TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

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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WHAT IS CKD?


What Happens in CKD


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The Importance of Phosphorus Control


All About Hypertension


All About Anaemia


All About Constipation


Potassium Imbalances


Metabolic Acidosis


Kidney Stones


 

SUPPORT


Coping with CKD


Tanya's Support Group


Success Stories


 

SYMPTOMS


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?


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)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, 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


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


UK Dry Food Data


UK Cat Food Manufacturers


2007 Food Recall USA


 

FLUID THERAPY


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


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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.

  • 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 - Scooter's Page 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 Vetererinary 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 the nationwide fluid shortage. A prescription is required.

 

The US Food & 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 Shortage


Unfortunately there has been a severe shortage of fluids in the USA since late 2013 when one of the major manufacturers of fluids, Hospira, reduced its production capacity while trying to improve its facilities following a series of warning letters regarding quality control procedures from the 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. Saline solution is the most severely affected, but lactated ringers is also in short supply. As a result, some of the fluid manufacturers are only supplying companies with which they have had contracts since 2013.

 

Things improved for a while in 2015 but as at 31 May 2016 fluid shortages were still common according to the American Society of Health-System Pharmacists, and things have not improved at the time of writing (July 2016). 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.

 

PBS discusses the situation as at June 2014.

US Food and Drug Administration also has some information.

 

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.

 

Supplier Quantity Price US$ Shipping Notes
 
BP Medical Supplies 1 5.99 Varies, $12-20 approx  
 
Atlantic Medical Supply 1 8.99 Free shipping over $150  
14 109.99 (7.86 each)
 

KV Supply

 

1 8.99 Free but handling charge of $5 for orders under $50 Only three bags per order per week
 
PetMart Pharmacy 1 9.25 $7.99 flat rate Not heard from any users as yet.
 
Leedstone 1 9.59 No free shipping. Cost $30 for 12 in 2015 Does not ship to CA
 

Valley Vet

1 9.99 Free shipping over $60  
 
California Pet Pharmacy 1 9.99 No free shipping. Costs from $5.75 Only two bags per customer
 

UPCO

1 10.95 Free shipping over $85. Does not ship to Virginia. Cannot add to basket until prescription provided
14 140.00 (10.00 each)
 

Drs Foster & Smith

1 10.99 Free economy ground shipping on orders $49 and over No minimum order size
4

39.96 (9.99 each)

 
Allivet 1

10.99

Free shipping over $49  
12 119.88 (9.99 each)
 

Petfood Direct

1 10.99

Free shipping if order over $49 and under 61lbs

Sites are affiliated
Pet360
 
Heartland Vet Supply

 

1 11.95 Free shipping over $75  
14 149.00 (10.64 per bag)
 

Pet Rescue Rx

1 11.99 Not stated Profits go to the shelter of your choice. Not heard from any users as yet.
 
Vet Rx Direct 1 11.99 Free shipping over $49 $10 off first order over $75. Bulk purchase discounts available
 
Lambert Vet Supply 1 11.99 Free shipping over $100  
 

Thriving Pets

1 15.00 Free shipping over $100 (after Tanya  discount).

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

12

144.00 (12.00 each)

 


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.

 

Unfortunately all varieties of this fluid are often out of stock as at July 2016.

 

Supplier Quantity Price US$ Shipping Notes
 
Lambert Vet Supply 1 8.99 Free shipping over $100  
 
Leedstone 1 9.69 No free shipping. $30 for 12 in 2015 pH not stated. Do not ship to CA
 
PetMart Pharmacy 1 11.99 $7.99 Plasma-Lyte A. Not heard from any users as yet.
14

132.99

(9.50 each)

 

UPCO

 

1 10.95 Free shipping over $85. Do not ship to Virginia. Cannot add to basket until prescription provided
14 140.00 (10.00 each)
 

Drs Foster & Smith

1 10.99 Free economy ground shipping on orders $49 and over pH type not stated. No minimum order size
4

39.96 (9.99 each)

 
Heartland Vet Supply 1

11.95

Free shipping over $75 Ph 7.4
12 154 (12.83 each)
 

Pet Food Direct

1 11.99

Free shipping if order over $49 and under 61lbs

Sites are affiliated
Pet360
 
Heartland Vet Supply 1 11.95 Free shipping over $49 $10 off first order over $75. Bulk purchase discounts available
 

Vet Rx Direct

1 12.49 Free shipping over $49 Same price for pH 6.6, 7.4 and PlasmaLyte. $10 off first order over $75. Bulk purchase discounts available
 

Valley Vet

1 12.99 Free shipping over $60 pH 7.4
 

Thriving Pets

1 15.00 Free shipping over $100 (after Tanya  discount).

Sells both pH types but 7.4 costs $10 extra. Enter tanya in promotional code box for 10% discount over US$100.

12

199.95 (16.66 each)

 


Sodium Chloride (Saline) 0.9%


 

Supplier Quantity Price US$ Shipping Notes
 
BP Medical Supplies 1 8.29 Varies, around $12-20  
         

Thriving Pets

12

99.95 (8.33 each)

Free shipping over $100 (after Tanya  discount).

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

 
Atlantic Medical Supply 1 8.99 Free shipping over $150  
14 109.99 (7.86 each)
 

KV Supply

 

1 8.99 Free but handling charge of $5 for orders under $50 Only three bags per order per week
 
Leedstone 1 9.15 No free shipping. Cost $30 for 12 in 2015 Does not ship to CA
 
PetMart Pharmacy 1 9.00 $7.99 flat rate Not heard from any users as yet.
 

 

Valley Vet

 

1 11.99 Free shipping over $60  
Valley Vet DEHP-free 1 8.99
 
California Pet Pharmacy 1 12.99 No free shipping. Costs from $5.75 Only two bags per customer
 

Drs Foster & Smith

1 10.99 Free shipping $49 and over No minimum order size
4

39.96 (9.99 each)

 
Allivet 1

10.99

Free shipping over $49  
12 119.88 (9.99 each)
 

Petfood Direct

 

1 10.98

Free shipping if order over $49 and under 61lbs

Sites are affiliated
Pet360
 

 

Pet Rescue Rx

 

1 10.99 Not stated Profits go to the shelter of your choice. Not heard from any users as yet.
 
Vet Rx Direct 1 12.99 Free shipping over $49 $10 off first order over $75. Bulk purchase discounts available

 


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 are being discontinued in the USA, so like fluids, they are increasingly hard to find. I would therefore recommend stocking up on them if you can find them. Terumo needle codes may help you if you are trying to track down UTW needles.

 

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

 

All the links below are for Terumo needles.

 

Supplier Quantity Price US$ Shipping Notes
 

Med-Vet International

100 5.95 Free shipping over $100. $10 under $100

Cannot sell needles to NY, CT, IL, NJ, RI, NH, DE, and MN. Needs valid ID for residents of MA

 
California Veterinary Supply 100 9.59 Free shipping over $68.99 Various sizes available
 

Vet Rx Direct

 

100 11.00 Free shipping over $49 Has some Terumo in a few sizes
 

Thriving Pets

100 12.95 Free shipping over $100 (after Tanya  discount).

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

 
Amazon 100 10.00 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
 
Med-Vet International 50 26.92 (0.54 each) Free shipping over $100. $10 under $100

Gauge 23

 

Thriving Pets

1 1.00 Free shipping over $100 (after Tanya  discount).

Gauges 19-23.

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

50 34.95 (0.70 each)
 

Lambert Vet Supply

1 0.79 Free shipping over $100. Size 23 only
 
Atlantic Medical Supply 50 39.99 (0.80 each) Free shipping over $150  
 
Leedstone 1 1.99 No free shipping. Various sizes available. Do not ship to CA.

 


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
 

Med-Vet International

 

1 .1.10 Free shipping over $100. $10 under $100 10 drop/ml
 

Thriving Pets

1 2.00 Free shipping over $100 (after Tanya  discount).

10 drop/ml, 72 inch

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

12 19.20 (1.60 each)
 
KV Supply 1 2.95 Free but handling charge of $5 for orders under $50  
 
Drs Foster & Smith 1 3.99 Free economy ground shipping on orders $49 and over 10 drops/ml, 103 inch. No minimum order size
 

Atlantic Medical Supply

1 5.29 Free shipping over $150 10 drop/ml

 


Syringes


 

Supplier Quantity Price US$ Shipping Notes
 

Pet Supplies 4 Less

1 0.46 Free shipping over $69. $5.99 below $69  
 

Thriving Pets

1 0.40 - 2.00 Free shipping over $100 (after Tanya  discount).

Various sizes.

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 11.32 Price depends on weight of order  
 
Emergency Medical Products 1 12.15 Free shipping over $175. $10.50 under $175 Has attached IV set, so much slower drip
         
Boundtree Medical 1 13.09 Unstated, presumably based on weight  
         
Amazon 48

345.99 (7.19 each inc shipping)

9.30  

 


Veterinary Diets


 

Chewy

Sells prescription diets and a variety of other brands. This site is reputed to offer excellent service.

 

Pet Food Direct

Sells Hi-Tor Neo, a low protein, low phosphorus food which does not require a prescription. Shipping can be expensive, but there are regular 20% off sales which can help offset the cost.

 

Amazon

Sells Hi-Tor Neo without prescription.

 

Southern Agriculture

Sells prescription diets from Purina, Royal Canin IVD, Waltham Royal Canin, Eukanuba and Hill's. 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 prescription foods for you to try too).

 

RX Petfood

Sells prescription diets from Purina, Royal Canin IVD, Waltham 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.

 


Medications and Other Supplies


Wal-Mart and Target both sell 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: 20 July 2016

Links on this page last checked: 19 July 2016

 

   

 

*****

 

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 2000-2016. All rights reserved.

 

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You may print out one copy of each section of this site for your own information and/or one copy to give to your vet, but this site may not otherwise be reproduced or reprinted, on the internet or elsewhere, without the permission of the site owner, who can be contacted via the Contact Me page.

 

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