Beth thank you for the reply . I received good news today my fur baby got a glowing report from a leading cat cardiologist after a detailed heart scan . Good news is there’s no need for meds just an annual check up , probably getting pushed out to 24 onths based on evidence found by the scan .

Once again thank you and good luck , Kindest Regards, John :wink:

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I’m so happy for you and your ragdoll kitty!

I mentioned above that I asked my IM vet if she could rx rapa out of state (or even out of the country). As I suspected, she is not legally allowed to rx it outside of the state of California, but she could recommend it to someone’s vet who lives out of state.

If someone’s vet needs an education about it from an overly qualified and highly respected IM vet (Stanford undergrad and UC Davis DVM), it seems she would be happy to help.

I also recommend her to anyone who just needs unrelated help or a second opinion for their pet’s care (my cats see other vets and then I run everything by her before I make a move).

Just pm me if her contact would be helpful to anyone.

@John_G @Vlad_Dad
Also, she told me she sees no reason for me to try to get the formula specifically for pets as long as I have access to human Rapamycin at a reasonable cost, which I do.

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Thank you Beth, I would love to have her contact for any future consultation. If you could DM me it, I would really appreciate it.

As to the specific formula v. human rapa, from what I understand it’s essentially the dosage + the delivery method + coating to avoid destruction of the active ingredient by the cats’ acidic stomach.

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My older cat (15 years old), has some protein in his urine. The rest of his kidney biomarkers are quite good. However, kidney health in cats is very important, and it’s vital to slow down any deterioration - a frequent cause of death and QOL issues for our furry friends as they get older. I am going to be proactive. I am not willing to simply watch the downhill journey as my vet seems to fatalistically resigned to (a very good vet and full of empathy). Changing his diet to a “kidney” low protein diet is a non-starter. The idea that there’s “nothing you can do” for kidney health, is an oudated idea in both humans and animals - we have SGLT2i drugs. These drugs clearly slow down the deterioration of kidney function. This is why I settled on dapagliflozin 5mg/day for my older cat. Reasons:

(1)Slow down the decline in kidney function - doable with SGLT2i. Big cause of death and health decline. Getting ahead of that proactively is better than waiting - the earlier, the better. Why wait?

(2)The SGLT2i class of drugs seem overall to possibly have good outcomes in healthspan - and perhaps even lifespan (ITP - canagliflozin).

(3)The primary indication for SGLT2i is diabetes. I think that in an aging animal, regardless of glucose metabolizm status, the addition of SGLT2i is of a health benefit, especially that with age this control tends to deteriorate - I want to get ahead of that. There may be additional benefits (cardiovascular), which I am uncertain about, but I’ll take it.

(4)There may be synergies between rapamycin and an SGLT2i - my cat is on rapamycin already.

(5)The SGLT2i class of drugs have been specifically cleared by the FDA for cats - bexagliflozin and velagliflozin. So we at least know that they have some level of safety for Felis Silvestris Catus.

(6)There is a very small very short term study of specifically dapagliflozin in cats, with very good outcomes for kidney function:

The effect of the sodium-glucose cotransporter type-2 inhibitor dapagliflozin on glomerular filtration rate in healthy cats

“The objective of this report was to assess changes in glomerular filtration rate in healthy cats after treatment with a SGLT2i. Eight healthy research adult castrated male cats were used in a randomized, controlled, cross-over study design. We induced isolated renal tubular glucosuria by dosing cats with the SGLT2i dapagliflozin. The cats received by mouth 10 mg dapagliflozin or control every 24 h in each of the 4, 5-d trial periods that were separated by a 7-d washout period. We assessed glomerular filtration rate (iohexol clearance method), serum urea, creatinine, symmetric dimethylarginine, and 24-h sodium and chloride urinary excretion on the fifth day of each trial period. We analyzed the data with a mixed linear model that included the fixed effects of treatment (treated and control) and trial period, and the random effect of the cat. Compared with controls, cats treated with dapagliflozin had a significant increase in mean (±SE) glomerular filtration rate (3.1 ± 0.2 vs 2.5 ± 0.2 mL/kg/min; P = 0.01), whereas there were no significant differences in serum urea, creatinine and symmetric dimethylarginine, and 24-h urine sodium and chloride excretion. We propose that dapagliflozin-mediated delivery of sodium and glucose distal from the proximal convoluted tubule induced compensatory increased sodium absorption at the thick ascending loop of Henle that resulted in decreased sodium delivery to the distal tubule leading to tubuloglomerular feedback-mediated glomerular hyperfiltration.”


The study was in male castrated cats - my cat is a castrated male. Note, this is in healthy cats, not diabetic or otherwise sick - this is my cat. Note furthermore: the study used a 10mg/day dose. I am using only half that dose - 5mg/day, further possibly enhancing safety. The study is tiny and super short. However, it is encouraging that the filtration rate was affected beneficially and no side effects were observed.

Things to watch out for, perhaps not all cats are going to be suited to this. Is your cat a good drinker? If not, I would worry about administering a drug that has the potential to be a mild diuretic. My cat happens to be an excellent drinker. Watch for UTI and associated problems. Obviously monitor closely and test regularly - I already have several recent comprehensive blood tests to establish a baseline, and I will test how this drug is impacting his biomarkers. Staying on top of any intervention with close monitoring is essential.

Obviously, giving the cat dapagliflozin is a calculated intervention - this is not a drug that’s been cleared by the FDA for cats; but until recently, rapamycin has not been either. You take responsibility for yourself and your loved ones, including the furry ones, and you do the best you know how to. YMMV.

Btw. I am not advocating that anyone put their pet on any drug including dapagliflozin, I am explaining how and why I did so.

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@CronosTempi
I think being proactive is an excellent idea. Out of my 5 cats (2 departed now) 3 got CKD!

I posed the question of sharing my dapagliflozin with my 2 CKD cats. My vet advised against it.

This is not to say it’s a mistake for an otherwise healthy cat, I have no idea.

Maintaining weight and hydration are two very big challenges with CKD, so her rationale made a lot of sense for MY cats.

These are not your problems at this time, but as you said you would, do keep an eye out for hydration issues and UTIs as they are so common in kitties, and as you realize, that is a side effect (I’m mostly just piling on for anyone else reading this)

I’ll share what she said. And just so you know, @CronosTempi , this vet would meet your discerning criteria (ps, she is CA based and does zoom consults).

She said:
I would not start an SGLT inhibitor at this time. There are 2 approved for cats: Senvelgo and Bexacat. Because the glucose lost in the urine is increased with these drugs, either of the cats could become low in glucose, they could have some increase in urine output- therefore be prone to dehydration and also lose weight, the side effects include intestinal signs. I believe the makers of the Senvelgo are researching its use in cats with kidney disease. The company is Boheringer-Ingelheim. I might entertain this in the future, but not right now when we do not know too much about these drugs in non-diabetic cats.

Just her opinion of course.

Because you are being proactive, I will share last month, with my vets approval, we just started all 3 on this supplement (excuse me if I’ve already posted this) (ps, one does not have ckd, but yes, my goal is prevention for him)

Aminavast
I open the capsule and mix it into a goop treat and my picky cats google it up
https://www.chewy.com/aminavast-kidney-support-cat/dp/219073
Here are the studies

AB070597 from the study is in the Aminivast supplement.

Also, I had heard akkermansia might help kidneys, and she researched and suggested I try it. I have not done so yet, but that is my next goal.
She said
start the Akkermasia at 1/10th the human dose- 50 mg or less and monitor for at least 2 weeks before increasing. I would keep their doses at 100 mg maximum. ( i should note, i shared with her I take the 500mg pendulum and not their 100mg)

My cats, with her approval, are on rapa, too.

Also I am with you on not feeding low protein and my vet is not a fan of doing that either. She doesn’t suggest high protein but she wants enough to prevent muscle wasting. The key for once they have CKD, and probably for seniors, is having low phosphorus. It’s not about the protein, although most vet diets and traditional vets would have you think so.

I have an incredible list of low phosphorus foods that also calls out the protein levels. Let me know if you want to check it out.

Really interesting story here about CKD and how low dose niacin and sodium bicarb (baking soda) actually works to get rid of the phosphorous and cure it:

https://orthomolecular.org/resources/omns/v17n22.shtml

I don’t know what dose to give the cats.

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That’s a good study, and a good result. The question is at what point you administer the drug/supplement. From the study, it seems the result is validated in cats that already have substantially impaired kidney function with some comorbidities. If I had a cat in that situation, I’d certainly feel comfortable administering this substance. However my cat is in much earlier stage, with just one biomarker out of whack, so I’m looking at much more of a preventative treatment, and that’s what guided me toward dapagliflozin.

However without a doubt, CKD is a highly prevalent condition in older cats, and trying to get ahead of the problem is quite justifiable, if the intervention has multiple benefits and relatively low risks.

I’m really hoping that rapamycin + dapagliflozin are of a substantial net benefit, but I do remain vigilant in monitoring the potential impact to the best of my ability.

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Interesting, so I just searched. I also see they mention calcium carbonate, too, which is one of the ingredients in Epakitin (a phosphorus binder for cat food).

FWIW, if giving Epakitin, one must closely monitor calcium levels in their cats because calcium carb can cause hypercalcemia In some cats. (I don’t give this)

Using aluminum hydroxide has been recommended by my vet and it’s the most widely used binder in the Feline Chronic Kidney Disease facebook group (lots of well informed people in there and I owe so much to them. I highly recommend using them as an additional resource. Even my vet has learned a lot from them… I’d run things by her and she’d research ). Aluminum hydroxide and low phosphorous foods (not rx foods) have been enough to keep the levels of our cats low, most of the time. The cat we lost last year only had high levels I had trouble containing during his last month.

A phenomenal source for those learning about CKD is Tayna’s site. This page talks about various binders and dosing. It includes niacin vs niacinamide.
https://felinecrf.org/phosphorus_binders.htm

FWIW, if anyone is using aluminum hydroxide, I learned that the one offered by Thriving Pets (a compounding pharmacy) is more pure, so I use that vs the brands you can get elsewhere… it’s all good though.

@Bicep do share anything else you learn, but here is another good thing to read (I am familiar with this person) Feline CKD: Niacinamide for Phosphorus Control - Raw Feeding for IBD Cats
Does your cat have CKD or are you also looking at prevention?

On niacin,
I see it’s mentioned out there in the interwebs and I just saw one person’s comment about it in the FB group that I’ll share. Obviously this is only one person, but it is a thing, even if not common.

As a reply to someone saying they are going to start niacin, this person said
“I do want to flag that thrombocytopenia (destruction of platelets) is the one known side effect of niacinimide and some cats do experience it (mine did). If you go this route it’s important to watch for signs of low platelets (excess bleeding, little purple spots on skin, extra pale nose) and get a blood test (CBC) after not too long to make sure your cat doesn’t have this reaction. Many don’t! But just want you to be cautious”

Also on niacin (and chitosan, which is an ingredient in the aforementioned Epakitin), I now see it’s in the food my vet told me about. The person who created this food is very respected. It’s not actually that low in phosphorus and the first ingredient is rice (until I used this, my cats had never had grains). I only had one cat who was willing to eat this food, the others wouldn’t touch it, but it’s an interesting food that it contains niacin and a binder) Kidney Support Diet – For Cats – Medicus Veterinary Diets

I’m also so glad you had me doing another deep dive today because I see Catney One has finally been made available last month (a binder and also mentioned on the Tanya site). I’m getting my hot little hands on this right away!!! It’s from the makers of Porus One, which is highly recommended for ckd. Cost is sadly prohibitive for many :frowning: