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My experience with CKD

I wanted to share my experience with chronic kidney disease (CKD) with my dog and hope it helps others. This is quite long.

My dog passed away from CKD at 14 1/2 years old. 11 weeks after her first diuresis, I let her go. I believe her CKD was caused by Rimadyl and made worse by Metacam. She only took Rimadyl for like 4 days but after that, her appetite decreased and never rebounded to what it was before. Rimadyl is known to cause stomach issues/ulcers so that was initially what her decreased appetite was attributed to but as I stated, her appetite was never the same. 2 months after taking Rimadyl, due to her decreased appetite, labs were done. Her BUN, creatinine, and SDMA were all normal. Due to her arthritis, she was given Metacam about half a year after she took Rimadyl which made her kidneys much worse but I did not know that at the time.

Her appetite got worse and worse so she had labs done again about one year after her previous labs. This time her creatinine was 1.7 (high) (dog's creatinine should be less than 1.4), BUN 54 (high), phosphorus 6.0 (borderline high).  SDMA was normal. The vet misdiagnosed her though. For some reason, she attributed my dogs's symptoms to pancreatitis (my dog did have chronic pancreatitis) but her main problem was CKD, not pancreatitis. These values, along with her symptoms, decreased appetite, not eating as well as before, should have been very straightforward. When a different vet saw her (after my dog got really, really sick), she immediately diagnosed my dog.

Unfortunately, I did not question the vet who diagnosed pancreatitis so my dog was not treated for CKD for a few months. One day, my dog stopped eating her dog food, refusing it almost totally and vomited at which point she was finally diagnosed by the other vet with CKD. I took my dog in for diuresis for 2 days and her labs normalized. For about one month, she was doing pretty well, better than she had been for a while. She was still a bit picky about eating and didn't eat her usual dog food but did eat other food. She was running on walks and had a lot more energy. Unfortunately, I was unable to put her on a kidney diet as she also had food intolerance issues. The one kidney diet she could tolerate, she refused to eat. So she was not on a commercial or homemade kidney diet which may have made quite the difference. I did not think my dog would be able to tolerate most of the homemade kidney diets I researched as most consisted of beef or chicken and she had issues with those proteins. She did get subcutaneous fluids, about 3X/week, and she did have a pee accident here and there. She had been checked for a urinary tract infection when she was diuresed and did not have one.

About 5-6 weeks after her diuresis,  she started getting worse, refusing more and more food. She was on and off Cerenia and Entyce. About 8 weeks after diagnosis, I took her in for a second diuresis as she vomited and was not eating well. I thought it would help her again, like it did before. This time she was diuresed for 3 days but her lab values remained the same, they did not go down. For about 2 weeks after this, she was still fairly active in terms of she played a bit, maybe for like 5 seconds, and she still enjoyed the few and short walks we took. However she was refusing more and more food and it was clear she was more and more fatigued. Her back legs were weak, she could not go up the doggy stairs like before and when she pooped, she had trouble forming her stooling posture and would stool a bit here, then move and stool a bit there which is something she had not done before.
When did I know it was time to let her go? She seemed to go downhill quite fast, almost overnight. One day, she was still somewhat active, and the next day, she was like a zombie. She didn't seem to enjoy anything. She was still aware, I could tell she was, but she didn't greet the family as she used to. She used to look out the car window but now she did not, she just slept in the car. She didn't want to eat anything. The only way I got her to eat her last week was to give her different things each day, pupperoni, ground beef, keebler crackers, hot dog. She would eat something once and then refuse it the next time and she was eating probably 25% of the calories that she needed to be eating. She was on Cerenia daily so she didn't vomit and hopefully, it made her less nauseous. Her tongue hung out and it was cold, not warm as it usually was. She used to give kisses and now she didn't. She didn't want to go on a walk, which was one of her favorite activities. She labored as she drank water, the way she drank it was different, it wasn't normal. All she wanted to do was sleep.
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Avatar universal
Part 2
I learned quite a bit going through this with my dog and I hope my advice helps others who may unfortunately experience this.

1) Probably the most important thing is to feed a kidney diet if your dog will eat/tolerate it. The commercial ones (Hill's, Royal Canin) have been formulated using evidence/science and shown to extend lifespan.

2) Be very wary of giving any NSAIDS, like Rimadyl and Metacam, to your dog as these medications are known to cause renal failure.

3) Labs lag kidney disease and therefore if something like a change in appetite occurs, this may be the first sign of kidney disease, although decreased appetite is not very specific and can be due to many different things.

4) http://www.iris-kidney.com/ This website has guidelines for kidney disease in cats and dogs.

5) If you have the money, it may be better to have your dog treated by an internal medicine vet than just a regular vet. I only used regular vets who recommended B12 shots, fluids, Cerenia, and Entyce which helped but they didn't know about/suggest other things that IRIS/vet literature recommends.
7) These are some great sites to learn about dealing with CKD. https://felinecrf.org/index.htm This is for cat CKD but it has great info that is also applicable to dogs. http://www.infobarrel.com/Users/TonyBooth/activity/1  is another very good site.

8) A tip on administering subcutaneous fluids at home. If your dog cries out in pain as mine did, it may help to tent the skin higher rather than not that high. Do not tent so high that it hurts the dog. Finding needles that are less painful may also help (see  holistic stuff but the other info is good. https://www.************/groups/211455130573/https://felinecrf.org/index.htm). I also tried numbing the skin area with aspercreme but that didn't seem to help. At first I used 18 gauge needles, then 20 gauge needles. Both made my dog yelp though.

9) How much fluid to give? The vets I dealt with recommended varying amounts. My dog weighed about 10 lbs. Recommendations were 100 ml every day to 250 ml three times a week to 175 ml three times a week. Her last 1.5 weeks, I was giving 200-250 ml every day. If your dog will drink a lot of water/broth, that should help.

10) Give phosphorus binders. None of the vets I dealt with even mentioned this, maybe because this is not a prescription medication? According to IRIS guidelines, phosphorus binders are recommended at certain lab values. I used Phos-Bind but started it rather late (I think too late) as my vets did not recommend it even after I asked about it.

11) None of the vets seemed to know about metabolic acidosis (it is a complex subject) and giving sodium bicarbonate to help with that. My dog jerked a bit sometimes. I think it must have been related to her CKD as it did not occur prior to her CKD and may have been an effect of metabolic acidosis but not really sure.

12) My vets had a very different impression of my dog. They thought she would live for 6 months to a year. They had no clue. As I saw my dog getting worse, I did not think she would live long, and I was correct. One vet said she could not predict and I think that is the best answer.

13) Dogs with CKD get weak in their back legs.

14) Be aware that your dog may have/get a urinary tract infection.

15) My dog's tongue started sticking out when she slept - I think this was due to her fatigue. When she was diuresed the first time, she felt so much better and had more energy and her tongue stopped sticking out. As she got worse, it started sticking out again.

16) My dog ate grass when her stomach was upset/she was nauseous. I was giving her Cerenia almost every day for the last 6 weeks but while on Cerenia, she still ate some grass.

17) I found my dog urinated a larger volume when she was doing better and started urinating a smaller volume as she started getting worse.

18) My dog liked dog biscuits, food with a more crunchy texture, as her CKD got worse. This is something others have observed.

19) Your dog may eat food if it has a different consistency after refusing it. For instance, my dog ate boiled fish at first, then refused it. When I offered a dried version of the fish, she ate it.

20) Your dog should be fed several times a day if you are able to do this. I didn't do this but I wonder if food should just be left out for CKD dogs. The problem is if it is canned or some moist food, you don't want to leave that out all day. My dog started wanting to eat at 9 or 10 PM rather than eating her dinner at 6 PM.

21) The vet gave me gabapentin for arthritis for my dog. I only gave it a few times, it is only supposed to be given as needed for pain. First of all, I read gabapentin is really only effective if given with a NSAID or opiate but it seems routine for vets to prescribe it for arthritis if NSAIDS cannot be used. Secondly, what it mainly does is sedate your dog. Gabapentin is excreted in the kidneys so with CKD, the dosage should probably be decreased but the vets said nothing about this/didn't seem to take this into account. I may therefore have oversedated my dog.

22) My dog may have had high blood pressure but it was hard to tell as she got very nervous at the vet. Perhaps she should have been on blood pressure medication but it was never started. Monitoring blood pressure is recommended in IRIS guidelines.

23) I thought a 2nd diuresis in the hospital would help but it did not in that her labs did not improve as it did after her 1st diuresis. She passed away 3 weeks after her 2nd diuresis.
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