Hi all, I just found this blog and it looks like a great group with some incredible knowledge and experience. My Chow/ACD mix has kidney failure. He was diagnosed back in Oct. but has never really had any symptoms until he started vomiting this week. He mostly vomits his dinner at 4am, we thought he was keeping his breakfast down but threw up again this afternoon. He is on Royal Canine renal food, he wouldnt eat the other brands. He still has an appetite but his bloodwork this week was double from Oct, BUN:88, Creatine: 8.o and phosphorus: 8.2. Our vet really doesnt seem to know what to do with him, they recommended giving him Aluminum Hydroxide as a phosphate blocker, he is on analypril and a blood pressure med as well. We started pepcid for his nausea. Is there anything we can do for his diet? Is it time for the subQ fluids? Im not sure he would handle the needle very well, and doesnt seem distressed at all but is slowly losing weight. Thanks for any advice you can give. Hes only 6 and is my foster failure and is breaking my heart :(
Hi. I'm so pleased you have joined the Group, but obviously, I regret the circumstances. Did you get chance to read my piece on CKF and diet at: http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease
If not, that's a good starting point, as there are things in there that will certainly inform and help with your best friend and the management of his CKF. Adding a phosphate binder would almost certainly help, but your vet cannot do this until the level of 8.2 is brought down to within normal range (2 to 6). His BUN is of more concern though, as this suggests nitrogen in the blood is becoming a big problem. My article suggests a few things that can be done, which may help, including nitrogen trapping ... see if you can get him to take a few fermentable fibers in his food. Things like cooked chopped cabbage or rice bran mixed in small quantities into the renal diet should have positive effects.
I think one of the issues here (not untypical) is that your dog (what's his name, by the way) is on various medications. All medications have some consequences in CKF dogs, because they produce toxins that the kidneys would ordinarily remove - but when the kidneys are deteriorating, the medications add to the stress on the kidneys and the toxins aren't all evacuated, so end up in the blood. It's a difficult decision for any vet ... maintain the medication to treat other conditions or help support the kidneys by stopping all but absolutely essential medications. This might be a discussion you should have with your vet, taking his advice.
The pepcid will certainly help at this stage, so keep him on that if you can.
The next question is IV fluids. Yes, at first, some dogs are nervous about the needle and what's being done to them. But, almost all dogs eventually accept the procedure as a normal routine, so persevere. IV fluids will rid the body of damaging toxins, and that's exactly what your boy needs right now, so his levels start to come down towards normal.
Others will hopefully add a few more suggestions as time goes on, but for now, I hope this post helps. Keep us informed and ask anything you like here ... you are a valued member and we hope our input in the management of your dog's condition proves beneficial.
I meant to add ... Royal Canine renal diet is not the best. It employs the use of grains, and there's not enough meat content. You might think about starting a home cooked diet, if that's a possibility. Let me know.
Thanks so much Tony! I havent read that particular post yet, but i have read several you posted already, its possible that was one of them, there is so much info in here! We did home cooked meals for all three dogs a while back so can definitely do it again. His name is Rufus, hes very scared at the vet but I think we will try a fluid treatment and see how it goes.
The ammonium hydroxide is supposed to be the phosphate blocker? its this mint flavored liquid and he wont eat his food when we try it so need to get something in pill for probably. He kept his food down yesterday but just puked again at 4am, so Im not sure the pepcid is doing its job.
Hi. The pepcid can take a short time to get up-to-speed, so stay with it. If it doesn't seem to be doing anything after 48hrs, there are many other good alternatives, so come back and let us know. The hydroxide is a classic phosphate binder and often a first choice among vets. I am assuming it is in fact aluminium hydroxide, and not ammonium hydroxide? The latter has been used as a binder, but it is much less common. Aluminium hydroxide can be given as a powder, which you could sprinkle on food, so it's worth asking about this.
Have you tried Rufus with some human grade chicken and boiled white rice? Human grade chicken is easily tolerated by the digestive system, so he may be less prone to vomiting, and the fact that it's human grade, it's a high quality protein - rather than harder-on-the-kidneys, low quality protein. If you give chicken, make sure you leave the skin on, as this contains lots of useful fats for dogs with CKF.
I have to mention my favorite food for CKF dogs, which is green tripe. If you can get hold of it in frozen form (some good pet stores do sell it), all you need to do is cook it in a microwave or on the stove - be warned, it stinks to high heaven - let it cool and then roughly chop with boiled white rice or some tinned renal food ... and dogs usually love it.
The IV fluids will help, I'm sure, so pursue this as soon as you can. In the meantime, does Rufus drink water or is he one of those dogs who rarely goes near his water bowl? The more fluids the better, as these will help flush the system of toxins and get those nasty blood levels down. Another good tip is to fill his bowl with filtered water rather than tap water, as tap water has various salts and chemicals in it that are not helpful to those with kidney failure.
Thanks again for all the info, he had a really bad day yesterday, threw up in a number of places, but ate and walked his normal walk and kept it down last night. It is aluminum hydroxide, but since its mint flavored he really doesnt want to eat food with it mixed in and the vet hasnt found anything that is flavorless. We will try the cabbage and I would like to change his diet, so we will work on that, but it sounds like unless his phosphorus goes down hes still in trouble. We are going to make an appt to try the fluids and see how he does. He drinks frequently, esp now that its so hot in No California.
Hi Michelle. Ask about getting the powdered form of alum hydroxide. I'm not sure whether it's flavored or not though, but worth asking, just in case it's not. I would also try and chase up the green tripe. This is low in phosphorus and high in nutrients, plus dogs usually love it. If he doesn't take to chopped cabbage, try rice bran, which you can sprinkle on food he likes. I'm sure the IVs will help, and if it does, ask about doing it yourself at home. This will be cheaper and less stressful for both you and Rufus. Great news that he kept his food down last night. Maybe the pepcid has kicked in. My guess is you are already feeding smaller quantities more often ... but if not it's worth doing, maybe 4 to 6 times a day. Smaller quantities will be better tolerated by his digestive system.
the vet found something at Walgreens, Amphagel??....I wrote it down at work so i dont think thats quite it but it comes in pill form so we are going to try that. We go to try the fluid treatment tomorrow at the vet...the specialist called back and agreed that moving him to chicken and rice would be good to see if its easier on his stomach and taking him off the renal med for now, which were suggestions from you and this page, so thank you. Hes pretty dire at this point so what we can do to make him feel comfortable is whats important I think. He is still eating, and thought he kept it down today he had pretty bad diarrhea from picking up the yard, so hopefuly the chicken will help. I'll look into the tripe, too thanks again! Michelle
Hi Michelle. Just to underline something ... if you are going to try chicken and rice, make sure it's white rice (brown is harder to digest) and make sure the chicken is human grade (i.e. sold for human consumption) as this is high quality protein and much easier for the kidneys to deal with. Also, leave the skin on, as useful fats are in the skin, which will help provide energy.
Amphojel (I assume that's what it is) is used primarily for human acid reflux and in the treatment of stomach ulcers. It is basically aluminum hydroxide, so no different to what you have been giving. The only drawback with it is the possibility to cause constipation, so this makes the IV fluids and having plenty of water available to drink that much more important.
Thanks, yes white rice, I thought brown would be too hard on his stomach. Our vet cant seem to find the Alum Hydroxide in any form except the minty liquid. Walgreens has it on the web but didnt have any available.
Hi. There are so many possible phosphate binder treatments, similar to or with alum hydroxide in them, I am surprised your vet isn't aware of them. The other thing ... given your vet's possible limited understanding ... it is crucial the phosphate level in the blood is within normal range BEFORE starting a phosphate binder. I would double-check this with him, just to be sure he is aware of it.
There are other types of phosphate binders, which instead of using aluminum use calcium as the base. However, ionized calcium levels in the blood must be normal and not elevated (hypercalcemia). And if nothing else works or you can't get the either version, you can actually use ground up eggshells. The same precautions apply, that is, blood phosphate and ionized calcium levels need to be normal in the blood test.
I have a call in to the vet about the phosphate binder, they special ordered one from a compounding pharmacy, in powder form, but we have held off on giving it to him. How do you get his phosphate levels down if not with the binder? We have started IV fluids daily, weve had a bit of a hard time with the needle but were getting used to it. We are struggling with what to feed him, we transitioned him to white rice and chicken, which he couldnt keep down yesterday, and now is picking the chicken out and leaving the rice. I know he needs some carbohydrates, any ideas what else we can try?
Hi Michelle. Have you read my piece on diet and CKF in dogs? If not, you can check it out here: http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease
The reason I suggest having a read of this, is because it contains some useful ideas on the best foods to try - and explains phosphate binders a little more. The best way of reducing phosphate levels is to use a phosphate binder, BUT when a dog is on antacid medication, caution and full vet supervision is required. It is also best for the phosphorus levels in blood to be within an accepted level, and this changes according to the stage of kidney failure. Your vet should advise if and when it is safe and appropriate to start using a phosphate binder.
If you are feeding chicken and rice, I suggest using chicken that is intended for human consumption. The reason for this is the protein is in human grade chicken is high quality (compared to low quality in most chicken intended for dogs) - and high quality protein does not produce nearly as many waste product toxins, so it's useful in the nutrition of chronic kidney failure dogs. Also, give your dog the skin of the chicken too, as this contains useful fats, which will help provide energy.
If he is reluctant to eat the rice - try adding a teaspoon of natural honey or a little salmon oil. Both these are good for CKF dogs and they taste nice, so the chance is it will help him start eating the chicken and rice together. Worth a try anyway. I can't resist mentioning green tripe. If you can get it frozen from a good pet store, so much the better, as this can be cooked in a microwave or on a hob and mixed with boiled white rice for a very tasty and naturally nutritional meal for CKF dogs. Green tripe is low in phosphorus and high in beneficial nutrients and vitamins.
Hi. After re-reading my post reply to you, I realized I got a little sidetracked and didn't finish writing what I had intended about phosphate binders ... there is actually no authorized phosphate binder for dogs, although most vets will use an aluminum based salt medication as a phosphate binder. While this will almost certainly reduce the phosphate level (beneficially), this should be accompanied by reducing protein in the diet (protein waste products produce high levels of phosphorus in the blood of kidney failure dogs).
The other problem with aluminum based phosphate binders is a) aluminum itself is a toxic substance, so care needs to be undertaken when using it; and b) reducing phosphorus too much can lead to problems with calcium absorption, so vets should always monitor what is happening in the blood very carefully while using phosphorus binders.
Hope that helps understand things a little easier.
I want to step in quickly and send you & Rufus best wishes. I joined the forum on June 10 and have received such wonderful support and advice. It's amazing how even the slightest tweak in daily care can bring some life to an ailing pet. Please stay hopeful and know you're in good company.
I read about 1/3 of your article last week and havent been able to get back to it...i will tonight. We are doing human grade chicken with the skin. i just bought some salmon oil and found a can of green tripe to try, also got samples of a dehydrated all natural veggie and fruit grain free food that the store recommended instead of the rice. Im still not sure I understand about the phosphate binder, the vet definitely recommended it without a second thought to how high his numbers are...it sounds bad for him, anything aluminum, so Id prefer to do the cabbage, would that produce a similar effect?
Hi Michelle. I would always go with what your vet says. I am not a vet and therefore cannot and should not give preferential advice. I would suggest you use the phosphate binder as prescribed. I might have given a bit too much information previously and caused concern where there really is no need for any. Aluminum can be dangerous in prolonged use. However, being blunt, your dog will not have prolonged use because you can expect to prolong life by a certain degree using kidney failure management, but not to provide many years of life (sadly). So, the phosphate binder will help reduce phosphate in the short term, and once under control, you might then try to introduce things like cabbage and rice bran to keep it within normal values.
Hope that helps and sorry if I caused you to question the value of phosphate binders.
After barely eating yesterday he wont touch anything at all now. last night he at two treats but no food, chicken, rice, even the tripe. he threw up some thick bile this am, we have a call into the vet but it feels like we are nearing the end. He doesnt appear to be suffering but is really lethargic and I imagine feels nauseous etc. thanks for all your help, Michelle
Hi. I'm so sorry he has had a turn for the worst. I truly hope your vet can offer some way through this. Sometimes it's not the end, but a bad day ... this disease tends to have it's severe ups and downs. You are in my thoughts and I'm just hoping for some good news. Rufus really needs IV fluids straight away (if you haven't already begun this) to flush the toxins out. This must be incredibly stressful for you and I'm sure between you and your vet, you will come up with the right answer ... which ever way things go. Please let us know what happens. Tony x
We started the IV fluids last week, so far hes not improving. The vet suggested an appetite stimulant, so we gave him that and the pepcid but he still wont eat anything. I wish i could say something positive, and the vet didnt have any other ideas. SO I think if hes still not eating in a couple of days it may be best to let him go. Hes obviously in alot of discomfort even thought hes not showing it other than vomitting. thanks all of you for your well wishes.
Hello Michelle. I think between you, you and your vet are doing all that's possible for Rufus. I totally understand your thinking process, and apart from perhaps doing a blood test to see how his BUN, creatinine and phosphorus levels are doing with the IV fluids - I can't offer much more by the way of suggestions right now. I'm sure you are already trying to feed whatever you can - and don't worry too much about protein right now - if he'll eat something, just let him have it. Have you tried hamburger (no additives), just plain cooked and cooled. Some dogs will take this. Worth a try.
Please keep me informed. I think it's worth giving it two or three days, just to see if anything changes, and then maybe if you think the time has come to make that decision, so be it. You are there and you are the only person that can decide. I know this is hard. Stay strong.
After we gave him fluids last night, this am he perked up and was hungry, of all things he ate the renal food today and has been keeping it down. He seems back to semi normal, and thought we know it wont last its a step forward. We were planning to recheck his numbers in a week to see if therIV was helping. Thanks for everything all of you!
Hi. What great news that is. It made me smile when I read it this morning. It just goes to show, sometimes the fluids take time to 'kick in'. Fingers crossed this good day continues into tomorrow and again the day after. If he's eating the renal diet, that will really help too. It will give him some energy and make him feel so much better.
Well done to you. Give Rufus a huge cuddle from me.
Thanks....this am we are right back to not eating and he threw up a ton this morning, lethargic, obviously not feeling well. Its hard to gauge and feels like we are postponing the inevitable. i guess we will recheck his numbers and see if the IV is making a difference and go from there.
Hi Michelle. Yeah, that's not untypical ... some good days, some bad ones, and the objective is to try and aim for more good than bad. When the bad days start stacking up, then decisions have to be made. It could be the IVs are taking time to have an effect. This can be slow, and sometimes it just means increasing the frequency of them and seeing if it helps. The balance between giving fluids, trying different foods, adding anti-nausea medication, all take their toll - but sometimes perseverance pays off.
Sending you healing prayers. My 15 year old Maltese was diagnosed with severe kidney failure in early April. So far he is eating the KD can food and drinking fluids. His kidney levels are back to normal. However, this Saturday he goes in for a blood test. Not sure what to expect.
I do wish you the best and know that you have a lot of support on this forum.
Sorry not to update sooner, I cant get on here at work (old browser version) and things have been busy. Good news is we tried adding Rufus' old food to the renal diet and hes been eating for three days pretty consistently! its a grain free high quality but also high protein food, but at least hes eating something. The fluids seem to be helping and hes still on the BP med and pepcid, we took him off the renal med after talking with the vet and the phosphate blocker...back for blood work this week and we will see where we are at. Thanks everyone!
Hi Michelle. That's good news. I know it's saying the obvious, but try increasing the renal food a little maybe every couple of days and reducing the high protein food by an equal amount. This will be better for Rufus, and he will tell you where his tolerance level is for eating the kidney food v normal food. The problem is while he may be eating the old food now (which is good as it gives him energy and calories), it will cause more toxins to be produced, which in turn will add more stress on the kidneys. The IVs won't rid all these toxins, and eventually it is the toxins that will do the most damage. It's all a bit of a balancing act and we just have to try and deal with the priorities as best we can.
Thanks Charlene! we tried chicken and rice for him but after a couple of days he wouldnt touch it,and he was still throwing up so the food seems to be what he will eat right now. Tony, we are decreasing the regular food, hoping to get down to almost none but it smells so much better than the KD diet that we might need to keep a handful in there.
Yes, kidney specific food is commonly unpalatable, but obviously much better than the standard variety because of the low protein low phosphorus and being high in other minerals. You can try adding a tiny little bit of pure honey to it (dogs often love this natural wonder food) or even plain yogurt, if he enjoys it. Both are good for kidney failure dogs.
The other alternative (apart from green tripe, which I won't bore you with again) ... is any human grade meat, including chicken with the skin on. These have lots of protein, but it's high quality protein, which is fine ... only trouble being it doesn't have the mixture of vitamins and minerals the kd diet food has.
The bloodwork is not encouraging, BUN 177!!, Creatine 8.4, Phos 13.8 all up from not quite 3 wks ago, so the vet doesnt think the fluids are doing much for him. They wont tell us its time but I dont want him to suffer, and the vet indicated that even though he seems almost normal, he probably feels pretty awful. I dont want to get to the point where he has a seizure, or worse. Any advice on if this is the time?
Hello Michelle. Yes, those are very high figures. I would urge you to restart kd diet and try to make it palatable with additions such as honey, plain yogurt, etc. He needs the phosphate binder - or if the vet says it isn't appropriate, add a tablespoon of chopped boiled cabbage to his food each day or rice bran if you can get hold of it. If he won't eat the kd diet then green tripe would be my first choice, then human grade meats with boiled white rice. All given in very small amounts four to six times a day. The fluids will be helping and without them he may not flush the toxins out, so you should be doing this at home to save on vet costs. I would also suggest some B12 vit supplements. If he starts turning his nose up at food on a regular basis, then add some anti-nausea meds to the mix.
I hope intervention gets the blood levels down. It may take a few days to have any real effect. The important thing here is to try by-passing the kidneys as much as possible, so we need to introduce nitrogen-trapping things to the diet. Cabbage is good at doing this in a natural way - and it helps with any ulceration of the stomach too - but too much can give diarrhea, so be cautious.
Tinned mackerel are a good source of omega-3 - as is salmon oil (pure variety) - which help add useful fatty acids to the diet.
Thanks Tony, we have been giving him the kidney diet with a bit of his old food, as he wont eat it without. Hes lost interest in chicken and rice, but I will try the honey as well. We have been giving him pepcid twice a day and will try the phosphate binder again. We are doing the IV fluids at home daily, but with his numbers continuing to climb the vet doesnt think its making a difference. I just dont want him to suffer as it seems hes close to the end and the vet said hes probably really uncomfortable although aside from vomiting and being a bit lethargic hes still perky and wants to get out for walks.
Hi again Michelle. I utterly understand and empathize with your concerns. Sadly, there is a point when the bad days outweigh the good ones and, regardless of what we try, nothing seems to have an effect on blood levels. All I can suggest is ... keep trying, for now. He seems generally contented if he still wants to go out and is quite perky, despite the lethargy and vomiting, so I don't think he's quite 'there' yet. He will tell you when he's had enough, so just be ready for when that day comes. I would rotate foods he seems to be eating - so day 1 maybe kd diet with yogurt and honey, day 2 human grade chicken with salmon oil and rice, day 3 green tripe with potato and rice and a little boiled cabbage - or your best combination of these high grade (low) protein low phosphate mixes. Fingers crossed, his numbers will start coming down a little. Tony x
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