Chronic Kidney Disease (CKD) is relatively common in mature, senior and geriatric cats. This year, my 17-year-old cat Marcel was diagnosed with advanced, late-stage chronic kidney disease. In a short period of time, I scrambled to learn everything possible about the disease and how to treat it. Had I known before what I quickly learned, about providing the best possible treatment options and support for early and late-stage CKD, I could have possibly prolonged Marcel’s life and quality of life significantly. But the motto, too little too late, applied in my personal journey. The application of my new valuable knowledge came just too late to save him. But it’s not too late to help your cat and provide you with what I wish I had known months earlier. This guide is an effort to give owners of CKD cats the best, most valuable resources possible, in the shortest time possible. CKD is a very manageable disease in cats, but it’s critical to catch it early in order to manage it and prolong your cat’s life. Getting a diagnosis as soon as possible, as early in the disease, will give you more time to apply all the best treatments available to help your cat. Here is the most valuable and useful information and guidance I can provide you and your CKD cat, all in one page with links to some of the best resources and support available today. May your cat live a long, healthy, and comfortable life with CKD with much more quality time spent with you!
Chronic kidney disease in cats is not a life sentence, but if it is properly treated, your cat can live a long and happy life. So let’s begin.
Symptoms to Look For
Common symptoms of CKD cats include urinating more often, urinating very large amounts, drinking water excessively, weight loss, lethargy, mouth ulcers, muscle wasting, lack of appetite, and a distinctive ammonia odor to their body. If you observe any combination of these symptoms, it’s time for a veterinary visit and blood test. Cats with CKD fall into four stages progressively advancing to the final stage, Stage 4 (where cats can live a maximum of 35 days):
Source: Northern Suburbs Veterinary Hospital
In the final stage, Stage 4, the symptoms to look for include: Refusal to eat or drink, an inability to walk, continued weight loss, vomiting, incontinence, confusion, hiding, restlessness, seizures, and/or shortness of breath. Usually at least two or more of these symptoms will be present.
Time for a Veterinary Visit & Blood Test
If you suspect your cat could have CKD and presents with any of the above symptoms, it’s time to visit your veterinarian. Your veterinarian will give your cat a complete head-to-tail examination and will also draw blood for a Blood Chemistry Panel and Complete Blood Count, a routine urinalysis, and may additionally want to do X-rays or an ultrasound to determine the size of your cat’s kidneys. Cats’ kidneys with CKD are typically smaller in size and the surface is different. The chemistry panel will determine what stage kidney disease your cat is in: Stage 1, 2, 3 or 4. See the diagram.
Source: Veterinary Practice
On the Blood Chemistry Panel, the important factors to pay attention to are: IDEXX SDMA, Creatinine, BUN (Blood Urea Nitrogen), Creatinine Ratio, Phosphorus, Potassium, Total Protein, and liver values. Your doctor will review these numbers with you, but as you come to follow the suggestions and resources below, you will become more familiar and will more fully understand the importance of these values and what the numbers represent.
For your cats’ Blood Count, you will want to pay close attention to their red blood cell count, white blood cell count, and whether your cat is anemic based on the Hematocrit (or PCV packed cell volume) and red blood cell count (RBCs) number. If the PCV is below 25%, the cat is anemic. This is of critical importance. Anemia can be quite common in CKD cats with late-stage, or Stage 3 or 4, and chronic kidney disease can cause it, so it’s important to know your cat’s blood count. In addition, signs of anemia to look out for in cats include pale gums, increased heart rate, increased breathing rate, lethargy and weakness (sleepiness), decreased appetite, increased water intake, and collapse. See more about anemia later in this article.
CKD and Diet, of Utmost Importance
After your cat has been diagnosed with mild, moderate, or severe CKD (Stage 1, 2, 3 or 4), your veterinarian may suggest and send you home with prescribed cat food that is “low protein, or restricted protein.” But cats are obligate carnivores and need protein from animal organs, bone, meat and skin. Protein-restricted diets are suggested because meat contains phosphorus. But you can reduce the level of phosphorus your cat is eating by selecting lower phosphorus foods, without reducing their protein amount. The nutritional needs for mild to moderate CKD cats typically require a high-quality protein diet that is from an animal source rather than grain-based, and generally, as cats age they need more protein, not less. This is because as cats mature and age into being seniors or geriatric cats, they lose muscle mass and can develop muscle wasting. Restricting protein for cats with low to moderate CKD can actually harm their kidneys. However, cats in advanced renal failure (Stage 4), do need a protein-restricted diet (Royal Canin, Purina Pro Plan, and Hills). In all cases, the protein source should come from 100 percent meat, not meat meal. Food with grains, or that come from non-meat sources, are not appropriate nor healthy for cats, especially cats with kidney disease.
Dietary intervention is critical and is the cornerstone to managing CKD, and you can maximize the quality and length of their life by providing them a diet that restricts phosphorus, increases potassium, increases omega 3 fatty acids, increases B vitamins (B12 for sure, and possible Niacinimide), increases antioxidants and reduces sodium. This cannot be over-emphasized or emphasized enough.
Lowering Phosphorous, It Is Critical
One of the most important things that you can do immediately to help your CKD cat is to buy foods with lower phosphorus levels. Restricting phosphorus has been shown in studies to be immediately helpful and essential in preventing further kidney damage. Once your cat is over a phosphorus count of 6 on their blood test, it is time to buy lower phosphorus foods or make your own. You can do this with either a homemade diet (made only specifically for a CKD cat), or a commercial canned food diet. Dry food is dehydrating, especially to cats that already have been diagnosed with compromised kidneys and are often already dehydrated. So canned food is recommended for hydration and for a CKD diet, not dry food. The links below under Helpful Resources include links to pages with a breakdown of cat food brands, and specific cans, and their phosphorous amounts.
Using Phosphorus Binders
When your cat’s blood phosphorus level has reached 6 or over, your veterinarian will recommend that you start using a phosphorus binder. If they don’t, ask them about it. A binder may need to be added to your cat’s diet to control their serum phosphate levels, which is absolutely critical to controlling their CKD. Controlling their phosphorus levels through food is really the most important thing you can do to manage your cat’s disease. Limiting their dietary phosphorus will help delay the progression of CKD. The recommended phosphorus range for cats with CKD is 2.7 – 4.6%. well below 6. Excess phosphorus above this, can damage the kidneys. This said, the first defense before using a phosphorus binder should be buying wet food that has significantly lower or the lowest phosphorus levels that they will eat — start here. If you can get your cat’s phosphorus level down to 4.6 with only food, you’re doing great! Adding a phosphate binder should be the last step, as it can cause constipation, which causes discomfort, and you want this binder to be a last resort – or have something to go to when their CKD worsens and the Stage of CKD rises.
Be aware that some phosphorus binders mixed into the wet food can reduce the palatability of the food. But it’s critical to use the binders daily, otherwise, they will continue to lose weight, lose their appetite, and their phosphorus levels will continue to increase. You can use Gerber’s baby food (chicken and turkey), tuna juice, or an appetite stimulant to help with this if your cat just won’t eat the food with the binder in it. But avoid using binders until they are absolutely necessary, and you have already been buying very low-phosphorus canned cat food for quite some time, if possible.
Some Common Phosphorus Binders Include:
- Epakitin Powder by Vetoquinol (calcium-based binder) Commonly prescribed by vets
- Phos-Bind (aluminum hydroxide based)
- Aluminum hydroxide by Thriving Pets
An alternative (Not veterinary recommended at all, but some research is proving positive results)
- Niacinamide, by Jarrows (250 mg) or NOW (500 mg, split in two) Ask your vet, do the research on this using the links below. This is not veterinary recommended, but has been said to work for many CKD cats to lower phosphorus levels. Follow very strict instructions as to dosage, usage, no more than 200-250 mg in AM and PM, and get regular blood tests to know how effective it is, and what your cats’ phosphorus level is.
Hydration and Giving Sub-Cutaneous Fluids
Because CKD cats have impaired kidney function, toxin levels have increased in the body, driving kidneys to work harder, your cat to drink more fluid, and fluids to be lost due to more frequent urination. Cats become quickly dehydrated due to fluid loss associated with urinating more volume and more often. To compensate for fluid loss, it may be necessary to give your cat sub-cutaneous fluids therapy (below the skin), possibly weekly, twice a week, or even daily (Stage 4). You can learn to do this yourself to save time, money and trips to the vet. Ask your veterinarian to show you how to give fluids. Your veterinarian will provide you with a bag of “lactated ringers,” which is a bag of balanced electrolyte solution, the proper sized needles, and a primary line. Make sure you know how to attach the line to the bag and control the flow of water. Practice at the vets office. Practice before you do it to your cat. This video provides good instructions to support you as a backup. It’s important to have your vet recommend an exact amount of fluids to be given, depending on the weight of your cat. Never go above or over this amount, as excess fluids can cause sudden heart issues, or even heart failure. Please be careful.
Addressing Loss of Appetite, Vomiting, Weight Loss
One or all three of these can and will be symptoms of CKD at some point in your journey. This is often caused by increased toxins due to the kidney’s decreased function. Please see the link below to Felinecrf.org for more information. With these symptoms, veterinarians will often recommend Cerenia (Maropitant) or Zofran (Ondansetron) to manage nausea, daily. Sometimes Pepcid AC or Famotidine can help too. A holistic approach to reducing nausea is the use of Slippery Elm Bark, with is cheap and effective. Gerbers baby food can also be easy on the stomach if your cat is not feeling well. The links below will provide more detail.
What Else Can Benefit Your CKD Cat
Omega 3 Supplements
When feeding your cat wet food, you can add an Omega 3 fish oil supplement to promote joint health, immune health, skin and heart health. One I like is Vetoquinol Triglyceride Omega Dog & Cat Supplement Capsules, Small Breeds on Amazon or from your vet’s office. Nordic Naturals also makes a good one for dogs and cats that guarantees purity from fresh, wild-caught fish. These are calibrated for animals, do not feed your cat human fish oil. Another recommended brand is MOXXOR-Omega 3.
Probiotics for Cats
Another easy, inexpensive, but effective addition to your treatment plan is giving your cat a probiotic mixed in their wet food. This supports digestive health. One I like is Nexabiotic for Cats, a premium probiotic that is made using ingredients for human consumption and lists Boulardii first amongst 23 strains, and 17 billion CFUs, which is important. It is potent, and will help with elimination, maintaining a healthy gut, and with improving any issues with inflammatory bowel disease (IBD).
Vitamin B12 / B Vitamins
Supplementing injectable B12 can also help your CKD cat. Cats can lose B vitamins through increased urination, and CKD cats are often lacking in B vitamins. Giving B12 (formulated for cats from your veterinarian) called Methylcobalamin, can make your cat feel better. Usually it is given every week by injection for four weeks in a row, then every other week for a month, then once a month going forward long-term. Ask your veterinarian for information about this.
Constipation
Constipation can be common in cats with CKD, and can trigger loss of appetite, vomiting and weakness, plus it can be very uncomfortable. It can be easily treated with two medications from your veterinarian. One is Lactulose, which acts as a laxative, and the other is MiraLax™, which acts as a stool softener. They have no flavor and can be given with food. A more holistic, alternative approach to consider is the use of Slippery Elm Bark, which is a natural product. Just make sure to know the safe dosage for how much to give your cat. The link to FelineCRF.org has a helpful page on constipation and how to treat it.
Anemia
Cats with CKD can often get anemia, especially advanced stages of CKD. Signs to look for in an anemic cat are severe lethargy, inability to walk well, overall weakness, they sleep a lot, have a loss of appetite, can have difficulty breathing, and can collapse. Be on the lookout for these symptoms in your cat. Anemia is treatable, but it can also kill your cat. Untreated anemia can be debilitating and may become life-threatening in severe cases. It is also very uncomfortable for them and leads to a low quality of life, so it should be addressed and treated as quickly as possible.
The type of anemia CKD cats get is called non-regenerative anemia, which happens when damaged kidneys no longer produce the necessary erythropoietin hormone that regulates the production of red blood cells. It is more common in cats with advanced CKD – Stage 3 and 4. You vet can determine if your cat is anemic with a Complete Blood Count (CBC) blood test. When the PCV is below 25%, your cat is anemic. In addition, the red blood cell count, hemoglobin count, white blood cell count, and platelets all matter and will be factored into your vet’s determination. The goal will be to increase the red blood cell count in your cat. Iron-rich foods are often not nearly enough, but can be considered. Your vet likely will prescribe the medication Darbepoetin, that will need to be compounded for your cat for proper dosage. It is expensive, but it is a lifesaver, and your cat will thank you. They will feel better quickly. In addition, keep your cat inside to prevent further causes and problems. Anemia can come from outdoor or indoor toxins, fleas, parasites, infection, injury, blood loss, or a serious illness. Reduce the exposure to any of these possibilities by keeping your cat safe inside.
MORE HELPFUL RESOURCES TO FOLLOW
Feline Chronic Kidney Disease on Facebook – A life-saver for CKD cat owners – https://www.facebook.com/groups/felinecrf/
Join this private group on Facebook. Don’t wait, do it now. There are some 20,000 members already around the world who share their detailed stories about their CKD experiences. The 15 Administrators of the page are extremelyknowledgeable, helpful, and experienced with CKD and they are totally committed to making your journey and navigation through the disease the best one possible. They will provide specific and invaluable advice upon receiving your cat’s latest blood test and blood count results. Just take a photocopy of the blood test pages and upload them to your post and hashtag #admins. They will respond. This invaluable page provides immeasurable support for how to treat all severity of kidney disease in cats. Page members also share what has worked and not worked for them, and you can gain helpful information through the members as well. The value of this group cannot be recommended highly enough or over-stated. It is a go-to resource for all cat parents helping their cats survive and thrive with CKD.Start here first. Once a member of the group, you can access the files and PDFs to download under the “More” column that will guide you in all aspects of treating CKD. I recommend doing this right away to become familiar with the content of the conversations and increase your knowledge about the disease and its treatment.
Feline Chronic Kidney Disease Center
The founder of the Facebook group listed above launched this very helpful website, which is a good introduction to CKD. It discusses symptoms and diagnosis, common disorders that accompany CKD, best diet for CKD cats to eat, and much more. Plus, it has a Chat feature. Check this out and read as much as you can.
Tanya’s Comprehensive Guide to Feline Chronic Kidney Disease
Tanya’s Comprehensive Guide to Feline Chronic Kidney Disease is truly the bible for CKD cat parents. Launched in 2000, it has been an invaluable online guide for 20 years and is constantly updated with the latest research. It has a link for “Just Diagnosed Cats” on the homepage, and is a good place to start. It is so incredibly comprehensive, it will answer about 99 percent of your questions about CKD. Helen addresses all Stages of CKD and you can jump into this detailed, thorough website at any point in your cat’s disease. She covers what CKD is, key issues, support, symptoms, diagnosis, treatments, diet, fluid therapy, supplies, related diseases, and offers a support group. She tells you all about what foods to feed your cat and why, with extensive research, food tables and food brands. This is critical for cat parents. Read this as soon as you can in your journey. Your cat will thank you.
Cat Info. Feeding Your Cat: Know the Basics of Feline Nutrition
Dr. Lisa Pierson, DVM, shares her deep knowledge about optimal feline nutrition and care. She details out how to make a healthy diet for cats, prevention, and management of feline UTI problems, diabetes, obesity, kidney disease, hyperthyroidism, vaccines, the litter box, dental health, trapping and vaccines.
Download Food Charts – Nutritional Composition, Commercial Cat Food Brands (Phosphorus Levels)
The following pages provide extremely useful guidance on low phosphorus cat foods, and moderately lower protein foods for cats with chronic kidney disease. These are commercial cat food brands that all meet the nutritional requirement for adult cats.
- http://felinecrf.org/diet_and_nutrition.htm (first read, then click on the canned food data for phosphorous levels, or click the link below)
- http://www.felinecrf.org/canned_food_usa.htm
- https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf (Lisa Pierson DVM’s list of food brands; ideally phosphorous levels should be well below the 200 range for a CKD cat)
- http://www.felinecrf.org/canned_food_usa.htm – Comprehensive canned food list
Helpful Supplies
http://www.fckd.center/supplies-needed
Disorders That May Accompany CKD
http://www.fckd.center/disorders-part-of-ckd
Conclusion
There is always so much more information that could be helpful. But if you check all of the resources I have suggested, you will have nearly everything you need to start your journey. I only wish I had it all sooner, and earlier in my own journey – but that is why I’m sharing this with you, so that you will benefit from my experience. I wish you the very best as you go forward with helping your cat live his/her very best life with chronic kidney disease. Here’s to a long, healthy, happy life for your beloved cat.
