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03/06/14 12:21 Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Treatments Overview

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Site Overview
What You Need to Know
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What Happens in CKD
Causes of CKD
How Bad is It?
Is There Any Hope?
Acute Kidney Injury

Nausea, Vomiting, Appetite
Loss and Excess Stomach
Maintaining Hydration
The Importance of
Phosphorus Control
All About Hypertension
All About Anaemia
All About Constipation
Potassium Imbalances
Metabolic Acidosis
Kidney Stones

Coping with CKD
Home > Treatments

The purpose of treatment is twofold. Firstly, you want to help your cat feel better. Secondly, if at all
possible you want to slow down the progression of the CKD.
There are a lot of treatments available for CKD, and when you first start out you may not know where
to start. You may have been given treatments by your vet, but you're not sure what they are for or why
you have been given them.
This section explains more about the treatments I know of for CKD in cats. It also discusses which are
the most important, how to find a good vet, and how to obtain supplies at reasonable prices.
If you can't find what you're looking for in this section - for example, you may have been given
clindamycin, but you don't know what it is (an antibiotic), so you don't know which page to check -
check out the Alphabetical Index [under construction].
Which Treatments are Essential Go to
This page explains the purposes of treatment, the importance of record keeping, and which treatments are

Many people get confused about which treatments are important and which are a waste of time, money and
effort, so this page explains more about the treatments that make the biggest difference. Please be sure to
read it, particularly if you're desperately scouring the internet for that non-existent miracle cure, and are
vulnerable to all those fabulous-sounding testimonials.

Remember, I'm not trying to sell you anything - I have no financial interest in anything mentioned on this site.
I do, however, get feedback from the thousands of people who have been members of my support group
over the years, who tell me what works for them and their cats.

Fluid and Urinary Issues: Go to page
Fluid Retention, Infections, Incontinence, Proteinuria
This section discusses treatments relating to fluid issues, such as dehydration and overhydration,
constipation and diarrhoea.

It also covers treatments for urinary issues, including incontinence, inappropriate elimination (peeing outside
the litter box), urinary tract infections, kidney infections, and proteinuria (protein loss in the urine).

Waste Product Regulation: Go to page
Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil
The toxins that arise in CKD can cause a variety of problems. This page discusses how to deal with some of
those problems, such as mouth ulcers, body odour, gastro-intestinal bleeding.

In addition, it talks about some general treatments that may be of use, such as antioxidants (including
CoQ10), a probiotic called Azodyl, Astro's CRF Oil, and oral adsorbents such as Epakitin (known as
Ipakitine outside the USA) and Kremezin.
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Tanya's Support Group
Success Stories

Alphabetical List of
Symptoms and Treatments
Fluid and Urinary
Imbalances (Dehydration,
Overhydration and Urinary
Waste Product Regulation
Imbalances (Vomiting,
Appetite Loss, Excess
Stomach Acid, Gastro-
intestinal Problems, Mouth
Ulcers Etc.)
Phosphorus and Calcium
Miscellaneous Symptoms
(Pain, Hiding Etc.)

Blood Chemistry: Kidney
Function, Potassium, Other
Tests (ALT, Amylase,
(Cholesterol, Etc.)
Calcium, Phosphorus,
Parathyroid Hormone
(PTH) and Secondary
Complete Blood Count
(CBC): Red and White
Blood Cells: Anaemia and
Urinalysis (Urine Tests)
Other Tests: Ultrasound,
Biopsy, X-rays etc.
Renomegaly (Enlarged
Which Tests to Have and
Frequency of Testing
Factors that Affect Test
Normal Ranges
International and US
Measuring Systems

Which Treatments are
Fluid and Urinary Issues
(Fluid Retention,
Infections, Incontinence,
Waste Product Regulation
(Mouth Ulcers, GI
Ipakitine outside the USA) and Kremezin.

Phosphorus, Calcium and PTH (Calcitriol) Go to
Phosphorus and calcium imbalances are common in CKD cats, and may cause elevated levels of a
hormone called parathyroid hormone (PTH). This can eventually lead to a condition called secondary
hyperparathyroidism. Controlling phosphorus levels is the primary method of controlling PTH levels, but
some people also use a treatment called calcitriol, a hormone which helps to balance PTH levels. Read
more here.

Miscellaneous Treatments Go to
Fortekor, Stem Cell Transplants, Kidney Transplants
This page covers treatments that don't belong in any other category. It includes stem cell transplants, which
some members of Tanya's CKD Support Group are finding helpful, but which are not widely available at the

It also discusses benazepril (Fortekor), a heart medication approved for the treatment of CKD in Europe,
Canada and Australasia, and kidney transplants (which are really expensive, and a treatment, not a cure).

Antibiotics and Painkillers Go to
CKD is not painful, but cats sometimes need painkillers for other reasons, such as for arthritis or after dental

CKD cats are prone to infections, so may need antibiotics on occasion. This page covers the treatments in
these categories that are most commonly used in CKD cats.

Holistic Treatments Go to
This page covers a number of holistic treatments, including the herbal remedy, slippery elm bark, which is a
gentle, soothing remedy which helps many cats with vomiting and nausea.

It also discusses treatments which are not appropriate for CKD cats, such as cranberries.

Erythropoiesis Stimulating Agents (ESAs) for Severe Anaemia: Go to page
Darbepoetin (Aranesp), Epoetin alfa (Epogen, Procrit, Eprex), Epoetin beta (NeoRecormon)
Anaemia is common in CKD cats, and if it is severe, you will need to consider using a treatment known as
Erythropoiesis Stimulating Agents or ESAs. This page discusses this treatment in detail, including the pros
and cons, commonly used dosages and sources of supplies usually a lot cheaper than those your vet can

General Health Issues in a CKD Cat: Fleas, Arthritis, Vaccinations, Dementia Go to page
CKD cats can of course have other health issues, such as fleas. This page discusses appropriate treatments
for these problems in CKD cats.

Tips on Medicating Your Cat Go to
If you have a cat who is a terror to pill, this page has tips on methods which may make it easier and less
stressful for both of you, such as Pill Pockets and compounded medications. It also explains why it is
important to follow any oral medications with water.

This page also has information on possible drug interactions.

Working with Your Vet Go to page
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(Mouth Ulcers, GI
Bleeding, Antioxidants,
Adsorbents, Azodyl,
Astro's CRF Oil)
Phosphorus, Calcium and
Miscellaneous Treatments:
Stem Cell Transplants,
ACE Inhibitors - Fortekor,
Steroids, Kidney
Antibiotics and Painkillers
Holistic Treatments
(Including Slippery Elm
ESAs (Aranesp, Epogen
etc.) for Severe Anaemia
General Health Issues in a
CKD Cat: Fleas, Arthritis,
Dementia, Vaccinations
Tips on Medicating Your
Obtaining Supplies
Cheaply in the UK, USA
and Canada
Working with Your Vet and

Nutritional Requirements of
CKD Cats
The B Vitamins (Including
What to Feed (and What to
Persuading Your Cat to Eat
Food Data Tables
USA Canned Food Data
USA Dry Food Data
USA Cat Food
UK Canned Food Data
UK Dry Food Data
UK Cat Food
2007 Food Recall USA

Intravenous Fluids
Subcutaneous Fluids
Tips on Giving
Subcutaneous Fluids
In order to give your cat the best possible care, ideally you and your vet need to work as a partnership. This
page gives tips on how best to do that.

It also covers how to find a good vet, and getting a second opinion.

Obtaining Supplies Cheaply in the UK, USA and Canada Go to
Some vets charge a fortune for supplies. The record is held by a vet who charged US$52 for one 1000ml
bag of lactated ringers sub-Q fluid (the needles and administration set were extra).

If you have to spend all your money on supplies, you have none left for testing. So use this page to find
reasonably priced sources for sub-Q supplies and prescription food in the UK, USA and Canada. Supplies
for other items, such as Azodyl or Epogen, can be found on the relevant page.

One Final Treatment...

is TLC (tender loving care). Don't under-estimate it! It can work wonders, as anybody who has seen a cat
pull through against the odds can testify. In the midst of caring for your cat, don't forget the cuddles and the
loving words. And don't forget to take care of yourself too.

Back to Page Index
This page last updated: 27 October 2013

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Subcutaneous Fluids
How to Give Subcutaneous
Fluids with a Giving Set
How to Give Subcutaneous
Fluids with a Syringe
Subcutaneous Fluids -
Winning Your Vet's Support

Heart Problems
Polycystic Kidney Disease
Dental Problems


The Final Hours
Other People's Losses
Coping with Your Loss

Early Detection
Canine Kidney Disease
Other Illnesses (Cancer,
Liver) and Behavioural
Diese Webseite auf

My Three CKD Cats:
Tanya, Thomas and Ollie
My Multi Ailment Cat,
Find Me on Facebook
03/06/14 12:21 Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Treatments Overview
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Contact Me

The group is hosted on yahoo!groups, part of yahoo. It has its own address separate from Tanya's website. You can either click here or
copy and paste this link into your browser:


If you are already familiar with yahoo!groups, just click on the link and apply to join (and don't forget to complete the short questionnaire
you'll be sent), but if you'd like to know more about how the group works, read on.

I own and run the group, but I am ably assisted by two moderators, Anne V and Anne A. They help with membership queries, approve
messages, and do lots of boring admin stuff behind the scenes to help the group run smoothly for the members.

The group has various sections, including a photos section and a realtime chat function but for most people the most important part of
the group is its message section. Basically, a member who wants support, vet recommendations, or to hear how others are coping with
a particular problem, sends a message to the rest of the group. Other members then respond if they can. All messages sent to the
group are stored in a message archive which members can search if they wish.

The group is private, i.e. messages sent to it are only visible to members, so people are not posting to the internet at large. The names
of group members are also private, so nobody will know you are a member unless you choose to send messages to the group.

Joining the Group Back to Page Index

There are two ways to join the group, via the group's website or via e-mail:

How to Join the Group via E-mail
Just send an e-mail to
You should then receive an e-mail in response asking you to confirm that you definitely want to join the group. Just click Reply and

If you join the group via e-mail, you will be able to send and receive e-mails to the group, but you will not be able to access the group
website and read the message archives or look at the photos. If you wish to do that, you will need to set up a yahoo! ID by visiting the
group website.

How to Join the Group via the Web
You can visit the group's homepage and follow the instructions. If you do this, yahoo!groups will help you set up your yahoo! ID, which
gives you access to the group message archive etc. A yahoo! ID is not the same thing as an e-mail address.

Here are the steps to follow. Don't worry, this all sounds far worse than it is! You should find that in practice it all works more smoothly
than it sounds when you're trying to explain it in writing:

Existing yahoo! ID
1. Go to the group website: http://pets.groups.yahoo.com/group/tanyas-ckd-support/
2. Click on the Join this Group button and you'll be taken to a Sign In to Yahoo! page.
3. Sign in and link Tanya's Support Group to your existing account.
4. Choose the e-mail address you wish to use for the group (see below).
5. There is a little box for you to tell me why you would like to join the group. You don't need to be inventive or fancy, it's not a
competition, it's just an extra check by yahoo!groups to keep spammers out.
6. Choose your message delivery options (see below).
7. Scroll down and click on the blue Join button at the bottom right of the page.
New yahoo! ID
1. Go to the group website: http://pets.groups.yahoo.com/group/tanyas-ckd-support/
2. Click on the Join this Group button and you'll be taken to a Sign In to Yahoo! page.
3. Scroll down a little and click on the Create New Account button.
4. On the next page you can create your new account. Some people are somewhat inventive in their responses, but in such cases it
is important to remember what responses have been given in case the information is needed later to access the account. I can't
see any of this stuff, it's entirely private between you and yahoo!groups, so I cannot help in case of later queries.
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5. Once the account is successfully set up, you'll be taken to a Congratulations! page.
6. Before you click on the Continue button on the Congratulations! page, untick the box that makes yahoo! your homepage (unless
that is what you want).
7. Also click on the Edit Marketing Preferences link below the Continue button. This takes you to another page where they helpfully
opt you in to everything, so go through and set it as you wish.
8. Then on the same separate page click on Account Info at the top of the page. You will be asked for your password again and
taken to the Account Info page. Click on Profile and opt out of the various choices as you wish. The key thing is, you do have
choices here, you can make things as public or private as you wish.
9. Now click on the Continue button on the original page. You will be taken back to the group page to choose your membership
10. Choose the e-mail address you wish to use for the group (see below).
11. There is a little box for you to tell me why you would like to join the group. You don't need to be inventive or fancy, it's not a
competition, it's just an extra check by yahoo!groups to keep spammers out.
12. Choose your message delivery options (see below).
13. Scroll down and click on the blue Join button at the bottom right of the page.
Membership Settings Back to Page Index

There are various choices you need to make regarding your membership of the group. The most important are which e-mail address to
use, and which way you read messages sent to the group by group members.

Membership Settings: Your E-mail Address
You need to decide which e-mail address you wish to use for the group. If you have created a yahoo! ID, yahoo!groups will normally
have also set up a free yahoo! e-mail account for you based on your new yahoo ID. You can use this e-mail address to access the
group if you wish, but it's not essential, you can use any e-mail address you wish. Since yahoo! is now scanning messages for
advertising purposes (similar to gmail), I would recommend not using yahoo! e-mail if possible (though it would probably be better than
using your work address for private stuff).

If you do not want to use your free yahoo! e-mail address, click on Add e-mail address to add a different one. Be aware, if you don't
add a new address here, yahoo! will use the yahoo! e-mail address as a default address. So if you don't receive the membership
questionnaire, it may well be because it's gone to your new yahoo! e-mail address.

If you ever wish to change the e-mail address you are using for the group, you can do that here:

Membership Settings: Message Delivery
This sets up how you will access messages that are sent to the group.

This is a pretty active group. If you're looking after your CKD cat, you want support but you probably don't want a full inbox all the time.
To help you manage this issue, you have three options for messages, and you can switch between them all as you wish:
1. Individual E-mails
2. Daily Digest
3. Web Only (No e-mail)
Individual E-mails
This is the default setting. If you apply to join the group via e-mail, you will end up with this setting. If you apply to join the group via the
group's webpage, if you don't choose one of the other settings, this is the one you will end up with.

This setting means that as soon as somebody sends a message to the group, it is sent directly to your inbox. It's a good choice if you
might want to know immediately if somebody has responded to you, or if you would like to store some of the group messages for your
reference. It's also good for being able to quickly delete messages which don't interest you.

The downside is that this is a busy group, averaging 50-100 group messages each day, so your inbox can quickly get full. One solution
is to create a folder to use for group messages. All messages sent to the group have a tag in the subject line [tanya-crf] so you can
filter all messages from the group to a new folder using this tag if you wish.

With both individual e-mail and message digest options, you can also choose the format of messages sent to you (Display Format),
either Fully Featured (html, pretty colours etc.) or Traditional (plain text).

Message Digest
This means that you receive e-mails from the group, but yahoo!groups waits until there are about 25 messages available and sends
them to you all in one go. With this option, you would therefore only receive 2-4 e-mails a day from the group, but it means you have to
wait for responses (though you can still check on the group website for messages) and it can be more difficult to find what you are
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looking for within each digest.

With both individual e-mail and message digest options, you can also choose the format of messages sent to you (Display Format),
either Fully Featured (html, pretty colours etc.) or Traditional (plain text).

Web Only (No Mail)
This means that you receive no messages at all from the group. This is a wise choice if you are using a work e-mail address, or if you
cannot cope with the group's message volume. With this system you simply go to the group's website and read the messages that
interest you there. Even if this is not your usual choice, it can be helpful to use this option if you are going on holiday.

So make your choices, then click the Join button at the bottom right of the page.

Important: Membership Questionnaire Back to Page Index
OK, so you've successfully applied to join the group. However, there is one more thing you need to do in order to join. I want to protect
the group members from spammers, so whichever way you apply to join the group, you will receive a short questionnaire asking:
1. Your first name
2. The country where you live
3. Your CKD cat's name and age
You need to respond to this before your membership will be approved.

Please don't worry about saying "the right thing." This is not a test to see if you are "good enough" for the group, everybody is welcome
here, whoever they are or wherever they come from, as long as they want to help their cat. This questionnaire is basically just to
reassure us that you are a real person applying to join rather than somebody trying to sell stuff and spam the group, but it also enables
us to tailor our responses to your group messages e.g. if we moderators know where you live, we will not suggest treatments not
available there.

Please note, only the two Annes and I can see your responses to these questions. The group will not know anything about you unless
you choose to introduce yourself.

Once you respond to the questionnaire, your membership application should be approved very quickly (most people are approved
within two hours or less).

Occasionally the questionnaire goes missing. You think we haven't sent it, and we think you haven't responded! If we haven't heard
from you five days after you apply to join, we will send you a reminder. Unfortunately, we can only use the address you've used to sign
up for the group, so if you've accidentally used your new yahoo e-mail address without realising it (see above), you won't see either the
questionnaire or our reminder. If you don't hear from us, please simply write to us at tanyas-ckd-support-owner@yahoogroups.com and
let us know. Please respond to the three questions in your response and we will either approve you (if your membership is pending) or
send you a personal invitation to join the group (if your membership application has disappeared into a black hole).

Messages Back to Page Index

Message Options: Sending Messages
You don't have to post, you can just lurk if you prefer.

If you wish to change the name that appears on messages you send to the group, Yahoo! explains how you can do that.

Starting a Thread
1. You can simply send an e-mail to ask your question by sending it to tanyas-ckd-support@yahoogroups.com.
2. You can go to the group website, click on Post Message in the sidebar on the left, and then write your message there.
Replying to an Existing Message
Messages sent in response to another message on the group also go directly to the group, not to the individual to whom you are
replying. Therefore if you wish to respond to a message somebody else has sent, you can simply click reply on your e-mail programme.
If you reply via the group website, you can click on the message in the group archives, then click reply which is top left above the

If you're changing the subject, or replying to a Digest (which have the subject line of Digest No. xxx), please change the subject line
appropriately to something more meaningful. And please remove everything except that to which you are replying.

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If you wish to reply privately to somebody, you will need to press reply, then delete the group e-mail address and paste their personal e-
mail address into the To: line if you are using e-mail. If you are replying via the group website, you will see a little envelope over on the
right under the person's name. If you click on that, your message will go to that person.

Message Content
You are welcome to discuss anything relating to care of your CKD cat. We do have a few guidelines we ask people to follow though:
1. Please do not refer to vets or vet clinics by name for legal reasons. Just say "my vet" or "Dr J".
2. Please do not ask for money or other donations.
3. Since this is a very busy group, we ask that condolences are sent privately to the bereaved group member. Certain other
messages should also be sent privately e.g. short "me too" messages, off topic posts etc.
4. Please trim your posts.
Moderation of Messages
When you first join the group, your messages will be moderated for a short while. This means that they will not reach the group
immediately, but will first be read and approved by one of the moderators. We do this to ensure that:
1. you are not a spammer;
2. you are keeping to other group guidelines (e.g. not naming your vet publicly);
3. you are trimming your messages appropriately.
If you comply with the group guidelines sent to you when you join the group, you will be taken off moderation quickly. The main reason
people stay on moderation is because they do not trim their posts. So please read up on this in the group guidelines. If you get stuck,
just ask for help.

Leaving the Group Back to Page Index

Some people decide to leave the group. Their cat may have died, or they may find the message volume is too much, or they simply
decide it's not the place for them. Leaving is fine, but if you're thinking of leaving simply because you cannot cope with message
volume, please consider changing your message options first, such as by going no mail. This means your inbox will not be full, but you
can still reach out for support quickly when you need it.

If you are leaving because your cat has died, please consider joining our sister group, Tanya's Feline Loss Support:

Conclusion Back to Page Index
I do hope you've decided to join Tanya's CKD Support Group! It can give you support, it can give you hope. It can make you smile too -
where else would people share your thrill at hearing that your constipated cat has pooped? (Believe me, when you've been dealing with
CKD for a while, things like this are real triumphs which can absolutely make your day).

I personally read every message sent to the group. I don't respond to every post (my priority is running this website) but I do keep an
eye on things and post occasionally if I can add to what has already been said.

Group Quick Links Back to Page Index
Some of these only work if you are already a member of the group.

Group homepage: http://pets.groups.yahoo.com/group/tanyas-ckd-support/
Managing your membership options: http://pets.groups.yahoo.com/group/tanyas-ckd-support/join
Messages archive http://pets.groups.yahoo.com/group/tanyas-ckd-support/messages

E-mail Addresses
Sending a message to the group via e-mail: tanyas-ckd-support@yahoogroups.com
Group owner e-mail address: tanyas-ckd-support-owner@yahoogroups.com
Joining the group via e-mail: tanyas-ckd-support-subscribe@yahoogroups.com
Leaving the group via e-mail: tanyas-ckd-support-unsubscribe@yahoogroups.com