Tanya

 

 

 

 

 

 

 

 

TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

24 July 2000 - 24 July 2020

Twenty years online!

(Not tax deductible since I am a private individual)

 

 

 

 

OBTAINING SUPPLIES CHEAPLY ONLINE: USA

 

ON THIS PAGE:


Obtaining a Prescription


Online Pharmacies


Fluids


Needles


Winged Infusion Sets


Fluid Administration Sets


Syringes


Buretrols


Veterinary Diets


Medications & Other Supplies


 

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Tanya's CKD Support Group Today

 

HOME


HOME


Site Overview


Just Diagnosed? What You Need to Know First


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WHAT IS CKD?


What Happens in CKD


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES: PROLONGING LIFE


Phosphorus Control


Hypertension

(High Blood Pressure)


Proteinuria


Anaemia


Potassium Imbalances


Pyelonephritis (Kidney Infections) and Urinary Tract Infections NEW


Metabolic Acidosis


Kidney Stones


 

KEY ISSUES: HELPING YOUR CAT FEEL BETTER


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The B Vitamins (Including Methylcobalamin)


Constipation


 

CAT FOOD DATA


Ways of Assessing Food Content, Including What is Dry Matter Analysis


How to Use the Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Brands: Helpfulness Ratings


USA Cat Food Brands: Contact Details


USA Food Data Book


 

SUPPORT


Coping with CKD


Tanya's Support Group


Success Stories


 

SYMPTOMS


Important: Crashing


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Early Detection


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Phosphorus Binders


Steroids, Stem Cell Transplants and Kidney Transplants


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


2007 Food Recall USA


 

FLUID THERAPY


Oral Fluids


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


Dialysis


 

RELATED DISEASES


Heart Problems


Hyperthyroidism


Diabetes


Polycystic Kidney Disease (PKD)


Pancreatitis


Dental Problems


Anaesthesia


 

OBTAINING SUPPLIES CHEAPLY


UK


USA Online


USA Local (Fluids)


Canada


 

SAYING GOODBYE


The Final Hours


Other People's Losses


Coping with Your Loss


 

MISCELLANEOUS


Prevention


Feline CKD Research, Including Participation Opportunities


CKD Research in Other Species


Share This Site: A Notice for Your Vet's Bulletin Board or Your Local Pet Shop


Canine Kidney Disease


Other Illnesses (Cancer, Liver) and Behavioural Problems


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SITEOWNER (HELEN)


My Three CKD Cats: Tanya, Thomas and Ollie


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Home > Supplies > USA

 


Overview


  • In most cases, your vet will charge more for sub-Q supplies and therapeutic kidney diets than other sources. If you can save money on the basics, you will have money available to pay your vet for regular check ups and tests.

  • Alternatively, there are good, reliable and cost effective online suppliers, both for fluid supplies and food.


Obtaining a Prescription


 

A prescription is required for fluids in every state, and in most states for fluid administration sets and buretrols. Ask your vet for a prescription that enables you to buy a case of fluids (12-14 bags) of fluid plus your other supplies at one time, and that allows you to order refills.

 

You also need a prescription for needles in NY, CT, IL, NJ, RI, NH, DE, and MN.

 

If your vet refuses to write a prescription, you may be able to insist that s/he does so, depending upon which state you live in — The American Veterinary Medical Association has more information on this.

 

Even if you do not live in a state where the vet must give you a prescription if you ask for one, the American Veterinary Medical Association states "As a veterinarian, when you determine that a medication is needed for a patient, you can discuss with your client the benefits of having the drug dispensed directly from your clinic. If your client still wants the prescription filled elsewhere, you should comply with their wish and provide a written prescription."

 


Online Pharmacies


 

If you don't live near a pharmacy which can order fluids for you cheaply, you will probably have to use an online pharmacy. Availability and pricing vary widely because of regular nationwide fluid shortages. A prescription is required.

 

The US Food and Drug Administration discusses precautions you should take when using online pharmacies. Unless indicated otherwise, I only link to sites which I or members of Tanya's CKD Support Group have used personally.

 

Since many of these suppliers charge shipping unless you reach a minimum spend, it is often worth trying to achieve the minimum spend, e.g. by buying needles or fluid administration sets (see below) or other supplies such as B vitamins from the same source.

 


Fluids


Fluids Shortages


Unfortunately there has been regular shortages of fluids in the USA since late 2013 when one of the major manufacturers of fluids, Hospira (now known as ICU Medical), reduced its production capacity while trying to improve its facilities following a series of warning letters regarding quality control procedures from the US Food and Drug Administration. Another major manufacturer, Baxter, also shut down for planned maintenance in December 2013. Since these closures coincided with the flu season, fluid supplies for both the human and veterinary markets have been low ever since. 

 

Things improved for a while in 2015 but in September 2017 I heard that Braun was closing its manufacturing facility for two months for an upgrade. This coincided with Baxter being affected by the hurricane in Puerto Rico, where one of Baxter's facilities is located. As at July 2018 fluid shortages were still common, and in light of Covid-19, the situation may not be too positive in the near future. Saline solution is usually the most severely affected, but lactated ringers is also sometimes in short supply. As a result, some of the fluid manufacturers are only supplying companies with which they have had contracts since 2013. Even if you are able to find fluids, you may be rationed as to how many bags you are permitted to buy at a time.

 

The improvements made by Hospira to their plants cost millions of dollars, and as a result of this and the low availability of fluids generally, prices have increased dramatically.

 

Do not wait until you are about to run out of fluids before trying to source them. Since fluids are usually good for at least a year, if your cat seems stable I would try to obtain a case or two as soon as you can so as not to have the potential headache of trying and failing to find any at short notice later in the year.

 

American Society of Health-System Pharmacists has details of current shortages.

 

PBS discusses the situation as at June 2014.

 

US Food and Drug Administration also has some information from October 2017.

 

Fluid Types


 

See Subcutaneous Fluids Tips for more information on the various types of fluid.

 

Santa Cruz Biotechnology


I used to link to Santa Cruz Biotechnology, which offered good prices for fluids. In 2015 I discovered that the US Department of Agriculture was conducting an animal welfare investigation into this company, so I stopped linking to them. In May 2016 the completed investigation led to a record fine of $3.5M and the revocation of the company's licence. I wouldn't touch this supplier with a bargepole.

 

Nature reports on the ongoing investigation.

 

Huffington Post reports on the outcome of the investigation.

 


Lactated Ringers Solution (LRS)


 

LRS is the most commonly used fluid type for CKD cats.

 

All quotes below are for 1000ml (1 litre) bags of Lactated Ringers Solution, though apparently some sellers are now shipping 500ml bags x 2 instead.

 

Some people who are not giving sub-Qs too frequently like the idea of buying smaller fluid bags, but these tend to work out more expensive than buying 1 litre bags and discarding what you don't use.

 

The US Food and Drug Administration reports on the recall of a particular batch of LRS fluids made by ICU Medical (Hospira), NDC number 0409-7953-09, lot number 07-514-FW, expiry date 1 Jul 2021.

 

Supplier

Quantity

Price US$

Shipping

Notes

BP Medical Supplies

1

5.99

Varies, $12-20 approx

Have only heard from one user so far. One person has been told they will only sell to vets.

 

PBS Animal Health

1

7.06

Free over $75

Sold in bottles. Have only heard from one user so far.

 

Pet Supplies 4 Less

1

9.99

Free over $69

 

 

Heartland Vet Supply

1

7.50

Free shipping over $75

 

12

83.40

 

Entirely Pets Pharmacy

1

7.55

Free shipping over $59.

 

 

Thriving Pets

1

10.00

Free shipping over $49 (after Tanya  discount).

Enter tanya in promotional code box for 10% discount over US$100.

12

96.00 (8.00 each)

 

KV Supply

1

9.49

US$4.99 for orders over $69 and under 20 lbs

 

 

Leedstone

1

7.99

No free shipping. Costs $7.95 for certain areas.

 

 

Lambert Vet Supply

1

9.99

Free shipping over $100

 

 

Valley Vet

1

9.99

Free shipping over $60

 

 

California Pet Pharmacy

1

9.99

No free shipping. Costs from $6.49

 

 

Chewy

1

8.99

Free shipping over $49.

Also offers DEHP-free LRS but it costs $11.46.

 

Med-Vet International

1

12.99

$10 for orders under $100.

Will apparently only deliver to veterinary premises.

 

UPCO

1

10.95

Free shipping over $60.

Does not ship to Virginia. 2% discount for orders over $110.

 

Vet Rx Direct

1

111.88

Free shipping over $49

$10 off first order over $75.

 

PetMart Pharmacy

1

9.49

$7.99 flat rate

Not heard from any users as yet.

12

104.76

 

Mountainside Medical

1

13.95

Free shipping over $100

 

 


Normosol-R/PlasmaLyte


 

Normosol-R comes in two pH types, 6.6 (a very similar pH to lactated ringers solution) or 7.4. Your prescription should show which pH you need.

 

PlasmaLyte is essentially the same as the Normosol-R with a pH of 7.4.

 

You can read more about these fluid types here.

 

Supplier

Quantity

Price US$

Shipping

Notes

 

Thriving Pets

 

12

119.95

Free shipping over $49 (after Tanya  discount).

Sells 6.6 pH type. Enter tanya in promotional code box for 10% discount over US$100.

 

Leedstone

1

10.82

No free shipping. Costs $7.95 for certain areas.

pH not stated but peering at the label, I think it is 6.6.

 

UPCO

 

1

10.95

Free shipping over $85.

Do not ship to Virginia. 2% discount for orders over $110.

 

Chewy

1

9.99

Free shipping over $49.

Save 5% with autoship

 

Heartland Vet Supply

1

10.95

Free shipping over $75

PlasmaLyte A. Ph 7.4

14

143.95

 

PetMart Pharmacy 1 9.49

$7.99 flat rate

Ph 6.6. Not heard from any users as yet
12 104.76
 

Lambert Vet Supply

1

11.99

Free shipping over $100

 

 

Valley Vet

1

12.99

Free shipping over $60

pH 7.4

 

Vet Rx Direct

1

11.10 ph 7.4

Free shipping over $49

$10 off first order over $75.

1

12.12 ph 6.6

 


Sodium Chloride (Saline) 0.9%


 

Supplier

Quantity

Price US$

Shipping

Notes

 

BP Medical Supplies

1

8.29

Varies, $12-20 approx

Have only heard from one user so far. One person has been told they will only sell to vets.

 

Leedstone

1

8.95

No free shipping. Costs $7.95 for certain areas.

 

 

KV Supply

1

8.09

US$4.99 for orders over $69 and under 20 lbs

 

 

Thriving Pets

12

119.95

Free shipping over $49 (after Tanya  discount).

Enter tanya in promotional code box for 10% discount over US$100.

 

 

Valley Vet

 

1

8.99

Free shipping over $60

 

 

Chewy

1

8.39

Free shipping over $49.

Save 5% with autoship

 

PetMart Pharmacy

1

10.99

$7.99 flat rate

Not heard from any users as yet.

12 121.32

 

California Pet Pharmacy

1

12.99

No free shipping. Costs from $6.49.

 

 

Vet Rx Direct

1

13.27

Free shipping over $49

$10 off first order over $75.

 


Needles


 

Most people use Terumo needles — you can read here why they are so popular. Unfortunately it seems that the favoured UTW (ultra thin wall) needles have been discontinued in the USA, so they are increasingly hard to find and many of the stockists below are running out or may have run out by the time you read this. I would recommend stocking up on them if you can find them. Some suppliers, such as Thriving Pets, apparently import Terumo needles from Canada so they can obtain the ultra thin wall.

 

If you are unable to obtain Terumo needles, you can consider Nipro ones instead. There is more information about needle choices here.

 

A prescription is required for needles in CT, MA, NJ, NY and RI.

 

According to ASD Healthcare, some Terumo needles were recalled in April 2019 because of possible sterility issues.

 

All the links below are for Terumo needles. Remember, ideally you want ultra thin wall, not thin wall.

 

Supplier

Quantity

Price US$

Shipping

Notes

 

Med-Vet International

100

7.50

Free shipping over $100. $10 under $100

Needles appear to be thin wall rather than ultra thin wall. Cannot sell needles to NY, CT, IL, NJ, RI, NH, DE or MN. Need valid ID for residents of MA.

 

California Veterinary Supply

100

10.99

Free shipping over $49/

Various sizes available

 

VetRxDirect

100

17.00

Free shipping over $49

Appear to be thin wall only. May require script even if your state does not require a script for needles.

 

Thriving Pets

100

14.95

Free shipping over $49 (after Tanya  discount).

Ultra thin wall (imported from Canada). Other sizes are available. Enter tanya in promotional code box for 10% discount over US$100.

 

Amazon

100

14.95

Varies

Various sizes available. Prescription not always necessary. I'm giving this link in case everyone else sells out, but be careful what you buy

 


Winged Infusion Sets (Butterfly Needles)


 

These are used when giving sub-Qs with a syringe rather than a giving set (see How to Give Subcutaneous Fluids: Syringe Method).

 

Supplier

Quantity

Price US$

Shipping

Notes

 

Thriving Pets

1

1.00

Free shipping over $49 (after Tanya  discount).

Gauges 19-23.

Enter tanya in promotional code box for 10% discount over US$100.

50

31.25

 

Lambert Vet Supply

1

0.79

Free shipping over $100.

Size 23 only

 

Leedstone

1

1.99

No free shipping.

Various sizes available.

 


Fluid Administration Sets (Giving Sets)


 

These are used to connect the bag of fluid to the needle. If you are careful not to contaminate them, you can re-use them 2-3 times.

 

Ideally you need them to be either 10 drop/ml or 15 drop/ml and at least 72 inches long. Click here to learn more about what features you need.

 

Supplier

Quantity

Price US$

Shipping

Notes

 

BP Medical Supplies

1

0.89

Varies, depends on weight

10 drop/ml, 72 inch

 

Mountainside Medical

1

1.19

Free over $100

15 drop/ml, 78 inch

Mountainside Medical

1.99

10 drop/ml, 78 inch

 
Net32 (Carolina Dental Supply) 50 45.90 Standard shipping costs $9.95

15 drop/ml, 78 inch

 

Med-Vet International

1

.1.25

Free shipping over $100. $10 under $100

10 drop/ml

 

Thriving Pets

 

1

2.50 up

Free shipping over $49 (after Tanya  discount).

Various sizes available.

Enter tanya in promotional code box for 10% discount over US$100.

12

27.00

 (2.25 each)

 


Syringes


 

Supplier

Quantity

Price US$

Shipping

Notes

 

Pet Supplies 4 Less

1

1.29

Free shipping over $69. $5.99 below $69

Price is for 20cc size.

 

Thriving Pets

1

1.00

Free shipping over $49 (after Tanya discount).

Price is for 20cc size. Other sizes available.Enter tanya in promotional code box for 10% discount over US$100.

 

Please see the Persuading Your Cat to Eat page for information on obtaining smaller syringes for assist feeding purposes.

 


Buretrols


 

Some people use buretrols to measure how much fluid they are giving. You can read more about them and which features to consider here.

 

Supplier

Quantity

Price US$

Shipping

Notes

 

Med-Vet International

1

3.27

Free shipping over $100. $10 under $100

Has attached IV set, so much slower drip

 

Health Products Express

1

21.96

Price depends on weight of order

 

 

Mountainside Medical 1 16.99

Free over $100

Pressure infusor bag
 

Boundtree Medical

1

14.79

Unstated, presumably based on weight

 

 


Veterinary Diets


 

Please see Which Foods to Feed for information on your veterinary kidney food choices, including trial packs. Some brands of Petsmart sell individual cans of therapeutic kidney diets.

 

The following sell cat food in bulk.

 

Chewy

Sells therapeutic kidney diets and a variety of other brands. I have never heard anything but praise for this company. Pet

 

Southern Agriculture

Sells various brands of therapeutic kidney diets. Prescription required. They will also sell individual tins, which can be helpful if you want to try different foods (though sometimes your vet can get a variety of therapeutic for you to try too).

 

RX Petfood

Sells therapeutic diets from Purina, Royal Canin, Eukanuba and Hill's. They need a prescription or contact details for your vet. I do not know of anybody who has used them as yet.

 

Alternatively, you could ask about buying in bulk from your vet. One of our cats needed a prescription food which cost US$2 per 5.5 oz can. However, when we bought a case, the price fell to US$1.40 a can.

 

Hollywood Feed

Does not sell veterinary diets but has good prices for some other brands.

 


Medications and Other Supplies


 

Wal-Mart sells a number of generic medications, such as lactulose or benazepril, for US$4 for a month's supply.

 

Please also see the following pages:

  • Medicating Your Cat for items to help make pilling less stressful for you both, such as Pill Pockets and gelcaps.

 

 

 

 

Back to Page Index

This page last updated: 06 September 2020

Links on this page last checked: 06 September 2020

 

   

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

Copyright © Tanya's Feline CKD Website 2000-2020. All rights reserved.

 

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