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Advice re phosphate binders for cats please

Discussion in 'Cat Health and Nutrition' started by urbantigers, Apr 30, 2014.


  1. urbantigers

    urbantigers PetForums VIP

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    Hi

    One of my cats has recently been diagnosed with fairly advanced chronic renal insufficiency following a bout of ill health (including seizures). He's doing really well so far but he due at the vets tomorrow for a check up and I want to discuss one or 2 things with the vet but would like to swot up on it all first.

    I am an avid reader of Tanya's crf site but sometimes you read so much you just don't know what is the best course.

    Jaffa is almost 17 years old and his renal insufficiency has been diagnosed as IRIS stage 3 but he has very high phosphorus levels so has been given a phosphorus binder. The one he has been given is mucogel which I think is an aluminium based binder? It's a white liquid and I syringe it into his mouth 3 times a day with food. That's been going ok so far but he's starting to put up a fight (a sure sign that he's feeling better!) so I'm not sure how much longer I can continue to administer it in this way. I dont' think it tastes good so adding it to food is probably not going to work.

    Anyway, looking on Tanya's crf site I notice there are 3 types of phosphorus binder - aluminium based, calcium based and other (?) which includes Renalzin). What I need to know is what are the criteria for choosing one of these over the other? Or does it just come down to what vets tend to prescribe? Are certain types more effective than others? I can't remember his phosphorus level off hand (am at work) but it was over 3 (about 3.4 I think) so very high. Within each type are there different types? I know that Renalzin is a paste and is, supposedly, flavourless meaning you can add it to food. But if that didn't work getting a paste down him any other way would prove difficult. Also, do you have to stick to one type of binder? Or can you mix and match, so to speak? eg mucogel with his breakfast, Renalzin with supper etc.

    He is also on benazepril (Nelio) and may need to have something for high blood pressure if the benazapril doesn't bring it down enough.

    I have every confidence in my vets but one of the downsides of the practice I use is that it is primarily a referral practice with the general practice being carried out by postgraduate students. All qualified vets but without a lot of experience and sometimes there's no substitute for experience. So I like to do my research and ask lots of questions.
     
  2. chillminx

    chillminx PetForums VIP

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    I have had several cats in the past with chronic kidney disease. None of them would eat the prescription renal foods so I switched them on to 'normal' foods to which I added a phospherous binder.

    I found they all did best on the binder Ipakitine. For a short while I tried one of them on Renalzin, but it gave him constipation, so I reverted to Ipakitine again. I also tried Mucogel with one cat, but it does taste disgusting and he hated it, so I used it no more.

    Some people find their cats do better on Renalzin, some on Ipakitine. Mucogel I believe has been around a lot longer (IIRC), and was all that was available in the past. But maybe some people find their cats are better with it than the other two. Personally I would stick to one kind for as long as it seems to suit your cat, then you have the other types as back-up if need be.

    The advantage of the Ipakitine is it can be mixed in food and is almost unnoticed by the cat. I say "almost" as it does have a slight taste. There were times when my cats would refuse to eat when there was Ipakitine in the food, and I would leave it out for a day to give them a break, then go back to it. It was always a temporary blip luckily.

    All my cats were on Fortekor which contains Benazepril. It is a drug which lowers blood pressure reducing the strain on the kidneys. If there is continuing high blood pressure another drug may be necessary, though this was not so in the case of any of my cats.
     
  3. Charity

    Charity Endangered Species

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    When our last puss had CKD, I use to feed him normal food and mix Renalzin with it and he was happy to eat it. I can't say if it gave him any problems as its hard to know whether things like constipation, which he had, are a symptom of the illness.
     
  4. Ceiling Kitty

    Ceiling Kitty Not available for comment

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    Hello hello, and sorry to hear Jaffa's news. There's a post on here somewhere that might be helpful; someone else whose cat has CKD was asking for help with the blood and urine results.

    Link: http://www.petforums.co.uk/cat-chat/362046-kidney-disease-stage-2-a.html#post1063651336


    Mucogel is a human antacid, and these are a pretty old-fashioned method of phosphate binding. That's not to say they're not effective, but the likes of Ipakitine and Renalzin have come along and are tailor-made. Because they are human stomach meds, Mucogel and its ilk taste bad for cats, as you are finding. In humans, the use of aluminium salts for phosphate binding has been associated with aluminium toxicity, which hasn't really been reported in cats but remains a concern when they are used long-term.


    Some of it probably comes down to personal preference. I'm not aware of any studies that compare Ipakitine to Renalzin specifically. A quick Google search found someone's diploma thesis that suggested that Ipakitine bound phosphorus better than Renalzin, but I'm not sure the difference was deemed significant. The likes of Ipakitine and Renalzin will be a lot more expensive than Mucogel. I think that ease of administration has to come into it here: which will Jaffa take better?


    Okay, you're aiming to get it into the lower half of the normal range.


    I'm not aware of any problems with combining binders, but this is something you'd really need to discuss with Jaffa's vet.


    There is a lot to be said for experience but, equally, freshly graduated vets bring with them the most up-to-date treatment information. It cuts both ways. Questions are good, though. :)

    The Journal of Feline Medicine and Surgery published a review of available phosphate binders in 2009 (November 2009 vol. 11 no. 11 913-924). I've pasted the abstract below, but if you want the full article you have to pay for access.




    Treatment Options for Hyperphosphatemia in Feline CKD: What's Out there?
    Aimee C Kidder, DVM DipACVIM (internal medicine)
    Dennis Chew, DVM DipACVIM (internal medicine)∗

    Department of Veterinary Clinical Sciences, The Ohio State University Veterinary Teaching Hospital, 601 Vernon L. Tharp Street, Columbus, OH 43210, USA

    Corresponding author. Email: chew.1@osu.edu

    Abstract

    Practical relevance Phosphorus is retained in chronic kidney disease (CKD), promoting renal secondary hyperparathyroidism and eventually resulting in hyperphosphatemia. Most agree that phosphate retention is a major contributor to the progression of CKD in many species and it is well known that hyperphosphatemia is associated with a significant mortality risk in humans with end-stage renal disease.

    Patient group Chronic kidney disease is a common ailment of geriatric cats.

    Evidence base There is evidence in cats suggesting that the use of a phosphate-restricted diet in IRIS stage 2–3 disease has a beneficial effect on clinical outcome. However, despite the fact that intestinal phosphate binders are commonly used in veterinary practice for patients with CKD, there have been few published reports focusing on the safety and efficacy of these products in veterinary medicine. No phosphorus binders are licensed as medications for dogs or cats. This article draws on data from clinical trials in humans and studies in cats to discuss treatment goals and options for phosphate retention and hyperphosphatemia in feline CKD.

    Clinical significance With careful monitoring of serum phosphate and parathyroid hormone, and implementation of phosphate-restricted dietary management and intestinal phosphate binders, progression of CKD and the degree of hyperparathyroidism in cats may be reduced.

    Audience Companion animal and feline practitioners are at the forefront in the management of CKD in cats.
     
  5. urbantigers

    urbantigers PetForums VIP

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    Thanks. That's useful. Is Ipakitine a powder? Ideally I'd like something that can be added to food but that I could give him directly if need be (eg if trying a new food and want to be sure he doesn't like the food as opposed to just doesn't like the taste of the binder in the food). I suppose I could put it in a gel capsule to administer? I'm hesitant to add anything to his food, at least until he's eating better, as I don't want to put him off eating.
     
  6. Ceiling Kitty

    Ceiling Kitty Not available for comment

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    Ipakitine is a powder - you could use gel capsules but I think it would be tricky, as you'd need a couple of scoops a day which might be too much for capsules. Renalzin might be better from that point of view, but off the top of my head I believe it is more expensive than Ipakitine.

    You're 100% right in waiting until he is eating well. We suggest never making any diet changes to cats with poor appetites as you could inadvertently create a full-on food aversion, which would make everything worse.
     
  7. urbantigers

    urbantigers PetForums VIP

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    Well the vet had never heard of Ipakitine or Renalzin! But has promised to look them up and see if she can get them. I know I can buy them online without a prescription but I'd rather start off getting them from the vet and making sure the dosage is correct and then if I want to use either long term I will probably buy online as it is cheaper. So sticking with the mucogel for now. His appetite was good yesterday - tea time Applaws went down a treat (he even came back to his dish to make sure he hadn't missed anything) then the Beaphor renal was all eaten at supper time but this morning - not interested :frown2: All manner of persuasion failed and he just licked some gravy. I left it with him on the bed and about 15 mins later he started eating. I guess all he wanted was breakfast in bed :D
     
  8. urbantigers

    urbantigers PetForums VIP

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    does anyone know of another aluminium based phosphate binder (other than mucogel)?
     
  9. chillminx

    chillminx PetForums VIP

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    Is Mucogel a phosphate binder:confused:. I thought it was an antacid prescribed for dyspepsia, heartburn and reflux disease.

    Makes of aluminium phosphate binders I know of are Alucap, Basalijel.

    Aluminium-containing compounds (such as aluminium hydroxide) are the least
    safe type of phosphate binder to give because prolonged aluminium intake can cause encephalopathy and osteomalacia.

    I assume I am right in thinking you are not in the UK, as you mention your vet has never heard of Ipakitine or Renalzin? I can't imagine any UK vet NOT having heard of these medicines as they are prescribed so often by vets for cats with kidney disease. Perhaps in your country they are marketed under a different name. Be worth looking into it and avoiding the aluminium based ones.
     
  10. Ceiling Kitty

    Ceiling Kitty Not available for comment

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    That's odd - are you in the UK?
     
  11. Ceiling Kitty

    Ceiling Kitty Not available for comment

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    Yeah it is, but it also has a phosphate binding effect.
     
  12. chillminx

    chillminx PetForums VIP

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    Thanks Shoshannah.:)
     
  13. urbantigers

    urbantigers PetForums VIP

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    Yes I am in the UK but my vet is not from the UK. I'm not sure where she is from but she very possibly trained as a vet outside of the UK and is now doing post graduate training here.

    I noticed they had a sign up in the waiting room with the top 10 most prescribed meds and prices. The top one was mucogel so that is obviously the one they are encouraged to prescribe. I do think it is working as Jaffa is so much better and his appetite has improved. I am wary of using it long term but really don't know which one to ask for as there are so many different types and then there are powders, paste, suspension.... it's all very confusing and I just want the best one for Jaffa. She wrote down the names and said she would find out whether they could get them for me. If they can I might ask for some of each just to try them and see if Jaffa will take them in food.
     
  14. wicket

    wicket PetForums VIP

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    Hi Urbantigers - when my girl had CKD my vet wasnt happy to go down the phosphorous binders route and just kept trying to sell me food she wouldnet eat.

    I did my own research, and tried both renalzin and ipakitine .

    Renalzin was a paste type liquid and my cat couldnt stand it - Ipakitine on the other hand is a powder and my girl happily ate her food with it added. I bought it
    on line and it was easy to work out the dosage - you really will get ripped off if you order it through your vets and all they will do is read the label then tell you what to give.
     
  15. chillminx

    chillminx PetForums VIP

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    Urbantigers, I never used to buy my Ipakitine from the vet anyway, as she added too much of a mark-up. I bought it from a reputable online pet drug store.

    http://www.vetuk.co.uk/dog-suppleme...hosphate-reducer-aiding-kidney-function-p-657

    I don't think it is really a complicated subject. I relied mostly on the sound advice given on Tanya's CRF website (which I think you said you have been reading). Many of the members on the support group used Ipakitine for their cats and found it worked well and the cats tolerated it, so I took this on board.

    I certainly found Ipakitine suited by cats better than Renalzin and I didn't choose to use Alucaps because of the risks of long term usage.
     
  16. Ceiling Kitty

    Ceiling Kitty Not available for comment

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    I agree with chillminx - don't worry about making the wrong decision when it comes to these two phosphate binders.

    Try Ipakitine, and if Jaffa's not keen, try Renalzin. Or the other way round, if you like. I personally wouldn't have any preference.

    I think it's unusual that Mucogel is so commonly prescribed there - not that there is anything wrong with it, I just find it unusual. I have never prescribed Mucogel for anything, ever. :blink:
     
  17. urbantigers

    urbantigers PetForums VIP

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    So what would you prescribe as a phosphate binder? Assuming that you didn't have someone ask for a specific one. I feel at a loss here because I am not getting much advice from my vet and feel as though I am the one doing the diagnosing and prescribing and I'm worried I'm missing something that could help him. He is not eating well at the moment so I am wary of adding anything to his food. But at the same time I think I'm turning mealtimes into something he fears because as soon as he's eaten anything I approach with a syringe full of vile tasting liquid and force it into him.

    I'm sure he is feeling nauseous and wonder whether there's something I can give him specifically for that which might help him eat? I think he wants to eat but something is stopping him. At mealtimes he tends to hover around demanding food but when I put it out he just nibbles a bit then walks away or sometimes just walks away without touching it. Often I can persuade him to eat a bit more by taking it to him and hand feeding and once he's got started then he often eats it hungrily as though he's starving. My vet just says he will be feeling nauseous due to all the toxins and high phosphate levels but has not suggested anything for nausea. Is there anything I can give him specifically for the nausea whilst we are trying to deal with the other stuff? He's not even showing much interest in Dreamies!

    He also makes a weird crunching noise when he eats as though he's crunching biscuits when he only has wet food in his dish. He doesn't do it right from the start but from about halfway through eating. Occasionally it is from the start and I've worked out that there is a link between his desire to eat and this crunching noise. The times when he refuses to eat at all tend to be the times when he makes this noise from the start. At first I thought he had a loose tooth or something but that does not appear to be the case. Lately he's started making that noise prior to vomiting. He makes the crunching noise, then proceeds to retching and then to vomiting. I mentioned it to the vet and she said she didn't know what it was and she had never heard of it in cats. Doing a bit of research on the internet has found that it may be teeth grinding

    Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - The Importance of Phosphorus Control

    But I can find no further information. Is this something that will stop if his phosphorus levels improve?

    I feel as though I'm not doing the best for my boy because I don't know what he needs and my vet doesn't seem to know much more than I do.

    ETA - I've just watched the youtube video in that link re teeth grinding and that is definitely what Jaffa does. Not so much the action (as he only does it when eating or prior to vomiting I guess that's not obvious) but the sound is spot on.
     
    #17 urbantigers, May 5, 2014
    Last edited: May 5, 2014
  18. chillminx

    chillminx PetForums VIP

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    I don't mean to be rude about your vet , but tbh she doesn't sound very knowledgeable about CKD and so might it not be better for you to go to another vet?

    My last cat with CKD used to make the "crunching" noise you describe, which IS teeth grinding, when he was eating. Or sometimes just before he vomited. I remember asking about it in Tanya's CRF support group and found it was not uncommon. Not sure what causes it, but there was nothing wrong with my cat's teeth - the vet checked.

    Your cat is probably off his food because he feels nauseous due to toxins from high levels of urea in his body. An anti-emetic would not be given unless he was actually vomiting constantly. He needs to have plenty of fluids - is he drinking loads of water even though he is not eating?

    It sounds counterproductive to keep giving him the Mucogel as he is getting upset and stressed about it. I don't understand why you don't switch over now to giving him Ipakitine or Renalzin:confused: Several of us have recommended it to you, including one member who is a vet herself. Why wait? It could even be the Mucogel that's making him feel nauseous.

    Once you have him on Ipakitine or Renalzin which you can mix with his food you should see an improvement.

    Have you joined Tanya's CRF support group, as well as read her website? A wealth of detailed information and support from the folks there. Though of course we are always happy to help and advise you.:)

    Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Tanya's Support Group

    and to join :

    https://www.bigtent.com/groups/tckd
     
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  19. urbantigers

    urbantigers PetForums VIP

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    That's simple. I can't afford to buy any at the moment. I've spent over £100 on food for him this month and nearly £400 at the vet so there isn't anything at all to spare to buy anything new. It is going to have to wait a couple of weeks.
     
  20. chillminx

    chillminx PetForums VIP

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    Sorry I didn't realise.:eek: I think I may have an unopened pot of Ipakitine in my store cupboard, which is still in date. I am very happy to mail it to you, so if you would like me to, can you PM me your address? :)
     
    sharonchilds likes this.
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