Dr. Larry Nagode (DVM, Ph.D.) professor at The Ohio State University Veterinary College recommends treating pets in chronic kidney failure with phosphorus values over 6 with aluminum hydroxide binders, rather than using calcium based binders like Epikacin. Dosage is based on your pet’s body weight.
Generic Aluminum Hydroxide Dry Gel Powder (USP) may be purchased from local compounding or hospital pharmacies or by mail order. This is the most convenient phosphorus binder because it is tasteless and easy to mix with wet pet food and may also be mixed with dry pet food.
To mix aluminum hydroxide with dry pet food simply place the aluminum hydroxide binder and dry pet food in a plastic baggie and the dry pet food will absorb the aluminum hydroxide binder overnight. Alternatively pet owners can slightly warm the dry pet food in the microwave for 5-8 seconds. Then shake the aluminum hydroxide powder with the pet food in a baggie like a “shake and bake”. The outer fatty coating of dry pet food which is called digest, softens with warming and that allows the aluminum hydroxide powder to attach more readily to the pet food.
The dry gel powder is non-prescriptive but some pet compounding pharmacies and other vendors may insist upon a veterinary prescription. For a dog or cat in chronic kidney failure that will need to be on phosphorus binders for a lifetime, aluminum hydroxide is most effective and least expensive option. Three brands of aluminum hydroxide dry gel powder are readily available: PCAA, Spectrum and Gallipot.
The USP gel powder pictured below, contains 300 mg of aluminum hydroxide per 1/4 teaspoon. A minimum of 76.5% of the weight of USP aluminum hydroxide dried gel powder is aluminum hydroxide; thus, a 500 gram tin of the product would contain 382.5 grams of aluminum hydroxide, enough to treat the typical 10 pound dog or cat for up to two years.
Note that a phosphorus value of 6 is within the “normal range” of many veterinary laboratories for dogs and cats. Dr. Nagode advises that those “normal ranges” represent “average” ranges for both kittens and cats. Adult pets should be treated with aluminum hydroxide binders with blood phosphorus levels of 6 and above.
Ideally once your pet’s phosphorus levels are at 4 and the sum of the phosphorus multiplied by the calcium is at a value of 40 or less, Calcitriol will be effective and may be started with your veterinarian.
Calcitriol is a natural form of Vitamin D, human kidney failure patients on dialysis used to receive. Newer versions of Calcitriol are still given to people in chronic kidney failure.
Calcitriol is compounded and dosed specifically for each dog or cat based on their individual body weight and blood creatinine levels. Calcitriol is very effective in pet chronic kidney failure patients ans as with humans helps to regenerate healthy pet kidney tissue and restore normal kidney function.
For example, a 10 pound pet with a phosphorus value of 7 would receive a dose of about 500 mg of aluminum hydroxide binder a day, with that dose divided between your pet’s meals. A 10 pound pet with a phosphorus value of 9 would receive 1000 mg of aluminum hydroxide binder, again with the dose divided between your pet’s meals.
Dr. Nagode indicates that it’s always better to error on the side of giving your pet more, rather than less of the aluminum hydroxide binder, and that he favors ramping up the dosage quickly if your dog or cat’s body is not responding within the first week to lower doses.
Dr. Nagode’s recommended aluminum hydroxide pet dosages run about double what many veterinarians believe is appropriate. If your pet’s current aluminum hydroxide binder dosage does not result in reduction of phosphorus values within one week, Dr. Nagode suggests doubling the dose!
Aluminum Hydroxide Pet Delivery: The aluminum hydroxide binder must be in your pets digestive system’s when food is being digested so that it can bind with phosphorus before it’s absorbed and carry it out of your pet’s body. That’s why any dry pet food that dog or cat owners leave out during the day needs the aluminum hydroxide binder.
Many kidney failure pet owners mix portions of their pet’s dry food with dried aluminum hydroxide gel binder and leave it overnight in a plastic baggie. This helps to ensure that the aluminum hydroxide binder is absorbed by the dry pet food which may then be left out for your dog and/or cat.