Alternagel (Aluminum Hydroxide) is cheap, available over the counter, effective, and is a very widely used phosphate binder in cats. But, aluminum is a toxic heavy metal, and, it's toxicity has been studied and confirmed in human medicine, (and it is probably toxic to all species).
Other viable alternatives to aluminum hydroxide are also highly effective and do not have the potential toxic issues.
Aluminum Hydroxide is the currently the best phosphate binder recommended and used by board certified internal medicine-kidney specialists. Egg shell powder contains calcium and phosphate therefore in my opinion would not help your cat's kidneys nor reduce phosphate levels-instead the opposite would result. CoQ10-cat dosage in general is ~10mg once to twice daily.
Dr Carol Osborne, DVM
1. Your cat should be on Rehmannia 8 and other supplements for life as maintenance. The dose is one capsule or tablet for 10 pounds of body weight. The dose for teapills is one teapill for 5 pounds of body weight.
2. I prefer Phoslo as a phosphate binder, but epakitin should be OK. Use the aluminum compound as a last resort. I did not comment about the efficacy of Epakitin. It is very effective, as is Phoslo. Phoslo is similar to ground egg shells in that they are both composed of calcium. Unfortunately, Phoslo seem to be harder to find, so be practical and use what you can get. Lastly, the phosphorus blood levels must be checked often (every 3 month). If phosphorus in the blood is not elevated a phosphate binder is not necessary for now.
3. I would not use psyllium in a cat. They can choke on the capsules, and if you can actually get a capsule down the cat, the cat would have to drink an extremely large amount of water to achieve effectiveness, which makes its use unpredictable. If powdered psyllium is mixed with water it expands to 10 times its volume and becomes a mess that no cat will eat. Use Azodyl instead for practical reasons.
4. Co-Q10 is important for every cell in the body. The dose is one mg per pound twice daily.
Thank you for your posts re feline CRF. Will you please tell me how long a kitty should be taking Rehmannia 8-for maintenance? I give my kitty one small pill in A.M. and P.M.
Along with Rehmannia 8, Renal Support, a pre/probiotic and other supplements (Omega 3 etc)--you mention Epakitin or an Aluminum binder for high phospherous levels. One of you stated that Epakitin is not as effective. Can you comment further. I also read the aluminum binder type is not safe. Egg shell powder would be more effective in binding phos. can you comment please? what psyllium husks for removing toxins as well? Also, what abour COq10-how much would a kitty receive per day of this supplement. Thank you
Hello-I agree with Dr Cheng's comments and wanted to add a couple suggestions for your dogs kidneys.
Home-made diets are another valid option for your dog's nutrition.
In addition, there is an excellent natural herbal kidney product called Kidney Essentials available at www.drcarol.com which along with an all-natural, vitamin supplement patented for dogs called Paaws offers the nutrients recommended by Dr Cheng, all available in an easy to give chewable tablet.
In our veterinary clinic these two products along with daily subcutaneous fluids and Vitamin B12 to combat the lack of red blood cells or anemia associated with kidney failure has been very effective in helping to reverse kidney failure in our canine patients with kidney issues.
I hope this information is somewhat helpful. Please feel free to contact our office if I can offer further suggestions.
Dr Carol Osborne, DVM
Dogs with chronic renal disease do better on Hill's K/D than cats, however, I think that there are ways to spruce up this diet and helping to maintain kidney function even more. You can either add to the K/D, use a homemade diet in addition to it, or supplement with holistic canned diet. The most important dietary change is no dry commercial food!
Good holistic renal friendly dog foods include: Wellness Senior canned food, Orijin Senior, and Natures variety Senior. Choose those with out gluten. Try to limit Beef, Bison and Buffalo meat. Although these meats are fine in most other instances they are pro-inflammatory and are not good choices for kidney disease.
Cooked homemade diet: 1 Tablespoon olive oil, 2 oz fish, meat, poultry, or tofu,plus 2 oz kidney meat, 4 egg whites, 1 cup chopped green vegetables, 1/2 cup combination of berries, tomatoes, apples and carrots, 1/2 cup cooked barley, millet or whole oatmeal. 1/2 garlic clove, and a pinch of salt for taste. Enough water or low salt broth to cover ingredients if making a stew.
Crock Pot method: place all the ingredients except for the berries in a crock pot and cook until done using the crock pot's directions. Feed at room temp or slightly warmer topped with the berries.
This recipe can also be cooked in a wok or stew pot. If using a wok: coat wok with olive oil, add chopped garlic than chopped kidneys than meat. When the meat is fully cooked add the other ingredients, except berries. Cover with broth or water and simmer for another 10-15 minutes. If using a stew pot place in all ingredients, cover with broth or water and bring to a boil simmer for another 30 minutes or so.
This recipe is limited only by your imagination and time. It can be made as you would a homemade tomato gravy, or as a skillet dinner (in the wok) with a very light gravy using less liquid. The only ingredients that should not be used are anything that disagrees with your dog' digestion, of course, and onions, grapes and raisins.
This recipe should be enough food for 2 days for a 15 pound dog.
If one half of the diet or more is home made than please add the following supplements:
1. A calcium and magnesium supplement at 200mg each, with vitamin D
2. Vitamin E 200 IU
3. A children's Multi Vitamin per body weight.
Some holistic veterinarian advocate raw diets for their patients. I do not believe that any single diet fits all, or thatonly raw diets or only cooked diets are the only choice for all dogs and cats, especially an older patient with chronic renal failure, who has been on a commercial diet all his life. This is a controversial issue and would require an entire text and will not be debated here.
The following supplements are also extremely valuable no matter what the diet:
1. Glucosamine: 500 mg twice daily. Helps with the lining of kidney's and bladder as well as joints.
2. Omega 3 Fatty acid: 500 mg twice daily
3. Wobenzyme, or other digestive enzyme per body weight
4. Additional probiotic (Azodyl contains some probiotic). Please use one that is stored in the refrigerated section. The exception being "Culterelle" brand probiotic. It is stored at room temperature but has been proven to be effective and is available at some pharmacies.
5. The Chinese herbal formula: Rehmannia Eight (also know as Eight Flavored Rehmannia, or Ba Wei Di Huang Wan, or Jin Gui Shen Qi). This is widely available online and in Chinese Markets. Use 1/2 to 2/3 of an human adult dose twice to three times per day.
If you do nothing else get the Chinese herbal formula "Rehmannia Eight". It is extremely important for kidney disease.
The following is a list of additional therapys that may help:
1. Acupuncture: helps to strengthen the kidneys.
2. Daily sub-cutaneous fluid therapy: Helps to act as kidney dialysis.
3. Having urinalysis's performed often and treating any urinary tract infection immediately.
4. Treating any concurrent disease to help maintain the immune system.
5. B complex and Vitamin B12 injections twice weekly or more often. B vitamins can be placed in acupuncture points as a form of acupuncture called: Aqua-puncture.
6. Abdominal X-Rays can assess the size and shape of the kidney's and urinary bladder and to see if either contains stones. Stones can act as a nidus for infection and interfere with function.