rate in cats with mild to moderate spontaneous chronic renal failure. Thanks for posting that Steve. I'll be sure and read the full paper when it is published. J. >I believe this is scheduled for full publication mid 2006. It's > important to note that creatinine concentration is particularly [quoted text clipped - 39 lines] > mortality rate in cats with mild to moderate spontaneous chronic renal > failure. > Dr. Martin - I would have to disagree, the recent studies have been > pretty overwhelming that the sooner k/d is started, the better the > results. k/d contains more than enough protein for a normal healthy > cat, let alone a renal failure cat. What? 1/2 gram above the bare minimum protein requirement? That means the cat must lick the dish clean to get her minimum daily protein requirement. Know a lot of renal cats with hearty appetites that beg for k/d, do you, Steve? The low protein, phosphorus and sodium content makes k/d unpalatable to many (most) renal cats. What about protein for renal cats that constantly lose protein in their urine? There's also no safety margin built into k/d for cats that won't eat their entire ration. It doesn't matter how "perfectly" formulated a diet is if the cat won't eat the entire ration. > This below from Dr. Joe Bartges on the AAVN Listserver today: > [quoted text clipped - 4 lines] > azotemia, > hyperphosphatemia, acidosis, etc." Carl Osborn: "Current evidence suggests that protein restriction probably has only a minimal effect, if any, on progression of renal failure." (in Ett. 5th) Gregory F. Grauer, DVM, MS, Dipl. ACVIM (SAIM) "Researchers have established that the minimum protein requirements for dogs and cats with CRF are higher than those of normal dogs and cats. Ideally, dogs with CRF should receive a minimum of 2 to 2.2 g and cats a minimum of 3.3 to 3.5 g of protein per kilogram per day." or 13.2 to 14 g/day for a 4 kg cat. Do the math- k/d contains 6.6 g of protein /100 kcal. - which translates into about 12 g/day for a 4 kg cat. Don't forget to consider urinary protein losses. Sure looks like a negative nitrogen balance on my calculator. "A good recommendation to effectively achieve dietary protein reduction is to feed the maximum amount of high-biologic-value protein that the animal can tolerate at its level of renal function." "Most veterinary nephrologists recommend that dietary protein reduction be initiated when the animal's blood urea nitrogen concentration is between 60 and 80 mg/dL" "A reduction in dietary protein intake has long been the cornerstone of management in dogs and cats with CRF. The benefits of this include decreased serum urea nitrogen and phosphorus concentrations. There are, however, also undesirable effects. Specifically, if dietary protein is restricted in relation to the animal's protein needs, reduced renal hemodynamics, protein depletion (decreased body weight, muscle mass, and serum albumin concentration), anemia, and acidosis can occur or be aggravated. Just as increased dietary protein intake results in increased glomerular filtration, restricted intake is associated with a reduction in the GFR. The anemia of CRF is exacerbated because protein depletion further compromises erythrogenesis. Dietary protein restriction also decreases renal ammoniagenesis, and therefore renal acid excretion." The *only* advantage of switching to a renal diet in the very early stages of CRF is because switching the cat over to an less palatable renal diet later in course of disease will be much more difficult and might lead to protein malnutrition if the cat doesn't adapt to diet. > What? 1/2 gram above the bare minimum protein requirement? That means the > cat must lick the dish clean to get her minimum daily protein > requirement. Know a lot of renal cats with hearty appetites that beg for > k/d, do you, Steve? The low protein, phosphorus and sodium content makes > k/d unpalatable to many (most) renal cats. Oh nonsense, k/d is more palatable than Friskies canned foods. We've done the PAL studies so many times in so many places it's ridiculous. The problem is not with the food, but with the practitioner. Any cat which is sick, in the hospital, out of its comfort zone, and then presented with a new food will do two things. 1) reject the food, and 2) associate the food with the hospital and being sick. Placing a CRF cat on k/d while in the hospital is a mistake. Three or four more days on _any_ food isn't going to affect the cat. Once home and once the cat is feeling a bit better - THEN the food needs to be changed. As for the 1/2 gram protein nonsense - You are assuming that cat owners only provide the bare minimum of foods - yea right - that's why we have such an epidemic of obesity in cats I suppose? The evidence is overwhelming - place a cat on k/d, and do it early, and you will reduce uremic crisis and extend the cats life substantially. There are now two Grade 1 studies in cats and 1 in dogs - all arriving at precisely the same conclusion. > > What? 1/2 gram above the bare minimum protein requirement? That means the > > cat must lick the dish clean to get her minimum daily protein [quoted text clipped - 3 lines] > > Oh nonsense, k/d is more palatable than Friskies canned foods. Bullshit! K/d is one of the most- if not the most- unpalatable diets on the market. Hill's receives so many complaints about cats refusing to eat k/d that they routinely recommend adding oregano. Even in this newsgroup and especially in the CRF lists *many* people say they have a lot of trouble getting their cats to eat k/d. More renal cats won't eat k/d than renal cats that will. Save your sales bullshit for someone that doesn't know any better. You're not helping yours or Hill's credibility. We've > done the PAL studies so many times in so many places it's ridiculous. Yeah- with pres-selected cats who would eat anything. Maybe you should join the CRF lists to learn what's happening in the real world with renal cats. What would you do without Hill's studies? Think for yourself? > The problem is not with the food, but with the practitioner. Any cat > which is sick, in the hospital, Now you're being stupid. I'm referring to cats fed at home by their owners- and you know it. *Every* vet I know or have known have said most of their clients' renal cats won't eat k/d. > As for the 1/2 gram protein nonsense - You are assuming that cat owners > only provide the bare minimum of foods - yea right - that's why we have > such an epidemic of obesity in cats I suppose? You're being stupid, again. Renal cats generally have poor appetites due to azotemia. That's one of the reasons why so many renal cats lose body mass- the other reason is the poor palatability of renal diets in general- and k/d specifically. My cat, who is usually not a picky eater, will not eat canned K/D. He may eat a few bites of a freshly opened can, but that's about it. He does like the dry though. But I would much rather feed him a canned diet. I even wrote to Hills asking if they would consider offering the prescription diet foods in a 3 oz size since I was throwing half a can away all the time. I was told to add a little hot water to the cold food or microwave it. My cat still refused to eat it. My previous cat, who did have CRF, also refused to eat canned or dry K/D. Sue >> > What? 1/2 gram above the bare minimum protein requirement? That means > the [quoted text clipped - 44 lines] > k/d > specifically. Phil, I can only rely upon the hard data that exists - not antecdotal claims and internet mythology. Point in fact Feline k/d is the second largest selling feline diet, fed to literally millions of cats around the world. We handle over 400 calls each day from vet clinics who call for advice, to get questions answered, and of course to complain. The complaints on k/d palatability have gone so low since the new products were introduced that they don't even fall into the Top 50 category anymore. Those are simple facts. Considering that it is the second highest volume diet - second only to c/d - logic would dictate that the number of complaints on palatability would rank second - and it isn't even close. As for PAL testing, that has been done by the accepted methodology, accepted by every researcher as the Gold Standard in PAL testing. That testing has been done on colonies of cats in four different continents, on cats that are not Hill's cats. The PAL on k/d vastly beat any other manufacturer of any renal diet manufactured and in fact is tested against Fancy Feast. The reality is that cats that are sick, in uremic crisis, aren't going to eat much of anything. To expect "kitty kandy" PAL with these cats is fantasyland. An even better reason to put cats on k/d early and avoid getting into uremic crisis when it isn't necessary. > Phil, > I can only rely upon the hard data that exists - I don't consider manufacturers' biased studies exactly "hard data". You've got to learn how to balance clinical studies with real life. Point in fact Feline k/d is the second > largest selling feline diet, fed to literally millions of cats around > the world. What do you expect? K/d is the *only* kidney diet that's available from most vets- Hill's makes sure of that by making vets offers that are hard to refuse. X/d or even g/d are much better diets for early stage CRF. You used to have credibility- but now you sound like a used car salesman. > > Phil, > > > I can only rely upon the hard data that exists - > I don't consider manufacturers' biased studies exactly "hard data". You've > got to learn how to balance clinical studies with real life. I see then - Grade 1 Evidence Based, triple blinded, naturally ocurring disease, clinical trial(s) (two of them now) conducted by a University has less weight than your anecdotal evidence??? I'm surprised - you have always held that clinical trials had more weight than Aunt Edith's opinions expressed over the internet. Why the sudden change in opinion? > Point in fact Feline k/d is the second > > largest selling feline diet, fed to literally millions of cats around [quoted text clipped - 3 lines] > most vets- Hill's makes sure of that by making vets offers that are hard to > refuse. Oh BS - that's utter BS in the extreme. Vets can choose from Purina, Eukanuba, Royal Canin, IVD, and in Europe Leo. why do they choose k/d? - because the data - in the form of clinical trials supports the choice. Why do you think Purina has so much trouble selling NF - could it be because they don't have a single Grade 1 published study to support it? What offers does Hill's make? None, in comparison to what the competition is offering. Purina, Eukanuba, Royal Canin are all giving away tens of thousands of pounds in free product. We haven't had a promotional program on k/d in over six years - back when we made major changes to the canine products. That promotion was tied into the newly announced Heska ERD kit. In contrast the other Big 3 - Purina, Eukanuba and Royal Canin are giving away literally thousands of pounds of food every week. Flat out giving it away free, no strings, in fact the clinic hasn't even ordered it and doesn't even know it's coming, the products just show up unannounced. I suppose you are going to fall back on the utter nonsense that we pay the tuition for all the vets? Let me know when you find a vet that agrees to that nonsense. > X/d or even g/d are much better diets for early stage CRF. No they are not - neither has any published data to support that position. Neither has the unique nutrients required for treating CRF. Are they better than Purina Pro Plan Ocean Fish and Crab in Aspic with zero carbs and 2.1% phos - sure, but they are not the right choice for CRF - at any stage where veterinarians can commonly diagnose it. > You used to have credibility- but now you sound like a used car salesman. Facts are facts Phil - Facts are that there are now two Grade 1 Evidence Based clinical trials that prove that k/d is the right choice as soon as CRF is detected. One done in England and one done by Polzin and Ross to be published later this year. This is a debate that you are destined to lose, because the data is piling up against you. Over the course of the next three years you will see further clinical trials completed which further disprove your position, and that all those Hi-Pro fanatics urging increased protein, are simply out to lunch. Facts are facts in regards to the PAL issues as well. The facts are that k/d is the second most commonly sold Prescription Diet and literally millions of cats all over the world eat it without any problems. Facts are Facts that k/d PAL issues are not even in the Top 50 reasons that praticing vets call about. This is quantifiable data - not simply an "opinion". Quantifiable data always trumps anecdotal opinions - at least it used to - unless you have decided to go over to the dark side and accept internet mythology and Aunt Edith's anecdotal opinions instead of quantifiable facts. > > > Phil, > > [quoted text clipped - 6 lines] > disease, clinical trial(s) (two of them now) conducted by a University > has less weight than your anecdotal evidence??? When my "anecdotal evidence" is based on my personal *direct first-hand experience"-- absolutely! Lets see if I understand you correctly: If a study tells you early renal cats do better on k/d, but in real life you can actually see the cats deteriorate. So you swtich the cats to a higher protein diet and all of them have dramatic improvements in their clinical condition. Are you going to ignore what your own two eyes tell you because of something you read in a study? Are you really that weak-minded? If a study tells you cats love k/d but in real life the cat won't touch it, you'll still believe the cat loves k/d because the study says so and the hell with what your own eyes tell you. LOL! Hey Steve: "These aren't the droids you're looking for". lol I'm surprised - you > have always held that clinical trials had more weight than Aunt Edith's > opinions expressed over the internet. I'm not talking about Aunt Edit's opinions. Nothing and nobody carries more weight for me than my own direct, first-hand experiences. > Why the sudden change in opinion? What are you talking about? I haven't had a change in opinion. I've been saying k/d is too low in protein for early renal cats, and that most cats find k/d unpalatable for years. > > Point in fact Feline k/d is the second > > > largest selling feline diet, fed to literally millions of cats around [quoted text clipped - 6 lines] > Oh BS - that's utter BS in the extreme. Vets can choose from Purina, > Eukanuba, Royal Canin, IVD, and in Europe Leo. why do they choose k/d? Because Hill's gives better kick-backs and perks- that's why. You know it and I know it. > > X/d or even g/d are much better diets for early stage CRF. > > No they are not - Tell that to the cats that *improved* after switching to x/d from k/d. neither has any published data to support that > position. There isn't any "published data" that refutes x/d either- > > You used to have credibility- but now you sound like a used car salesman. > > Facts are facts Phil - Reality is reality- Steve. Your facts were tailor made for Hills. This is a debate that you are > destined to lose, How can you say I'm destined to lose when I've already won- time and time again with several early renal cats? You don't seem to understand, I have no need to debate the issue because I've already seen cats deteriorate on k/d and improve after switching to x/d. What I don't understand is how you can argue over something you know nothing about! You have no direct first hand experience- you're a *salesman*- and you've never even tried x/d in an early renal cat- so how the *f.ck* do you know which is better? You've been relying on Hill's funded studies for so long that you've lost the ability to think and reason for yourself. I've *seen* early renal cats improve after switching from k/d to x/d. That's all there is to it. You don't have to like it. There's *nothing* that you or anyone else can say that will change reality. What the hell is wrong with you? How can you presume to tell me that our cats didn't improve on x/d? > because the data is piling up against you. I wouldn't bet on that just yet, Steve. Here's a quote from your buddies Polzin and Osborne from Ettinger's text: "Current evidence suggests that protein restriction probably has only a minimal effect, if any, on progression of renal failure." David J. Polzin, DVM, PhD, Diplomate ACVIM Professor, College of Veterinary Medicine University of Minnesota, St. Paul, Minnesota Carl A. Osborne, DVM, PhD, Diplomate ACVIM Professor, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota Here's a repost of Greg Grauer article in SAIM: Gregory F. Grauer, DVM, MS, Dipl. ACVIM (SAIM) "Researchers have established that the minimum protein requirements for dogs and cats with CRF are higher than those of normal dogs and cats. Ideally, dogs with CRF should receive a minimum of 2 to 2.2 g and cats a minimum of 3.3 to 3.5 g of protein per kilogram per day." or 13.2 to 14 g/day for a 4 kg cat. Do the math- k/d contains 6.6 g of protein /100 kcal. - which translates into about 12 g/day for a 4 kg cat. Don't forget to consider urinary protein losses. Sure looks like a negative nitrogen balance on my calculator. > "Steve Crane" <eodemolay@cox.net> wrote in message Posted this morning on the AAVN listserver. "We generally recommend that cats be gradually switched to a diet formulated for the treatment of renal failure at the time of diagnosis. We have recently completed a double-blinded, randomized, clinical trial designed to determine if a renal diet is superior to an adult maintenance diet in minimizing uremic episodes and mortality rate in cats with stages 2 and 3 chronic kidney disease (serum creatinine 2.1 - 4.5mg/dl at the time of enrollment in the 2-year study). Throughout the study we were unable to identify laboratory abnormalities that would allow us to reliably predict which cats were at the greatest risk of developing uremic crises, and therefore would have been most likely to benefit from dietary modification. Since the results of our study indicate that the renal diet prevented or delayed uremic crises and death, we recommend that renal diets be initiated for all cats with mild (serum creatinine concentration >2.0mg/dl) chronic renal failure. The study manuscript is currently in the process of review and will hopefully be published soon!" Sheri Ross, DVM Assistant Clinical Professor Small Animal Internal Medicine (Nephrology/Urology) University of Minnesota Veterinary Teaching Hospital 1365 Gortner Ave., Saint Paul, MN 55108 rossx031@tc.umn.edu > > "Steve Crane" <eodemolay@cox.net> wrote in message > [quoted text clipped - 6 lines] > maintenance diet in minimizing uremic episodes and mortality rate in > cats with stages 2 and 3 chronic kidney disease > Sheri Ross, DVM > Assistant Clinical Professor > Small Animal Internal Medicine (Nephrology/Urology) > University of Minnesota Veterinary Teaching Hospital > 1365 Gortner Ave., Saint Paul, MN 55108 > rossx031@tc.umn.edu Chapter 260 pages 1773 - 1785 Chronic Kidney Disease TEXTBOOK OF VETERINARY INTERNAL MEDICINE, SIXTH EDITION 0-7216-0117-0 Copyright © 2005, Elsevier Inc. David J. Polzin Carl A. Osborne Sheri Ross "Although the ideal quantity of protein to feed dogs and cats with CKD remains unresolved, a general consensus of opinion supports the fact that reducing protein intake ameliorates clinical signs of uremia in CKD and is therefore indicated for stage ****4**** CKD." "The concept of reducing dietary protein intake in CKD patients that do not have clinical signs of uremia has been questioned. Limiting protein intake has been advocated for these patients to slow progression of CKD. This suggestion derives from studies in rats indicating that dietary protein restriction limits glomerular hyperfiltration and hypertension and slows the spontaneous decline in kidney function that follows reduction in kidney mass. Studies in humans have supported the concept that protein restriction slows progression of CKD, albeit this effect may be small. In contrast, multiple studies have failed to confirm a beneficial role for protein restriction in limiting progression of kidney disease in dogs or cats." "Although a role for protein restriction in slowing progression of canine and feline CKD has not been entirely excluded, available evidence fails to support a recommendation for or against protein restriction in patients with stage 3 CKD." Give it a rest, Steve. > > "Steve Crane" <eodemolay@cox.net> wrote in message > [quoted text clipped - 6 lines] > maintenance diet in minimizing uremic episodes and mortality rate in > cats with stages 2 and 3 chronic kidney disease >Sheri Ross, DVM >Assistant Clinical Professor >Small Animal Internal Medicine (Nephrology/Urology) Chapter 260 pages 1773 - 1785 Chronic Kidney Disease TEXTBOOK OF VETERINARY INTERNAL MEDICINE, SIXTH EDITION 0-7216-0117-0 Copyright © 2005, Elsevier Inc. David J. Polzin Carl A. Osborne Sheri Ross "Although the ideal quantity of protein to feed dogs and cats with CKD remains unresolved, a general consensus of opinion supports the fact that reducing protein intake ameliorates clinical signs of uremia in CKD and is therefore indicated for ****stage 4**** CKD." "The concept of reducing dietary protein intake in CKD patients that do not have clinical signs of uremia has been questioned. Limiting protein intake has been advocated for these patients to slow progression of CKD. This suggestion derives from studies in rats indicating that dietary protein restriction limits glomerular hyperfiltration and hypertension and slows the spontaneous decline in kidney function that follows reduction in kidney mass. Studies in humans have supported the concept that protein restriction slows progression of CKD, albeit this effect may be small. In contrast, multiple studies have failed to confirm a beneficial role for protein restriction in limiting progression of kidney disease in dogs or cats." "Although a role for protein restriction in slowing progression of canine and feline CKD has not been entirely excluded, available evidence fails to support a recommendation for or against protein restriction in patients with stage 3 CKD." Give it a rest, Steve. > "Steve Crane" <eodemolay@cox.net> wrote in message Posted this morning on the AAVN listserver. "We generally recommend that cats be gradually switched to a diet formulated for the treatment of renal failure at the time of diagnosis. We have recently completed a double-blinded, randomized, clinical trial designed to determine if a renal diet is superior to an adult maintenance diet in minimizing uremic episodes and mortality rate in cats with stages 2 and 3 chronic kidney disease (serum creatinine 2.1 - 4.5mg/dl at the time of enrollment in the 2-year study). Throughout the study we were unable to identify laboratory abnormalities that would allow us to reliably predict which cats were at the greatest risk of developing uremic crises, and therefore would have been most likely to benefit from dietary modification. Since the results of our study indicate that the renal diet prevented or delayed uremic crises and death, we recommend that renal diets be initiated for all cats with mild (serum creatinine concentration >2.0mg/dl) chronic renal failure. The study manuscript is currently in the process of review and will hopefully be published soon!" Sheri Ross, DVM Assistant Clinical Professor Small Animal Internal Medicine (Nephrology/Urology) University of Minnesota Veterinary Teaching Hospital 1365 Gortner Ave., Saint Paul, MN 55108 rossx031@tc.umn.edu > > "Steve Crane" <eodemolay@cox.net> wrote in message > [quoted text clipped - 13 lines] > 1365 Gortner Ave., Saint Paul, MN 55108 > rossx031@tc.umn.edu Chapter 260 pages 1773 - 1785 Chronic Kidney Disease TEXTBOOK OF VETERINARY INTERNAL MEDICINE, SIXTH EDITION 0-7216-0117-0 Copyright © 2005, Elsevier Inc. David J. Polzin Carl A. Osborne Sheri Ross "Although the ideal quantity of protein to feed dogs and cats with CKD remains unresolved, a general consensus of opinion supports the fact that reducing protein intake ameliorates clinical signs of uremia in CKD and is therefore indicated for stage ****4**** CKD." "The concept of reducing dietary protein intake in CKD patients that do not have clinical signs of uremia has been questioned. Limiting protein intake has been advocated for these patients to slow progression of CKD. This suggestion derives from studies in rats indicating that dietary protein restriction limits glomerular hyperfiltration and hypertension and slows the spontaneous decline in kidney function that follows reduction in kidney mass. Studies in humans have supported the concept that protein restriction slows progression of CKD, albeit this effect may be small. In contrast, multiple studies have failed to confirm a beneficial role for protein restriction in limiting progression of kidney disease in dogs or cats." "Although a role for protein restriction in slowing progression of canine and feline CKD has not been entirely excluded, available evidence ****fails to support**** a recommendation for or against protein restriction in patients with stage 3 CKD." Give it a rest, Steve. The tough guy wanna-be, mudslinging lunatic troll says "give it a rest" as he posts the same exact message for the third time in a row. > Path: newsdbm04.news.prodigy.com!newsdst01.news.prodigy.com!newsmst01b.news.prodigy.com!prodigy.com!newscon02.news.prodigy.com!prodigy.net!nx01.iad01.newshosting.com!newshosting.com!207.69.154.102.MISMATCH!elnk-atl-nf2!newsfeed.earthlink.net!stamper.news.atl.earthlink.net!newsread1.news.atl.earthlink.net.POSTED!5be4e383!not-for-mail > From: "Phil P." <phil maxshouse.com> [quoted text clipped - 68 lines] > > Give it a rest, Steve. > The tough guy wanna-be, mudslinging lunatic troll says "give it a > rest" as he posts the same exact message for the third time in a > row. troll! I gotta admit that kind of felt good > "Steve Crane" <eodemolay@cox.net> wrote in message Posted this morning on the AAVN listserver. "We generally recommend that cats be gradually switched to a diet formulated for the treatment of renal failure at the time of diagnosis. We have recently completed a double-blinded, randomized, clinical trial designed to determine if a renal diet is superior to an adult maintenance diet in minimizing uremic episodes and mortality rate in cats with stages 2 and 3 chronic kidney disease (serum creatinine 2.1 - 4.5mg/dl at the time of enrollment in the 2-year study). Throughout the study we were unable to identify laboratory abnormalities that would allow us to reliably predict which cats were at the greatest risk of developing uremic crises, and therefore would have been most likely to benefit from dietary modification. Since the results of our study indicate that the renal diet prevented or delayed uremic crises and death, we recommend that renal diets be initiated for all cats with mild (serum creatinine concentration >2.0mg/dl) chronic renal failure. The study manuscript is currently in the process of review and will hopefully be published soon!" Sheri Ross, DVM Assistant Clinical Professor Small Animal Internal Medicine (Nephrology/Urology) University of Minnesota Veterinary Teaching Hospital 1365 Gortner Ave., Saint Paul, MN 55108 rossx031@tc.umn.edu . >> X/d or even g/d are much better diets for early stage CRF. > > No they are not - neither has any published data to support that > position. Neither has the unique nutrients required for treating CRF. Steve, I specifically recall a poster provided by Hills to veterinary clinics listing medical conditions and appropriate diets. On that chart G/D was listed as one of the diets appropriate for treating early renal disease. Justification in the literature provided by Hills included slightly reduced levels of high quality protein (higher density of essential amino acids), decreased levels of sodium and phosphorus, elevated levels of omega 3 and 6 fatty acids and, I think, a balance of soluble and insoluble fibre that decreased the amount of urea absorbed from the colon (Perhaps is was a sales rep that mentioned the last one). That was a few years ago. Has Hill's changed their tune about G/D and its use in early renal disease since then? More importantly, have they changed the formulation? Perhaps I should be speaking to the medi-cal/royal canin rep to find out if they offer a better diet for my purposes. Bear in mind that I'm not trying to be confrontational here, I just want to provide the best for my patients. J. . We handle over 400 calls each day from vet clinics who call > for advice, to get questions answered, and of course to complain. The > complaints on k/d palatability have gone so low since the new products > were introduced that they don't even fall into the Top 50 category > anymore. It's not been my experience K/D or any of the other renal diets are very palatable to cats (although I do agree that the newer K/D formulations have improved in palatability). Yet I can't think of too many vets that would go through the trouble of calling Hills and complaining about it. It would be more interesting if you had access to returns statitistics. In Canada at least, Hills offers a palatability guarantee for all their prescription diets. If someone's pet doesn't like the food they can bring it back to the vet for a full refund. We just call Hills and tell them what was returned and our account is credited. I'd be willing to bet that K/D ranks pretty high on the list of returned food. J. Another thread providing examples of this troll playing tough guy on the Internet. This troll has no mental capacity to debate anything without name-calling and a pretense of holiness. > Path: newsdbm05.news.prodigy.com!newsdbm04.news.prodigy.com!newsdst01.news.prodigy.com!newsmst01b.news.prodigy.com!prodigy.com!newscon06.news.prodigy.com!prodigy.net!border1.nntp.dca.giganews.com!border2.nntp.dca.giganews.com!nntp.giganews.com!elnk-atl-nf1!newsfeed.earthlink.net!stamper.news.atl.earthlink.net!newsread2.news.atl.earthlink.net.POSTED!5be4e383!not-for-mail > From: "Phil P." <phil maxshouse.com> [quoted text clipped - 62 lines] > the other reason is the poor palatability of renal diets in general- and k/d > specifically. Dogh boyee wrote: > Another thread providing examples of this troll playing tough guy on > the Internet. This troll has no mental capacity to debate anything > without name-calling and a pretense of holiness. troll much? i think you're acting like a cremudgeon (it's a step down from being a troll) dick I MEAN RICHARD wrote: > Another thread providing examples of this troll playing tough guy on > the Internet. This troll has no mental capacity to debate anything > without name-calling and a pretense of holiness. AND a curmudgeon Oh nonsense, k/d is more palatable than Friskies canned foods. We've > done the PAL studies so many times in so many places it's ridiculous. > The problem is not with the food, but with the practitioner. Any cat [quoted text clipped - 4 lines] > on _any_ food isn't going to affect the cat. Once home and once the > cat is feeling a bit better - THEN the food needs to be changed. Mmm....my CRF cat definitely thought Friskies and Fancy Feast were tastier than K/D. She was fed K/D at home, not at the vet's. I don't think my experience is that different than a lot of people who have CRF cats and try to feed K/D. > Oh nonsense, k/d is more palatable than Friskies canned foods. We've > > done the PAL studies so many times in so many places it's ridiculous. [quoted text clipped - 10 lines] > think my experience is that different than a lot of people who have CRF > cats and try to feed K/D. What year was this, Lauren? Most people's cats will prefer grocery store crap to k/d; especially with all of the salt that is normally present in those foods. Years ago there used to be a palatabilty issue, but not so much these days. It's interesting to note how people will take an experience they have and extrapolate that to cover millions of other people's cats! Also interesting is that I don't recall Lauren EVER mentioning that she had a cat that experienced renal failure, let alone ever being fed k/d from Hill's, the company she hates! ;) There are numerous circumstances impacting cats with renal failure. There are 3 different versions of Feline k/d available. Most people judge their experiences on one version that was fed many years ago. Those examples ususally don't apply to what the situation is, TODAY. Steve has a valid point here. Anyone else who had a cat that liked something else may have a point as well. But, instead, it looks like we are in for a fresh round of Hill's Hating. >> Oh nonsense, k/d is more palatable than Friskies canned foods. We've >> > done the PAL studies so many times in so many places it's ridiculous. [quoted text clipped - 14 lines] > store crap to k/d; especially with all of the salt that is normally > present in those foods. That's what I see in my cats. They do eat K/D willingly, even the healthy ones -- when/if I don't keep them away from it. But if I have both foods out, they go to the Friskies canned first. (They get Friskies as a treat only a couple times a year, I think of it as being equivalent to me eating a Wendy's or McD hamburger once in a long while.) But, it was Steve who said the opposite (unless maybe he meant something other than grocery store Friskies) >> Oh nonsense, k/d is more palatable than Friskies canned foods. We've That's what I see in my cats. They do eat K/D willingly, even the healthy > ones -- when/if I don't keep them away from it. But if I have both foods > out, they go to the Friskies canned first. (They get Friskies as a treat > only a couple times a year, I think of it as being equivalent to me > eating a Wendy's or McD hamburger once in a long while.) I tried feeding it by itself, and with other foods. My cat was even on Periactin and she still wouldn't eat the K/D. She did eat the A/D for a couple of days though, but that's not a "renal diet". I would have loved it if she ate the K/D but no such luck. Maybe they need to stink it up more like their A/D is. Most people > judge their experiences on one version that was fed many years ago. Only one out of 5 or 6 of our renal cats will eat *any* version of k/d- regular canned, canned w/chicken or dry. The ones that do eat k/d, don't eat enough of it to meet their caloric/protein needs and need to be supplemented with g/d or mostly x/d. This is *now*- the *present*. A few years ago, k/d was even more unpalatable. Even though k/d is too low in protein for cats in early stage CRF, I wouldn't have a problem with it if the cats would eat enough of it- but they don't. It doesn't matter how perfectly formulated a diet is if the cat won't eat it. > Even though k/d is too low in protein for cats in early stage CRF, I > wouldn't have a problem with it if the cats would eat enough of it- but > they > don't. It doesn't matter how perfectly formulated a diet is if the cat > won't eat it. I brought Tiger back to the vet today, to learn how to give her the fluids. I asked the vet whether it was the right thing to do, starting her so soon. She kept insisting that it was, and that it was better to start now than wait until she declines too much. She again pulled up Tiger's skin to show me how it doesn't smooth out immediately, and said she's dehydrated. Now, I live with this cat and I see her drink plenty of water. If I put 10 bowls of water in different corners of my apartment, she'd make sure to visit all 10. When Harriet was staying with me, all Tiger wanted was to get into the bedroom because she knew there was another water fountain in there. She eats only wet food. So, the "dehydration" hasn't convinced me she needs the extra fluids, but would the extra fluids be good for her kidneys? She also recommended starting her on a Eukanuba prescription food, which she said wasn't as protein restricted as the Hill's. I didn't get any food today, because I'd like to read more about kidney problems. I did come home with a bag of fluid and needles, but I told the vet I was going to do some more research before deciding what to do. Any good, basic web sites I can start with? -- Liz A couple of good sites about CRF.....felinecrf.com and felinecrf.org. Sue >> Even though k/d is too low in protein for cats in early stage CRF, I >> wouldn't have a problem with it if the cats would eat enough of it- but [quoted text clipped - 25 lines] > -- > Liz > > Dr. Martin - I would have to disagree, the recent studies have been > > pretty overwhelming that the sooner k/d is started, the better the [quoted text clipped - 6 lines] > k/d, do you, Steve? The low protein, phosphorus and sodium content makes > k/d unpalatable to many (most) renal cats. My vet had prescribed k/d for a cat I had that had CRF. She wouldn't touch it. She would eat the a/d (I believe that's what it was called), but unfortunately only for a couple of days, then she wouldn't touch that either. I went back to feeding her Fancy Feast. Yes, I know that the greatest food for a CRF cat, but at that point, I just needed to get food in her. > "Researchers have established that the minimum protein requirements for dogs > and cats with CRF are higher than those of normal dogs and cats. Ideally, [quoted text clipped - 5 lines] > Don't forget to consider urinary protein losses. Sure looks like a negative > nitrogen balance on my calculator. I must have missed this one. Phil, you've made a fundamental and basic error in your calculations. The values you apply above - 2 to 2.2 grams per day - were developed based upon typical and normal digestibility levels of protein in typical cat foods. Your end values of 13.2 to 14 grams per day are based on average digestibility of average pet foods. That creates a huge fundamental calculation error. To illustrate the error - consider opposite ends of the spectrum - egg vs. meat & bone meal. Egg considered to be ~100% digestible versus meat & bone meal at ~55% digestibility. The values you quote above are based on standard protein digestibility in typical cat foods which run ~70%. 14 grams of protein that is 100% digestible (egg) yields 14 grams of protein 14 grams of protein that is 70% digestible (average cat foods) yields 9.8 grams of net protein. Your calculations are fundamentally flawed because you are assuming the protein in k/d is equal in digestibility to the protein used in the studies that established the net protein needs of a cat. This forces a fundamental and basic error in your calculations of >25% . Adding just a 20% difference in digestibility of protein to your calculations puts k/d above the 14 equivalent grams of protein per day. > > "Researchers have established that the minimum protein requirements for dogs > > and cats with CRF are higher than those of normal dogs and cats. Ideally, [quoted text clipped - 7 lines] > > I must have missed this one. You seem to be missing a lot lately. Phil, you've made a fundamental and basic > error in your calculations. The values you apply above - 2 to 2.2 grams > per day - were developed based upon typical and normal digestibility > levels of protein in typical cat foods. Your end values of 13.2 to 14 > grams per day are based on average digestibility of average pet foods. > That creates a huge fundamental calculation error. I don't think so, Steve. Even if k/d was 100% digestible and 100% metabolizable, the cat would *barely* meet her daily protein needs- assuming she licked the plate clean. You're also completely ignoring the fact that CRF cats are constantly losing protein in their urine. > I don't think so, Steve. Even if k/d was 100% digestible and 100% > metabolizable, the cat would *barely* meet her daily protein needs- assuming > she licked the plate clean. You're also completely ignoring the fact that > CRF cats are constantly losing protein in their urine. Phil - once again you missed the entire point - the data you are using, the values you are using - are BASED on the LOW digestibility rate of typical commercial foods - get it????? If the values you are using - the 13-14 gms/day are BASED on 70% digestibility in the first place - the values of 13-14 grams ONLY apply to foods with the same protein digestibility levels. Do the math - 70% digestibility of 14 grams of protein = 9.8 grams of actual available protein. 85% digestibility of 12 grams of protein = 10.2 grams of actual available protein. > > I don't think so, Steve. Even if k/d was 100% digestible and 100% > > metabolizable, the cat would *barely* meet her daily protein needs- assuming [quoted text clipped - 4 lines] > the values you are using - are BASED on the LOW digestibility rate of > typical commercial foods - get it????? I don't think *you* get it. I said: "Even if k/d was 100% digestible and 100% metabolizable, the cat would *barely* meet her daily protein needs- assuming she licked the plate clean." > 70% digestibility of 14 grams of protein = 9.8 grams of actual > available protein. > 85% digestibility of 12 grams of protein = 10.2 grams of actual > available protein. Ah so! K/d provides even *less* protein than I estimated! Thanks for reinforcing my position. > > "Researchers have established that the minimum protein requirements for dogs > > and cats with CRF are higher than those of normal dogs and cats. Ideally, [quoted text clipped - 12 lines] > grams per day are based on average digestibility of average pet foods. > That creates a huge fundamental calculation error. Just to straighten you out on a few things: the nutritional requirements (NRC-1976-86) for cats was originally based on *purified* diets which were much *more* digestible than commercial diets. Thus your argument is utter nonsense. The AAFCO increased the minimum requirements because commercial diets aren't as digestible as purified diets used in the original studies, thus the new AAFCO MDRs take into consideration the variations in the availability of protein in commercial diets and provide additional protein to offset the variations. "Rounding this value, a minimum protein (N × 6.25) of 140 g/kg diet is recommended for the adult cat." (NRC 1986 p 9 "Protein". ) K/d contains 1279 kcal/kg @ 6.6 g/100 kcals. or 84.4 g. protein/kg. A little light, wouldn't you say? The AAFCO *minimum* level for adult maintenance is 26% (DMB). K/d contains 28.6%. Thus, my estimation was *correct*. The only error in my calculation was I might have ***overestimated*** k/d's ability to provide sufficient protein for CRF cats. Now I understand why so many vets give bogus information about nutrition! Look whose educating them: double-talking petfood company sales reps! > "Steve Crane" <eodemolay@cox.net> wrote in message > Just to straighten you out on a few things: the nutritional requirements > (NRC-1976-86) for cats was originally based on *purified* diets which were > much *more* digestible than commercial diets. Thus your argument is utter > nonsense. No Phil - the data you provided - the calculations you made - that set 13-14 grams per 4kg cat - that value did not derive from the 40 year old NRC values based on "purified diets". Do you prefer data from over 40 years ago?? do you think we may have learned a couple things since then??? > The AAFCO increased the minimum requirements because commercial diets aren't > as digestible as purified diets used in the original studies, thus the new > AAFCO MDRs take into consideration the variations in the availability of > protein in commercial diets and provide additional protein to offset the > variations. Again data based on 30+ year old technology. One would assume that since you quote the AAFCO data you must also accept the AAFCO feeding trials - which k/d passes with no problems. Phil you're going to lose this argument - the data that will be coming out over the next 2-3 years is going to utterly bury this erroneous concept of insufficient protein in renal diets. > > "Steve Crane" <eodemolay@cox.net> wrote in message > > Just to straighten you out on a few things: the nutritional requirements [quoted text clipped - 5 lines] > 13-14 grams per 4kg cat - that value did not derive from the 40 year > old NRC values based on "purified diets". You missed my point. My estimate was based on AAFCO recommendations. The AAFCO increased the minimum requirements for cats because commercial diets aren't as digestible as the diets used in the original NRC studies. > Do you prefer data from over 40 years ago?? err- I used the AAFCO 2005 Official Publication for minimum protein requirements for cats. > Phil you're going to lose this argument - the data that will be coming > out over the next 2-3 years Great. Lets continue this argument in 2-3 years when you can back up your claims. I think you're so hell bent on pushing k/d that I don't think you even understand the point of my argument. > "Steve Crane" <eodemolay@cox.net> wrote in message > > Do you prefer data from over 40 years ago?? > > err- I used the AAFCO 2005 Official Publication for minimum protein > requirements for cats. Which is based on what Phil? - come on, time to be honest here - the AFFCO values are based on what? - it's right there in your AAFCO manual - NRC values from materials published _prior_ to 1975-1981. PUBLISHED before 1975 - means studies that are well over 30 years old, some could be over 50 years old. Data from 1981 comes from studies well over 25 years old. Even the new NRC guidlines - if they are even officially published - are based on data published before 2002 - which would not include all of the new Grade 1 clinical trials in renal disease. > > "Steve Crane" <eodemolay@cox.net> wrote in message > > > Do you prefer data from over 40 years ago?? [quoted text clipped - 5 lines] > AFFCO values are based on what? - it's right there in your AAFCO manual > - NRC values from materials published _prior_ to 1975-1981. That's one of the reasons why the AAFCO *increased* the NRC's minimum protein requirement. The NRC recommendations were minimum nutrient requirements for cats, not recommended allowances for inclusion in cat foods. You should stick with the NRC- they make k/d seem better because the NRC protein requirements were lower than the AAFCO! So, you're trying to tell me that the cat evolved so much in the past few months that her protein requirements have *decreased* and the AAFCO 2005 recommendations are no longer valid? LOL! The fact that Hill's funds Dr. Ross's studies wouldn't have anything to do with your trying to manipulate the context of her published data in Ettinger's 6th ed., would it? What happened? I though you weren't going to respond to this thread anymore until you could back up your dubious claims with published, peer-reviewed data? > > > "Steve Crane" <eodemolay@cox.net> wrote in message > > > > Do you prefer data from over 40 years ago?? [quoted text clipped - 11 lines] > foods. You should stick with the NRC- they make k/d seem better because the > NRC protein requirements were lower than the AAFCO! It doesn't matter which you accept - AAFCO is based on NRC, NRC data is based on data from 25-40 years ago. > So, you're trying to tell me that the cat evolved so much in the past few > months that her protein requirements have *decreased* and the AAFCO 2005 > recommendations are no longer valid? LOL! Oh Nonsense Phil - nobody said or suggested any such thing. Geesh Phil - I didn't think you could possibly keep missing this. The AFFCO and NRC data for minimum protein are based on common commercial pet foods values - digestibility levels 20-35% LOWER than k/d protein digestibility. > The fact that Hill's funds Dr. Ross's studies wouldn't have anything to do > with your trying to manipulate the context of her published data in > Ettinger's 6th ed., would it? Sure, anytime you think Ross, Osborne and Polzin and others would deliberately deceive the veterinary community, pass a peer review process to deliberately deceive the medical world, and do all this for a few scheckles - You've got to be kidding me. Once again it is NOT the data from Ettingers 6th ed, but newer material not yet published anywhere except in abstract form for ACVIM. As you well know a textbook is out of date before it get soff the printing press. Nice place for basic info, but will never be the leading edge of anything. > > > > "Steve Crane" <eodemolay@cox.net> wrote in message > > > > > Do you prefer data from over 40 years ago?? [quoted text clipped - 24 lines] > values - digestibility levels 20-35% LOWER than k/d protein > digestibility. Bullshit! The reason why the AAFCO increased the NRC's minimum protein requirement is because the studies used in the NRC used *purified* diets which were *more* digestible than commercial diets. Don't conjure up bullshit to sell your angle. You salesmen will say anything to sell your angle-- that's why very few people trust the food industry. You're not helping consumer confidence in Hill's. I thought you said you weren't going to comment again until your paper was published. So much for your credibility. > "Steve Crane" <eodemolay cox.net> wrote in message > news:1135138664.637284.236440 g44g2000cwa.googlegroups.com... >> > So, you're trying to tell me that the cat evolved so much in >> > the past few months that her protein requirements have [quoted text clipped - 15 lines] > very few people trust the food industry. You're not helping > consumer confidence in Hill's. As if they they would be better off employing a lunatic mudslinger. > I thought you said you weren't going to comment again until your > paper was published. So much for your credibility. So Steve Crane is a salesperson and Phil P. is an unpublished lunatic mudslinger. > Path: newsdbm04.news.prodigy.com!newsdst01.news.prodigy.com!newsmst01b.news.prodigy.com!prodigy.com!newscon02.news.prodigy.com!prodigy.net!nx01.iad01.newshosting.com!newshosting.com!207.69.154.102.MISMATCH!elnk-atl-nf2!newsfeed.earthlink.net!stamper.news.atl.earthlink.net!newsread2.news.atl.earthlink.net.POSTED!5be4e383!not-for-mail > From: "Phil P." <phil maxshouse.com> [quoted text clipped - 14 lines] > Organization: EarthLink Inc. -- http://www.EarthLink.net > Xref: newsmst01b.news.prodigy.com rec.pets.cats.health+behav:418750
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