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Old 04-03-2012, 06:01 PM   #1
Hamtastic
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Post Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

This thread has been very long in the making. I have done a fair amount of research and got in touch with a good number of very experienced hamster caretakers, ration planner, and my very good vet. None of the parties expressed interest in being referenced in this summary, so I will not list any names, but to everyone who has helped: Huge Thank You!
---

If you have already had the unfortunate experience of being a parent to a hamster with kidney failure, you might have quickly found the dearth of information on how to feed and treat your ham. I personally was overwhelmed with the news of my Lucy being diagnosed with chronic kidney disease and seeing "don't feed high proteins, don't feed anything with moderate to high phosphorus content, don't feed salt, etc." but no actual examples of what I could feed. It meant excluding all commercial hamster mixes AND lots of commonly offered hamster ingredients, such as mealworms, sunflower seeds, oats, wheat, and lots lots more!

In any case, the goal of this thread is to provide information about dietary changes, including a sample menu, and going beyond the diet, as well as general information on symptoms and diagnosis of impaired kidney functions.
---

Table of Contents:
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Last edited by Hamtastic; 04-03-2012 at 06:30 PM.
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Old 04-03-2012, 06:01 PM   #2
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Default Re: Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

Introduction to Chronic Kidney Disease (and nomenclature)

Kidney function can become impaired due to any number of conditions, including Cushings disease. It is often difficult to diagnose exactly what causes kidney failure, as blood tests are required along with urine samples, and hamsters are already tiny and fragile to extract blood. Furthermore, kidney failure is not reversible, and neither is a condition like Cushings, so knowing the cause is not necessarily helpful. What is important is to know what to do once kidneys begin to function poorly to delay the build up of toxins in blood to critical levels.

The condition of impaired kidney function is called Chronic Kidney Disease (CKD) and has also been called Chronic Renal Failure, though the first term is now considered correct nomenclature.

Kidneys remove toxic waste from hamsters’ bodies and conserve water. Impaired kidneys don’t do a good job of filtering out the toxins and cause their accumulation in blood, which can be seen in abnormal blood test results. Loss of fluid through urination also occurs, as the filtering function of kidneys worsens, and instead of concentrated small amounts of urine, frequent urination of dilute liquid is seen. Eventually, without treatment, a hamster will become severely dehydrated and also reach a critical level of toxins in blood, reslting in uremic poisoning (which is eventually fatal). Proteins are also lost through urine, resulting in weight loss.

A good summary of the disease and definitions of concepts given to me by my Vet (from Kindness Animal hospital in Waltham, MA, U.S.A.)

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Last edited by Hamtastic; 04-03-2012 at 06:33 PM.
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Old 04-03-2012, 06:02 PM   #3
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Default Re: Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

Symptoms and Diagnosis

Specific Gravity (S.G.) of a liquid is a measure of its concentration with respect to pure water. S.G. of pure water is 1.000 by definition. Normal, concentrated urine has a higher density of substances dissolved in it than pure water, and so its specific gravity is a higher number, such as around 1.005-1.006. Urine passing through impaired kidneys is dilute and has S.G. of 1.002 or less (closer to pure water).

In hamsters with CKD, the following easily-noticed symptoms are generally present:
• Frequent urination
• Significant weight loss without any obvious causes (such as overgrown teeth)
• Possibly reduced vitality (sleeping more, etc.)
To diagnose CKD, a vet visit is highly recommended. If you suspect CKD in your hamster, a qualified veterinarian should test your hamster’s urine for protein content and specific gravity. While there exist test strips one can buy on-line for this purpose, the strips do not give specific gravity values under 1.003, which is where the realm of impaired kidney function starts. So a more precise diagnosis is advised (as well as ruling out other common causes of those symptoms, like perhaps diabetes).

In larger animals, it is possible to “stage” CKD to see exactly where in the progression of the disease an animal is, but that requires a blood test. My vet personally did not advise a blood test for my tiny dwarf hamster, because it would be very stressful and would ultimately not help make her better, unless further research is solidified, where prescription medication dosing is finalized for hamster-sized subjects (to be discussed later in this thread).

Note: elderly hamsters can develop this condition as part of normal aging process.
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Last edited by Hamtastic; 04-03-2012 at 06:35 PM.
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Old 04-03-2012, 06:02 PM   #4
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Default Re: Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

Guidelines
  • Low protein, but not too low! (around 10-12% seems good to maintain muscle mass and energy level)
    Main sources of protein will be boiled grains (low in phosphorus), a bit of hard-boiled egg white (no yolk, as it is high in phosphorus) once a week.
  • Vegetables and fruit are good! Fresh and added to a soup or porridge. They contain good vitamins and minerals. For example, small pieces of banana, and dried raisins and papaya soaked in water (so that they are not too sticky and chewy and don’t get stuck in a hamster’s pouch).
  • Boiling foods and discarding the resulting broth dramatically reduces phosphorus and sodium content. Therefore, soups are a good way to feed and hydrate a hamster with CKD.
  • Supplemental potassium and omega-3 are helpful for a hamster with CKD. Flax oil, which can be purchased in a health food store, is excellent at providing very high amounts of all omega fatty acids in concentrated form while being a delicious treat. (health food stores carry various kinds of bottled Flax Oil).
  • There are food pellets developed for other animals with CKD, such as dogs, which are suitable for hamsters. Hills Prescription Diet k/d pellets are a good supplemental food for an all-in-one nutritional choice as well as providing means for grinding down ever-growing hamster teeth. (Whole or lightly cracked walnuts in the shell are also great for that purpose.)
  • Puffed (plain, unsweetened, unseasoned) grains, such as millet, rice, and corn, are good to keep available to crunch on at all times. (Whole Foods stores carry all three kinds).
  • Fresh water should be available at all times. Mixing water with unflavored Pedialyte electrolyte solution could be helpful, but there are also cheaper bulk Oral Rehydration salt powders available on-line for convenient mixing at home at lower prices, as liquid Pedialyte spoils quickly after opening. Subcutaneous fluid injections might become necessary at advanced stages of CKD, if an owner opts to try them.
    (Edited to add: this is something I have not had to do yet, as my Lucy has been fine with water from soups and her bottle. I would also do a thorough research on correct osmolarity before offering custom-mixed electrolyte solutions.)
  • Additional measures to explore: subcutaneous fluid injections and phosphorus binders.
  • Health checks are important: check your hamster’s teeth for overgrowing while on soft foods, check for dehydration.
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Old 04-03-2012, 06:03 PM   #5
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Default Re: Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

Dietary Restrictions and Nutritional Table

Foods low in sodium, phosphorus and protein are advised. Low phosphorus slows the progression of the disease, and low protein is going to make a hamster feel better (no therapeutic value—simply for comfort measures).

Unless a hamster is already diabetic, worrying about sugar intake becomes secondary to nonexistent, as many CKD hams are already underweight. Excluding sugars, such as those contained in fruit and veggies, simply imposes yet another restriction on the already very restricted diet.

Sample nutritional information of some common food ingredients used for hamsters:
(Keep in mind that 100g of heavy sunflower seeds is going to take up a smaller volume than 100g of puffed grains!)



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Last edited by souffle; 04-04-2012 at 02:01 PM.
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Old 04-03-2012, 06:03 PM   #6
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Default Re: Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

Sample Diet

“Hamster Soup”

This soup is an easily prepared and inexpensive basis of the CKD hamster diet (also works for diabetic hamsters, though without the CKD ingredient restrictions). It provides nutrition and hydration in one dish. Ingredients may be varied to keep a hamster interested.

Sample ingredients:
  • Pasta (whole wheat, quinoa, spinach, spirals, elbows, or any other available varieties)
  • Diced fresh potato (making sure no skin or dark spots remaining on the surface after peeling)--this ingredient is optional
  • Grains: pearled barley, rice, millet, buckwheat, quinoa, amaranth, etc.
  • Finely diced vegetables: broccoli, cauliflower, spinach, zucchini, squash, carrot, etc.
    NOTE: when adding boiled veggies to a soup, it goes bad quite a bit faster than going with pure grains. You may choose to add fresh veggies on the side instead.
Preparation:

Boil grains, potato, and pasta together until they are almost soft enough to eat. Discard the broth and add some freshly boiled water. Add sliced vegetables. Mix and steam together for a few minutes. This soup is good for a few days and does not take long to prepare. Less broth and more of the solid ingredients is preferable. Once a week, a small amount of hard-boiled egg white can be mixed in with the soup. Make a new soup every few days, serve fresh daily.

When the soup is ready for serving and placed into a hamster food bowl, add a couple drops of flax oil and mix with the broth. Kelp flakes are good as well, and a small pinch of debittered nutritional yeast. (Photos show sample dry grain selection for a soup and a fully prepared soup):



Kelp flakes are a matter of some debate in the Kidney Disease community, due to their high iodine content, but overall they seem to be helpful with hydration, and RatRations includes and recommends them with their diets for rats with impaired kidney functions (NOTE: pre-made rat diets are not applicable here for hamsters—I have looked into them).

In addition to the soup, offer occasional fresh vegetables, steamed raisins, Hills pellets, puffed rice/millet/corn grains (plain puffed varieties), Timothy hay products (such as Kaytee cubes or Oxbow Botanical Hay in the U.S.)—protect your hamsters’ pouches and pick out harder sharp pieces), and any other treats you deem appropriate based on their nutritional value.
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Last edited by Hamtastic; 03-23-2013 at 11:30 AM.
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Old 04-03-2012, 06:04 PM   #7
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Default Re: Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

Hydration / Subcutaneous Fluid Injections

Water:

Fresh water should be available at all times. Mixing water with unflavored Pedialyte electrolyte solution could be helpful, but there are also cheaper bulk Oral Rehydration salt powders available on-line for convenient mixing at home at lower prices, as liquid Pedialyte spoils quickly after opening. Subcutaneous fluid injections might become necessary at advanced stages of CKD, if an owner opts to try them.

Fluids:

For hamsters who remain dehydrated or who are suspected to be more significantly uremic, these will require subcutaneous lactated ringers or saline fluids by injection. The dose is 2.0ml for every 10 grams body weight. This may have to be repeated daily, but some can be injected every other day or every 3rd day.

To check if a hamster is dehydrated, use a “pinch test”: gather the skin around the scruff of the hamster’s neck and toward shoulder blades gently into a pinch and release. A well-hydrated hamster’s skin will snap back into place quickly. A dehydrated hamster’s skin will move back into position significantly slower. Electrolytes and, in severe cases, subcutaneous fluid injections will help with dehydration.
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Last edited by Hamtastic; 04-03-2012 at 06:42 PM.
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Old 04-03-2012, 06:04 PM   #8
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Default Re: Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

Medications - going beyond simple measures (still a topic for further research)

• FAMOTIDINE:

CKD causes retention of the hormone gastrin. This causes a stimulation of and an elevation of hydrochloric acid secretion in the stomach. The excess HCl causes the patient to not want to eat as well. It also can cause stomach irritation and even ulcers. To combat all this, administer 1.0mg of generic famotidine tablets (in the U.S. a popular brand name for famotidine is Pepsid-AC--antacid tablets, though any generic version is just as good!) This is a 10mg tablet and must be crushed and divided to get 1/10 of a tablet. Administer this orally once daily. (For example, mix the powder into a serving of soup). Famotidine does not require a prescription.

• HYPERPHOSPHATEMIA:

If the serum level of phosphorus can be determined to be elevated (blood sample must be analyzed), aluminum hydroxide can be administered orally. Alternagel is one such brand of this antacid. The AlOH binds the phosphorus within the intestine and it is eliminated in the stools. The dose for a 30 gram hamster is about 0.1ml orally three time daily until the phosphorus level is in the normal range.

• The Future (to be carefully researched for proper dosing):

Approximately 67% of humans and cats who have CKD eventually develop high blood pressure (hypertension). If the blood pressure of a small rodent could be measured, blood pressure reducing medications such as amlodipine could be titrated to this species.

Another large percentage of humans and animals with CKD develop a PLN -- protein losing nephropathy. These patients benefit from ACE inhibitors such as enalapril or benezepril. The problem is assessing which patients have PLN and how to dose these medications.

Calcitriol: this is the active form of vitamin D which is no longer synthesized by the damaged kidneys. Cats who take Calcitriol (blood creatinine > 2.0 and blood phosphorus < 6.0) statistically live three times longer than similar CKD cats who do not take Calcitriol.

Procrit or Epogen: CKD patients also fail to produce the hormone ESF (erythropoietin stimulating factor). This hormone stimulates the bone marrow to produce red blood cells. CKD victims eventually become anemic. In cats when the Hct drops below 20, Procrit or Epogen injectable is initiated. This allows the cat to rebuild RBCs and overcome this anemia of CKD. Small rodents could certainly benefit from this product. The Hct would have to be measured and a protocol for these drugs would have to be developed.
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Last edited by souffle; 04-04-2012 at 02:04 PM.
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Old 04-03-2012, 06:05 PM   #9
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Default Re: Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

My Experience

Lucy is a hybrid winter white dwarf hamster.



She came to me aged around 5.5 months old and weighed 57 grams in her prime. Within a few months I noticed that she was becoming leaner, and when I measured her again after a long break, she weighed in at shocking 37 grams. Her diet was well-researched, with high protein levels. Her teeth were good. I thought I’d checked for every possibility, before I finally brought her to a vet.

She checked out as healthy in all aspects until we looked her urine test results. Lucy’s specific gravity was 1.002 and she had a significant amount of proteins in her urine—the cause of her weight loss. She was given a few months to live, and I grew quite depressed, as she and I had only recently had a breakthrough with taming and confidence levels.

I changed her diet completely to the soup I discussed above. I do include a tiny dash of kelp flakes with Lucy’s soup. She gets Hills Prescription Diet k/d pellets (available at all times), which she initially disliked, but now crunches on. They help keep her teeth filed to a proper level. I also offer plain puffed grains (rice, millet, and corn). I chose not to offer baby cereals, as the ones I’ve looked at appear to have added phosphorus or contain grains high in phosphorus to start with (wheat and oatmeal). Lucy’s diet since last October has been exclusively the soup (freshly heated daily, freshly made every few days) as prepared above, Hills pellets, puffed grains, and some Timothy hay. Very occasionally I give her treats of walnut bits and such, based on the rough nutritional table I’ve put together. I do mix in a pinch of powdered Famotidine tablet to Lucy's soup daily (1/10th of a 10mg famotidine tablet).

Prior to her diagnosis, Lucy became more reclusive, sleeping in her nests versus being out on her wheel. She also became a nibbler, which I thought was related to her feeling unwell. After I changed her diet, her energy level surprisingly went up tremendously. She is a ball of energy when I take her out of her habitat, dashing around, being her inquisitive self. She's also friendlier and no longer nibbles (unless my hands smell like food!)

In the beginning of January, Lucy started gaining weight. She is currently up to 42 grams and looks a fair amount rounder than she did at 32-33 grams that she was from October to January. This can be a normal weight fluctuation due to any number of reasons, so it is possible for a hamster with CKD to gain some of the weight back.

Here is Lucy’s weight history, for reference (March of 2011 when I got her and going to 2012):



Words of wisdom: If your hamster is diagnosed with CKD—Don’t panic! Focus on making your ham feel better, and you might well have him or her around for a while yet! My Lucy is doing okay so far, 5.5 months since her diagnosis, and she is currently 1.5 years old (though could possibly be as old as a year and 8.5 months, which looking at her I would say is unlikely).
Update: Lucy is now two and a half years old - still going strong!
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Last edited by Hamtastic; 03-23-2013 at 11:33 AM.
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Old 04-03-2012, 06:05 PM   #10
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Default Re: Chronic Kidney Disease / Chronic Renal Failure: diagnosis, "treatment" options

Testimonials and Advice

“My CRF hamsters have been around 16-20 months at diagnosis, and as they’ve passed the 2-year mark, I’ve held at about 10-12% of calories from protein so long as they’re retaining muscle mass and activity levels. Some just need more. It’s those middle months that are a guessing game.
Working out the lowest nitrogen proteins a CKD hamster likes will help too. High BUN levels make them miserable, so if your hamster gets crabby but seems well hydrated, you might try changing protein and backing off the level a bit to see if that sets things right for it within a few days.”


“I’ve always had the best luck keeping as much variety as possible, even if it’s just rotating ingredients in and out of the soup over a couple days at a time. Remember appetite is the key. Also, when making blends, they focus on bitter and sweet flavors. I try to keep these as guidelines for separate dishes. I wouldn’t mix bitter broccoli and sweet raisins, for example, as those wouldn’t be as palatable to them together as separately. Grains are fine with either, of course.
Also, keep a good eye on your hamster’s incisors as it’s transitioning to more of a wet diet. Make sure it’s chewing enough to keep the teeth trim. I’ve had great luck with hazelnuts in the shell, especially if I crack it just enough for them to sense the food inside.”

“Moisture in foods is going to help at all stages. In the early stages, the ham may drink so much that it doesn’t get enough calories, as there just isn’t room to take in everything necessary. In the later stages, they don’t take in enough fluids, but can still be enticed by yummy foods, so we have to make sure food delivers water. I wouldn’t feed dehydrated/flaked foods over fresh ones, or dry grains in favor of cooked ones – especially if you’ve seen weight loss.

Check your hamster often by pinch-test for hydration, and if it becomes chronically dehydrated in a way you can’t manage by encouraging it with enticing drink and wet food, then talk to your vet about subcutaneous fluids. It’s not difficult or expensive. You can order Ringer’s online with a prescription and get the best price from a reliable vendor. Some stores have good prices on ReliOn syringes. I’d guess you could do it for around $30/month.

Pedialyte is not inherently better than other electrolyte formulas. It’s just the one I use with sick and diabetic hams, and always have on hand. I’ve tried others, and still keep going back to Pedialyte. Mostly that’s just a sense of how it’s performed for hundreds of hams in a variety of situations – not the same choice you’re making.

For a CRF ham, I’d provide two bottles in the cage – one with plain water and one with a 50/50 mixture of unflavored Pedialyte and water. I keep both fresh, and pay attention to which the ham seeks out most often given the constant choice. If it’s drinking a great deal of Pedialyte and no plain water, I sometimes cut the Pedialyte to 1/4 strength. If it’s not drinking much of either, I add a couple drops of apple juice or other favorite flavor to each bottle. Sometimes that helps them regain an interest.

As for a mix, it hasn’t been a big consideration here, because once baby cereal [note: baby cereal is generally not low in phosphorus] or hamster soup are available 24/7, their interest in plain old mix wanes fast. I pull out the dried corn (which I do for diabetics anyway), and leave them a bit of their regular mix, because again, appetite is the most important thing to protect, and sometimes they just want what they like.

Hamster soup is a lifesaver in all kinds of situations. Here’s my basic explanation, but you’ll withhold the proteins, or use them for flavor and remove before serving:

'I make soup for diabetics or sick or old hamsters. You can make it in a baby food or other tiny jar. Put in a couple teaspoons of uncooked grains or cooked pasta. Add 2-4 times as much water as you did grains. Then stir in some chopped vegetables and cooked chicken or turkey or fish. Add bits of veggies he likes. Microwave it till the grains are chewy. Put some in a little dish to cool for now, and put the lid on the jar to save the rest in the fridge for the next couple days. You can serve it cool on a hot day, or warm on a cold day, or at room temperature anytime.'

I give fruits raw and veggies lightly steamed or stewed in soup. Dense or dried fruits like raisins can be steamed also. You’ll see what your hamster prefers, and you really can’t do it wrong.“


***
“Unfortunately kidney failure is a progressive and incurable condition. It can be caused by an episode of dehydration but is more often age related and due to the chemical amyloid being deposited in the 'working units' of the kidney rendering them unable to function. There is a fine balance between restricting protein in the diet and not giving enough protein. A hamster cannot survive without a certain amount of protein and will start to break down body mass to provide essential amino acids if it does not get them from the diet. The protein also needs to be the correct type.

Some animals respond to anabolic steroids to prevent the body breaking down proteins and straining the kidneys but I think myself that injecting a hamster with these would be painful and I don't think worth this pain just to extend its life by a little while.

Some lines do age much more rapidly than others so a year old in one hamster may be middle age whereas in another it is very old. Their body clocks do seem to tick at different speeds.

Increase your hamster’s complex carbohydrates with foods such as puffed rice, cooked rice, porridge and feed a tiny amount of cooked egg white (albumin) once a week or so as this is an essential protein. The addition of B vitamins may help and a sprinkle of debittered brewers yeast from a health food store in its porridge or rice will help too or you could use a multivitamin in its water if it contains B vitamins.”
***

“Milk Thistle seeds are good for kidney problems, try to find some of them.”

“Here we use a product called Nutrical for poorly rats and hamsters. Low protein but lots of energy and vitamins to keep them going whilst they get the weight back on. It comes in a tube, squeeze a blob onto your finger and they lick it off. It is very palatable. It might help a little until you can sort your hamster’s diet.”
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