24 July 2000 - 24 July 2020

Twenty years online!

(Not tax deductible since I am a private individual)








Take a Deep Breath

The Emotional Rollercoaster

Anticipatory Grief (Worrying About the Future)

Practical Issues



Quality of Life and Personal Limits

Other Family Cats

Creating Memories

One Last Thing...




Site Overview

Just Diagnosed? What You Need to Know First

Search This Site



What Happens in CKD

Causes of CKD

How Bad is It?

Is There Any Hope?

Acute Kidney Injury



Phosphorus Control


(High Blood Pressure)



Potassium Imbalances

Pyelonephritis (Kidney Infections) and Urinary Tract Infections NEW

Metabolic Acidosis

Kidney Stones



Nausea, Vomiting, Appetite Loss and Excess Stomach Acid

Maintaining Hydration

The B Vitamins (Including Methylcobalamin)




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



Coping with CKD

Tanya's Support Group

Success Stories



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.)



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



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



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



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




Heart Problems



Polycystic Kidney Disease (PKD)


Dental Problems





USA Online

USA Local (Fluids)




The Final Hours

Other People's Losses

Coping with Your Loss




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

Diese Webseite auf Deutsch



My Three CKD Cats: Tanya, Thomas and Ollie

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Home > Support > Coping with CKD



  • This page is about how to cope with living with CKD on a daily basis, both from an emotional and a practical perspective.

  • The fact that CKD is ultimately terminal can be very hard to deal with. You may also be worried about how much to put your cat through, bearing in mind your cat's personality and the costs involved.

  • Fortunately, people and cats do usually learn to cope, and in most cases seeing how your cat improves and then stabilises makes it well worth it.

Take a Deep Breath


If you've just received the diagnosis, you're no doubt feeling scared and frightened, and may well be worried that you can't do this. The good news is, I think you can.


It is true that your life and that of your cat have now changed. This is upsetting, I know, but you have to face up to it and try to approach it positively. Your cat has not changed, but you now know there is a health problem, and knowing about it increases your chances of helping your cat cope with the disease.


Focus on finding your "new normal" what works for both of you now in light of the diagnosis and all that comes with it. Your new normal may change again over the months and years, but that is OK, you will adapt to that new normal too. You are flexible.


If you're not sure how much you and your cat can cope with, I would suggest that you opt for a trial period of, say, one month, during which you treat your cat to the best of your ability, and according to your financial limitations, and then review the situation. With luck your cat will be stable and happy and you will both be getting into a routine that works for you both. If your cat is critically ill, I would still give yourselves a minimum of two weeks of treating proactively before making any irrevocable decisions.


Try not to panic if your cat has a bad day. It does not necessarily mean the end is nigh, there will be good days and bad days, hopefully far more of the former, especially once things have stabilised


The Emotional Rollercoaster


The emotional rollercoaster refers to the mixed emotions you will feel as you care for your CKD cat. When your cat is doing well, you will feel good but will probably also be wondering how long it will last; and when your cat is poorly, you will feel emotionally drained and very frightened. These ups and downs are referred to on Tanya's CKD Support Group as the emotional rollercoaster. This page talks about how to cope with the rollercoaster ride.


These days there are also the additional stresses brought by trying to help a CKD cat in the time of Covid-19.


You Need Care Too

One of my support group members, Stephanie, wrote "We cannot control whether they will die, because they will, as all living things do, but oh boy, can we control the way in which they live." 


Although this is good news, it is also a big responsibility, and occasionally things will get on top of you, particularly if you have little or no support at home. Some people cope better than others, depending upon their own personality or how well their cat is doing; but everybody living with CKD needs some level of support at some stage of the disease.


You have to accept that you are going to have days when you feel overwhelmed, when you really do not think you can cope anymore, or when you feel you don't want to live this way anymore. You know what? it is perfectly fine to feel that way. You are caring for a chronically ill family member, and facing the eventual loss of a treasured friend, a major emotional trauma. Accept that you may sometimes feel this way, and that it is fine to do so; and just get through the bad days as best you can.


Be kind to yourself and accept that something's probably got to give. Yes, your home may in part resemble a pet food or hospital supply store, but as long as it's hygienic, who cares. Focus on the important things: make sure you get enough sleep, eat properly (important note: a CKD carer's diet requires large quantities of chocolate), keep things clean, hang on to your job if you have one and care for your family. Anything else is a bonus.


On the other hand, try to keep some degree of normality in your life. If you love, say, ice-skating, try to continue to fit it into your life. Sitting at home all day constantly monitoring your cat can be unhealthy for you and irritating for your cat.


Your cat may not act exactly the same, which you may find scary at first, fearing a crash. We all want things to be the way they were before, but life is all about change, and we must go with the flow. Don't focus on the numbers or hope for your cat to get better instead, focus on trying to make your cat as comfortable and happy as possible, and savour your time together. Eventually you will both learn to accept this new normal.


Try to get into a routine, but don't sweat it if things slip sometimes. Consistency is the goal, not perfection. Cats are very forgiving. If you're having a really bad day, or if sub-Qs don't go too well one day, take a day off. I would always give blood pressure or heart medications and make sure your cat eats, but otherwise the occasional day off should not be a problem for either of you.


It is crucial that you also look after yourself. The line about putting on your own oxygen mask before helping others fit theirs applies here. If you are feeling stressed, take a hot bath, buy yourself a book (if you like thrillers (here is a blatant plug for my Dad's books he's really good, and I'm not remotely biased) or a bunch of flowers, and most importantly, give your cat a big hug and tell yourself that having to live with CKD is much, much superior to the alternative. Consider using Bach Flower Remedies (see Holistic Treatments) for yourself on days like this. 


Don't forget, your cat can pick up on your mood, so try also to focus on the fact that you do still have your cat with you, and try to enjoy his or her presence. Don't only interact with your cat by medicating and giving fluids. Stroke your cat, talk to them, tell them how you are trying to help.


Remember, you are not doing things to your cat, you are doing them for your cat. It may sound strange, but many people find that if they take the time to explain to their cat what they are doing and why, the whole process goes much more smoothly. This is particularly the case as your cat starts to realise that what you are doing helps him/her feel better. Many people find the bond with their cat is deepened as they progress along the CKD journey together, and find that they develop as a person whilst learning how to care for their beloved cat.


Dear Mom is an article from a feline diabetes website which will probably also resonate with people with a CKD cat.


Pet Caregiver Burden has a series of articles about the stresses of caring for a chronically sick cat.


Letting Go Of The Guilt

Many people seem to feel guilty for not having noticed sooner that their cat was sick. Remember, it Is not actually possible to notice CKD until at least 40-66% of kidney function has already gone that's the nature of the disease, so you have nothing to feel guilty about.


Even if you still think you have something to feel guilty about (food choices are a major source of guilt, even though food does not cause CKD), ditch it anyway, because it uses up valuable energy which you need for the journey ahead. And your cat loves you, whatever you did or didn't do.


Ultimately, all any of us can do is our best. If you do your best as often as you can, using the information and tools you have at your disposal to the best of your ability, and accepting that your best on some days will be a different best to that on other days, then you have no reason to feel bad or guilty or to reproach yourself in any way.


If Others Do Not Understand

Sadly this is a common problem. Many people around you will not understand why you are so upset about your cat's illness. I only had one friend who really understood how I felt when Tanya was sick.


You will probably also lose count, as I did, of the number of people who tell you that you are foolish to spend your money treating your cat; yet what could be a more important way of spending money than on extending the life of a loved one?


If you wish, you can try to explain to those around you why it matters to you that your cat is terminally ill; but it might be better just to save your energy and try not to take it too personally. Really, these people are to be pitied because they have clearly never experienced the special bond that you have with your cat. If all else fails, tell them you need to feel you have done your absolute best to help your cat in order to minimise any guilt you might feel later on; many people will be able to understand if you phrase it that way.


Even if you have a good relationship with your friends and family, having a sick pet can be difficult for people who love you to handle. My Mum finds it very hard when my cats are sick because she can't bear to see me unhappy and wants to wave a magic wand and make things better again; but she can't.


In many cases, it may be easier to seek support from people who are less emotionally involved with you, such as on Tanya's CKD Support Group


Tanya's CKD Support Group

If you're feeling alone, come and join Tanya's CKD Support Group, where you will find other people prepared to rejoice along with you on your up days and to support you on the down days.


Many people find it really comforting to learn they are not alone as they ride the CKD rollercoaster, and it really can make all the difference to how you cope on a daily basis.


As an added bonus, you can obtain practical suggestions for problems that arise from people who have already experienced the same problems and who know what works in handling them. 


It is a busy group, but you don't have to receive all the messages, you can just dip in as and when you wish. You can read more about how the group works here.


Working With Your Vet

If you and your vet have a good rapport and are able to work as a team, it can make a world of difference to how you cope with CKD. Conversely, if your vet is not prepared to work with you at giving your cat a chance, it is an extra burden you could do without.


It may be that you and your vet are never going to see eye to eye, in which case you need to find another vet; but it might equally well be a simple misunderstanding. British vets in particular are very conscious of the quality of life issue, and may misinterpret your attempts to give your cat a chance and to make him/her more comfortable as you being incapable of letting go, no matter how ill your cat is.


Do be prepared to listen to your vet's opinions and medical  knowledge, they have an important role to play in helping you to make decisions about your cat's wellbeing. At the same time, your vet must understand and respect that this is your cat and your opinions are valid too. Try to make it very clear to your vet that you have your cat's interests at heart, not your own, that you will let go when the time comes (if indeed you will), but that you feel that time is not yet here.


Essentially you have to learn how to be your cat's advocate. The Working with Your Vet page has more information on how to work in partnership with your vet. 


Anticipatory Grief (Worrying About the Future)


Anticipatory grief means that you worry about and grieve over losing someone you love before they have actually gone.


When you are caring for a terminally ill cat it is common to panic if your cat is having an off day, even though ups and downs are very common in CKD. However, sometimes it's even worse than that, and you find yourself worrying even on good days. You worry so much about what is around the corner, and how you will cope, that you forget to enjoy the time you have together right now. You may begin to focus more on your cat's illness than on your cat, forgetting that this is still the cat you know and love, even though his or her behaviour may be a little different.


I did this all the time with Tanya (though I was a little better with Thomas). I spent much of my time sobbing, as I envisaged life without her, and I forgot to focus on the fact that right at that moment we were still together. Yet all that worrying and sobbing did not change the course of her disease, or postpone her death. When I look back now, I wish I had spent less time fearing the future and more time living in the present, stroking and holding my lovely girl.


I know people who have struggled with anticipatory grief whose cats lived for four years or more! In retrospect, they realise they wasted a lot of energy on something that was a long way off.


Sometimes anticipatory grief may lead you to try to distance yourself emotionally from your cat, in a sub-conscious effort to spare yourself pain when s/he dies. But it doesn't work, you are going to feel pain at that time anyway, so you may as well try to enjoy your time together now, in fact try to savour every moment, enjoying your cat's uniqueness.


Try to take it a day at a time rather than thinking too far ahead. When you get up each day, if your cat seems relatively stable, give thanks and resolve to enjoy the day. If worrying thoughts enter your mind, send them away, telling yourself "yes, s/he will die, but not today." Remember, your cat does not worry about the future, but lives entirely in the present. We could learn a thing or two from them here.


When my Harpsie was diagnosed with terminal cancer, and the vet said he might only have a week or two to live, I made a conscious decision that I was going to do my best not to do anticipatory grieving. I figured if we didn't have much time left, I was going to savour and cherish every moment, and anyway, there would be plenty of time for tears later. So each day I would get up, and be glad Harpsie was still there, and if he would eat breakfast (I was very lucky that he did keep eating) and his breathing was no worse (he had secondary lung cancer), and he seemed reasonably comfortable, I'd say to myself "I don't think today is the day", and then I'd focus on enjoying his company.


Of course I would get bad moments if he became subdued later in the day or something like that, and sometimes I'd get upset anyway, because the thought of losing him was so horrible. But I did largely avoid anticipatory grief, and I'm so very glad I did. I now have memories of our last two weeks together of him eating as I held the plate for him, of little chats where I told him how much I love him, rather than of me sobbing into his fur all the time (though I did this sometimes, of course). So do try if at all possible to just live in the moment and not worry too much about tomorrow. But of course there's nothing wrong with expressing your sorrow and fear sometimes too, bottling it up is not good for you.


Anticipatory grief often includes bargaining. When Harpsie was diagnosed with terminal cancer, my bargain was "OK, I accept I have to lose him, but I would at least like to be allowed to keep him until June please". In fact, we had to have Harpsie put to sleep on 23rd May because of breathing difficulties. My bargain was not a bargain at all, because the situation was completely beyond my control Harpsie's cancer progressed at a rate that had nothing to do with me or my efforts to help him. The Pet loss link below does have some information on the types of bargains which are more likely to be helpful to you.


I know all this is easier said than done, but this quotation might help you to live in the moment:


"There are persons who shape their lives by the fear of death,

and persons who shape their lives by the joy of life.

The former live dying; the latter die living."

Horace Kallen


Doug and the B Brothers has an excellent article about how to cope with the fear that typically accompanies caring for a cat with CKD.


Pet Loss has a helpful article about what it calls "pre-bereavement", or coming to terms with the fact that your cat has a terminal illness.


The Association for Pet Loss and Bereavement has a weekly online chatroom available on the first and third Thursday of every month from 8 p.m. until 9.30 p.m. (US Eastern time) to help people cope with anticipatory grief.


Tiny Buddha has some helpful tips on mindfulness and staying in the moment despite CKD.


Practical Issues and Support


There are also practical issues which can cause stress when you are living with CKD. One very important thing you can do to help you to help your cat is to find a good vet. See Working With Your Vet for tips on how to do this.


Here are some tips to help you deal with your cat's CKD from a practical perspective:

Creating a Routine


One important step I recommend is to get into a routine as soon as you can. This may be hard initially when you don't know whether you are coming or going, but it will help you and your cat cope better (cats love routine) and will ensure you don't forget to give a medication.


Keep written records of your cat's situation so you have less to remember. This will also help you whenever you go to the vet's, or if you have to go to the ER or visit a specialist.


If you are prone to forgetting whether or not you have given a pill,  My Med Schedule allows you to create a free medicine schedule and to receive reminders via text or e-mail.


Also try to make things easier for both of you. For example, if your cat adopts a bed a long way from the kitchen, place food and water bowls and a litter tray nearby so your cat does not have to walk too far.


Some people get depressed because their cats start to hide from them. It is common for cats to hide at the beginning of the CKD journey when they do not feel well, see Symptoms.  This should improve as your cat starts to feel better. Medications are often an important part of your cat's treatment plan. If you think your cat is starting to fear you because s/he does not like being pilled, see Medicating Your Cat for tips on how to make medicating less stressful for both of you.


It is important not only to interact with your cat when giving treatment don't forget cuddles. It can help if you use a special word before medicating your cat this helps your cat know when medications are coming, and means s/he should not be wary of you when you approach at other times.


It is always hard at the beginning, especially if your cat is in crisis at diagnosis, but hang in there. Once you have your routine going (e.g. you've managed to find a food your cat likes, and s/he enjoys it and keeps it down), and you can see how it is helping your cat, the thrill and relief will be indescribable.


Balancing Other Commitments

Most people have to earn their living in some way, which will probably limit the amount of time that they can spend with their CKD cat. This can be particularly distressing if your cat is having a bad time yet you have to go into work or care for your children or elderly relatives (or even do all of these).


Try not to feel guilty about the conflicting demands on your time. Take some time off work if possible, but do not beat yourself up if it is not. Try to make your cat comfortable and arrange for somebody to call in and check on your cat's wellbeing if you can if you are at work during the day, a phone call at lunchtime to tell you your cat is bearing up can be enormously comforting. Alternatively, some people set up webcams to monitor their cats remotely (see below).


If you need to take time off work because of your cat, I would simply say a family member is sick. If you say you need time off to care for your cat, many people will be unsympathetic, but your cat is indeed a family member, even if it does not occur to them that that is what you mean.


If you work five days a week, spend some time on your free days doing things that will help you during the busier times, such as cooking and freezing meals for you to eat during the week, putting a week's worth of pills into gelatin capsules, placing online orders for supplies etc.



Some people who travel regularly set up a webcam so they can check on their cat. Actually, some people do this even if they are only going into work for the day! This is because it can be very reassuring to check on your cat and see if food is being eaten and the litter tray is being used.


The following models have been used by members of Tanya's CKD Support Group:


Foscam FI8910W has been a popular choice but only used models now seem to be available on Amazon.


The Foscam FI9821PR is a possible alternative, though the price has shot up from US$49.99 to US$139!


EZVIZ-Mini 360 is popular with some members of my support group.


Financial Concerns


Unfortunately veterinary treatment is not cheap. There is no reason why it should it be, vets have trained for many years and have a lot of overheads; but that doesn't make it any less stressful for you if money is tight.


Below are some possible ways to ease the financial burden. Please do not feel guilty if financial constraints limit what you can do for your cat, it is not your fault.


Obtaining Supplies More Cheaply

It is possible to buy many of your supplies at much reduced prices if you know where to look. Obtaining Supplies Cheaply has links to suppliers in the USA, UK and Canada.


Also, if you can afford the upfront outlay, consider buying in bulk. Once we knew Thomas was stable, we bought his supplies for two months at a time from our vet and it worked out much cheaper for us. 


If you are finding things a struggle, check out the Essential Treatments page to learn which treatments are crucial and where you can afford to be a bit more flexible.


Vet Assistance

If your cat is not insured and you are unable to obtain cheap supplies, but your cat is doing well on treatments, politely ask your vet if he/she could possibly give you a reduction for regular tests or treatments, or perhaps provide some of the supplies you need at cost, either regularly or occasionally.


Your vet does not have to agree to this but may do so in some cases.


It is also worth contacting local shelters and asking them if they know of any low cost vets in your area.


The Royal Veterinary College in London (near Kings Cross) offers free health screening, follow up monitoring and therapeutic kidney diets for CKD cats. Medications and additional tests will be charged for. Eligible cats include cats who are aged at least nine who fall into one of the following categories:

  • Healthy cats

  • Cats diagnosed with chronic kidney disease who have not yet started eating a therapeutic kidney diet

  • Cats diagnosed with an overactive thyroid and not yet on medication

  • Cats diagnosed with high blood pressure

  • Cats suspected of having one of the conditions listed above

Cats with diabetes or other significant health problems are not eligible.



If your cat is insured, then obviously the financial burden will be much less and treatment options might be available to you that you otherwise could not afford.


I do not know of any insurance company that would take on a CKD cat post-diagnosis, but I would consider insuring your non-CKD cats  in order to remove this strain in the future. You can either obtain commercial insurance or self-insure (save money every month in a savings account for a rainy day).


If you do insure your cat, make sure you use a company that provides cover for life; some companies will only pay for a condition for a maximum of twelve months, which is of limited use for a cat with a chronic disease like CKD. Other companies may only insure up to a certain age (as young as eight in some cases).


I do insure my cats, currently I am using Petplan UK and have had no problems with them, in fact I have been very pleased with them, though they are not particularly cheap.


The three companies I hear about most in the USA are Petplan, Trupanion and Healthy Paws.


Pet Insurance University explains more about what to look for when purchasing pet insurance.


Pet Insurance Review compares cover options in USA and Canada.


Financial Support in the USA

If you need funds urgently, you can try selling your unused stuff on eBay, hold yard sales or sell baked cookies or lemonade.


You might wish to consider setting up a GoFundMe account or something similar.


There are also the following possible options to obtain financial support to help with your cat's vet bills.


Care Credit

Care Credit is a payment scheme accepted by some veterinary clinics in the USA or Canada.


This is essentially a credit card for veterinary fees, which offers a variety of payment options, from interest free periods (usually for six months, though it depends upon the vet) to extended payment plans. If your vet offers this card, you can usually apply when you are at the practice and get a decision very quickly, which can be helpful if your cat needs urgent, expensive care, such as hospitalisation.


Try to avoid paying interest if you can because, like many cards, the Care Credit card has a high interest rate once interest kicks in, and it will be backdated to the date of the transaction. You have to use the account at least once a year to keep it active.


Of course, if you already have a standard credit card, you might prefer to use that.


Financial Assistance: USA

There are a number of organisations which may be able to assist, though many of them can only help with emergencies, and fund availability can vary. Some vet schools, including Cornell, have financial assistance programmes which can offset a small percentage (usually around 5-10%) of vet school costs.


The Humane Society of the United States has an article about what to do if you are having trouble paying for your cat's care.


Need help with vet bills or pet food? There ARE resources available (2020) Arnold B The Dogington Post has an up to date list of possible help sources.


Help exists for those struggling to pay veterinary bills (2014) DeGioia P VIN News Service mentions a few possible sources of help.


Best Friends has a list of possible resources.


Animal Friends Rescue Project has a list of possible resources.


Pet Guardian Angels of America has an extensive list of financial resources.


Animal Protection League of New Jersey has a detailed list of financial resources.


GoFundMe has some suggestions for obtaining help with vet bills.


Frankie's Friends may be able to offer assistance with vet bills.


Shakespeare Animal Fund may be able to assist in some cases.


Red Rover offers assistance with veterinary emergencies to people on low incomes.


The Pet Fund offers fundings to those with pets in need, though there is usually a waiting list.


Low Income Relief has a list of possible resources, though it is dated 2016.


NY Save offers assistance in NYC.


Mayor's Alliance for NYC Animals has information on sources of assistance in NYC.


FACE Foundation offers assistance for pets with life-threatening conditions only within San Diego County.


Financial Assistance: Canada

Paws for Hope helps cats in need in Canada, and one member of Tanya's CKD Support Group successfully applied for funding.


Farley Foundation can offer assistance to some people in Canada.




Covid-19 has brought new challenges to us all on many levels. I feel really sorry for those people experiencing financial difficulties and job losses, and it must be very hard for people who are struggling emotionally. My heart goes out to those who have lost loved ones. My cousin died unexpectedly in March (not of Covid-19) and I was unable to go to her funeral.


Obtaining Veterinary Care

I hear regularly from people who find it extremely distressing having to drop their cats off for treatment and then wait outside and talk to the vet on the phone about their findings. Please try to focus on the fact that at least now you can obtain veterinary care, which wasn't possible during lockdown.


The American Veterinary Medical Association has very detailed information on how to keep your cat safe and what your vet is doing to keep you and your cat safe.


Euthanasia in the Time of Covid-19

Covid-19 and euthanasia are bad enough separately, but when the two come together, it is the pits. My poor petsitter had to drop her dog off for euthanasia rather than be present while her dog crossed


It may be possible to have a mobile vet come to your home to put your cat to sleep. The American Veterinary Medical Association has some information on the Covid-19 guidelines for mobile vets.


Worrying Your Cat Will Catch It

I can understand people's fears on this, but I think we need to prioritise here. As a CKD caregiver, you've got enough on your plate without worrying about things that may never (and most probably never will) happen.


I'm a control freak, but I don't actually worry much about Covid-19 in my cats, because it's simply beyond my control. Since they never leave home, they are not being exposed to it unless I bring it in; so I take all the precautions I can to protect us all and that is all I can do. CKD cats often have to go to the vet's fairly regularly, but vets are also taking all the precautions they possibly can, so the risk at the vet's is very low.


Please let this go. We'll worry about it when and if it happens. Instead, focus on the things you can control that can help your cat feel better, such as getting food into him/her. Oh, and focus on things to help you too. Enjoy a sunset, eat more chocolate (my top tip for life generally; I wonder why my waistbands are getting tight?). Life is terminal, so we may as well try to enjoy the ride while we are still on it.


International Cat Care explains the theoretical risks and how to minimise them.


Centers for Disease Control and Prevention discuss Covid-19 and cats.


Centers for Disease Control and Prevention explains how to help should your cat catch Covid-19.




Travelling, whether for business or pleasure, can be stressful when you have a CKD cat, especially if you have to travel frequently.


You may decide not to go on holiday while your cat has CKD but bear in mind that your cat could live for several years with this disease. Your options are therefore:

If you do go away, please try to enjoy your break: if you return with recharged batteries, it can give you the boost you need to carry on and your cat will benefit.


Travel: Catsitter

In the USA and Canada it is possible to book petsitters who are happy to give your cat sub-Qs and medications each day. I used to do this in the USA and found it very useful. The cats certainly preferred staying at home in their familiar environment.


Petsitters are less common in the UK, and petsitters who can give sub-Qs are an even rarer breed. You might be able to persuade a family member or a friend to learn how to treat your cat and to step into your shoes while you are away if your cat is relatively stable. In this case, timed feeders may be useful.


You could also ask at your vet's: often one of the vet nurses (vet techs) will be happy to come in twice a day to check your cat, give sub-Qs and medications and deal with food and litter trays in order to boost their income. This is what I do, and when you have a sick cat it is particularly reassuring to have a veterinary professional caring for your cats. On one occasion, my wonderful petsitter noticed from some quite subtle signs that my little old lady was not very well so she took her into work with her and placed her on IV fluids and she and my vet monitored her all day. On another occasion, when my return home was delayed because I was travelling with my mother who was hospitalised, my petsitter was able to carry on petsitting and even offered to do so for free. Bless you, Emma, you're a sweetheart!


If you do book a catsitter, triple check the timings with the sitter. I heard a horror story on my support group of a lady who went on a business trip lasting several days, leaving her cat in the care of a carefully chosen professional petsitter. Unfortunately the petsitter had written July in her diary rather than June, and the lady returned to a severely dehydrated and starving cat who needed hospitalisation to recover.


Petsitters International can help you locate a petsitter in a number of countries.


National Association of Professional Pet Sitters can help you find a petsitter in the USA.


Travel: Cattery

If you are in the UK, you probably have a cattery nearby. I used a local cattery for many years with no problems. Most catteries will not be able to give sub-Q fluids but will be well used to medicating cats.


Many catteries ask to see vaccination certificates, but your vet should be able to give you an exemption letter for your cat if necessary.


Travel: Vet Boarding

You can also consider booking your cat into your vet's. Many cats would find this stressful, but at least your cat will get the necessary medications while you are away, and the staff in most veterinary surgeries will also stroke the cats and play with them if they are well enough and if time permits.


Travel with Your Cat

I think cats are most happy in their own environment. However, some cats are used to travelling (e.g. camping trips) from an early age, or you may have no choice but for your cat to travel e.g. if you are moving home or if you live in a disaster area.


At the very least, you will probably have to take your cat to the vet's office, so getting your cat used to that can reduce stress for both of you.


Travel: General Tips

Ideally, you want to drive or use a taxi, though I have also taken my cats on planes, trains and the subway.


Get your cat used to whichever cat carrier you are using by leaving it out in your home with the door open and a favourite blanket or throw inside. Many cats will choose to go in and sleep there. This way it will at least smell familiar to them when they are in the car or the plane.


Feliway may help with travel spray it liberally in the carrier and the car if you are using one.


When travelling, it may help to cover the carrier so your cat is less stressed by everything flashing by.


Ensure on long journeys that you have your cat's medical records and supplies to hand.


Travelling By Car

This is usually the best choice for cats because you can control your environment better.


If you have to make a long journey in the car, do a few shorter trips first to get your cat more used to it and to see what works and what doesn't work about your routine.


If you are travelling by car, get as large a carrier as you can. The Pet Tube Car Kennel is recommended by some people travelling by car. It is available on Amazon, but it is very expensive.


Depending upon which type of carrier you are using, you may be able to put a litter tray inside it. If not, be sure to put puppy pads in the carrier on top of a washable blanket or towel. Peel off and dispose of used puppy pads as soon as you can. DryFur Pet Carrier Insert Pads may be better than puppy pads, since they absorb urine so your cat stays dry.


Ensure your cat is wearing a collar and harness. I would not allow my cats out at rest stops in a car unless we were staying overnight.


If you need cat-friendly accommodation en route, some motel chains accept cats, such as Motel6, though be sure to mention your cat when you make a booking. Ideally you will not leave your cat unattended in the room, but if you need to do so, put the Do Not Disturb sign up.


Travelling By Plane

Travelling by plane is more stressful because there are so many restrictions these days, but it is doable. I've flown across the Atlantic (in both directions) with three cats, so I've been there, done that. One of our flights was a nightmare, but that was to do with the airline in question (Air France) rather than the flying itself.


You want your cat to travel in the cabin with you. This is common in the USA, and can even be done across the Atlantic in most cases. There is a limit on how many animals are allowed to travel per flight, so be sure to book early.


The first thing to do is to obtain a suitable soft-sided carrier that is acceptable as hand luggage. It needs to be lightweight and fit under the seat in front of you, but be big enough for your cat. I always use Sherpa carriers, though I have also heard good things about Sleepy Pod.


You also need to carry your supplies with you as hand luggage. It is probably better to pack your needles in your checked luggage, but I would take other medications and food. After you have gone through security, buy a water bottle for your cat's use.


Do not use anti-anxiety medications. The American Veterinary Medical Association says "It is recommended that you DO NOT give tranquilizers to your pet when traveling by air because it can increase the risk of heart and respiratory problems."


You will need to pack a small litter tray and litter in your hand luggage. Bacofoil baking trays for roasting turkey are a good option, lightweight and disposable, though PetSmart also sells disposable litter trays. I took my cats into the disabled toilet before boarding the aircraft but they were too stressed to use the litter tray.


When you go through security, you usually have to carry your cat through the metal detector while the cat carrier goes through the luggage scanner. We had no problems with this, but it may be wise to have a harness on your cat (though this may trigger the metal detector). Apparently you can ask the TSA to  allow you to take your cat out of the carrier in a private room, which would probably be less stressful.


Don't worry about your cat howling on the plane, it is highly unlikely anybody could hear over the noise of the aircraft.


Some people in the USA register their cats as emotional-support animals (a psychiatrist will have to sign off on this), which may give you more flexibility in terms of taking your cat in the cabin. The Guardian has an article about this.


The Humane Society of the United States has information on the pros and cons of the various forms of travel, including which questions to ask airlines you might use.


Quality of Life and Personal Limits


You will probably be very concerned about your cat's quality of life; but please do not forget your own quality of life in the process. CKD is a very hard disease to live with, and if you feel you must be a saint in the process it can be even harder.  


Try not to become too despondent if what you try doesn't immediately help your cat feel better. Cats are individuals, and what works well for one cat won't work as well for another. Take a deep breath and keep trying. Don't feel inadequate if you don't know what all the medications are for. I know this website is so comprehensive that it can feel overwhelming at times, especially at the beginning. Don't panic. Keep reading. Keep breathing.  Eventually things will fall into place, especially if you join the support group where people can make suggestions tailored to your cat's situation.


If your cat is relatively healthy, you may decide to give up on the site, thinking you can come back later when you need it. Please don't do that! I often hear from people who have done that and regret it. If you have a stable cat in early stage CKD, you have the luxury of time, time to get to grips with this disease. At the very least, read the Key Issues page so you know what to watch for.


You may experience immense frustration e.g. if your cat is urinating inappropriately (which fortunately is not that common in CKD cats). Whilst your frustration is probably aimed more at the disease than at your cat, it is possible that occasionally you will find yourself taking this stress out on your cat by shouting at him or her. This is obviously not something to be proud of, and you should try to avoid this kind of behaviour; but it is at least understandable. Please do try your best not to take your stress and frustration out on your cat, but if it does happen, try to put some space between you for a while until you regain some perspective; and tell yourself that your cat will remember many years of loving care rather than one moment of weakness.


We all have our own personal limits in other ways too. Just as some people have more emotional resources than others, so some people have more money than others. If you can easily find the money to pay for your cat's treatment, that is one less stress for you; or you may not have too much money but are happy to go without other things in order to pay for your cat's treatment. It becomes more complicated though if you have others to consider apart from your cat; or if you simply do not have much money. It might theoretically be possible, for example, to take out a loan to pay for your cat's care; but not everybody can bear the strain of making loan repayments for months or years to come.


One thing that can be very difficult is if your other half is not supportive, and/or objects to the cost (financial or your time) of caring for your cat. Even if your partner does not understand, ask them to at least tolerate your efforts because it is important to you.


There is no shame in acknowledging your own personal limitations in all these areas, and trying to accept them. This does not mean you love your cat any less, just that you have other demands on your financial and emotional resources, and that you must juggle everything as best you can. You are only human and can only do your own personal best as long as you do that, you have nothing to reproach yourself for.


Your cat also has limitations. Some cats cope better with treatments than others. See Medicating Your Cat for tips on making the pilling process easier for both of you.


Going to the vet's is not exactly top of most cats' wish lists either. VCA Hospitals has tips on making the process a little easier. There are global campaigns to encourage vets to make visiting the vet less stressful for cats. Cat Friendly Clinic enables you to search for a cat friendly clinic near you. 


Hospitalisation can also be a challenge. Some cats are so timid or frightened at the vet's that they find being an in-patient highly stressful. Actually, I think most cats find hospitalisation scary I wish vets would find ways to make this easier on them, e.g. by not having dogs in the same room. If your cat is going to be kept in hospital, have a little chat. Explain that you know it is scary, but that it is the best way to help them, and it is only for a short while. Or have your cat kept on intravenous fluids in hospital during the day and bring him/her home overnight. Your cat will probably be exhausted when s/he comes out of hospital; this is normal. so don't panic.


Give yourselves a couple of weeks of treatment to try to get into a routine see above. If your cat is not coping, discuss with your vet which treatments are the most crucial (I would say food, sub-Q fluids if appropriate, phosphorus binders if required, medication for hypertension and anaemia if present, and treatments for nausea and/or constipation if needed all things that can help your cat feel better), and give those to your cat, and skip the rest if necessary. Remember, the goal is to make your cat feel more comfortable, not to torture you both. Give it a couple of weeks, and with luck things will look a lot brighter. If, however, you decide your cat simply cannot cope anymore, then you must do what is best for him or her.


Mary Helen and Snicklefritz


Here is Mary Helen's story of how she decided what was important to her and her elderly CKD cat, Snicklefritz. This was in response to someone who asked why people keep cats with CKD alive when there is no cure for the disease. Your own criteria may be different but I think Mary Helen's words help us to realise that cats do not worry about their own health the way we worry for them.


"Snicklefritz wanted to live, and it was my job to support that until she was ready to leave. Because she could not speak English, it was up to me to work with the vet to carry out her wishes. Really very simple.


"My father is in kidney failure and he doesn't always feel great, but he is preparing for dialysis and transplant screening, because he's willing to endure those "extreme measures" so that he can continue to live. Why should our cats be different?


"Snicklefritz was 22 years old and age had taken its toll, but her will to live was strong. Her eyesight had dimmed over the years and she no longer looked out the windows, but just because her world had gotten smaller didn't mean she didn't treasure her little niche.


"She was arthritic and didn't walk and jump like she had, but that didn't keep her from enjoying her plush cat bed right in the middle of the living room, the center of the action, where she could watch and enjoy as family life with a toddler swirled around her. She happily slept with crayon drawings, stuffed animals, all kinds of crazy things tucked into her bed by my daughter, to the point where sometimes her happy purrrring face and the tip of her tail were all that you could see. She didn't need to walk much, her loving presence filled our house and people came to her.


"She reigned supreme in her little fiefdom, and she was not about to give that up until she was ready. I'm not saying she liked the medicines, the vet trips, the fluids. But even though her life was very limited physically, she was happy loving us and being loved, and it was enough for her.


"My mother lives out of state and had heard the saga of Snicklefritz's decline. She loved Snickle dearly and had gently suggested a couple of times that perhaps it was time to let her go. Well, my mother came to visit and watched as my darling 3.5-pound, arthritic old girl carefully and slowly walked across the room. With tears in her eyes, Mom looked at me and said it was like watching the walking dead.


"And then, Snickle taught my mom a lesson. In her classic Snickle-way, she taught my mother an important thing about life. Never cranky, never scolding, always full of joy and love...


"She went over and somehow managed to hop up to Mom's lap by herself. And she settled down and began to purrr her HUGE happy purr. And she looked up at my mother's face and gave her that slow wink of contentment and love.


"Snickle may not have had much of a life, but it was enough. She might have felt pretty lousy, but it was worth it to be able to be with those that she loved.


"She was 22 and wasn't going to be cavorting about like a kitten, CKD or not. But she was older and wiser and needed different things to make her happy. A soft bed, a loving family, that was what mattered to her at the end. She made a tremendous effort to say "goodbye" to us in her final illness and then she let go and stopped fighting. It was time, and although I miss her more than I can describe, I know that she was ready to go.


"I think we can focus too much on what our cats have lost through their illness and not enough on what remains. Simple things like warm sunshine and time with our loved ones are the essence of joy...


"My daughter was privileged to know Snicklefritz until she was almost 3.5 years old and was nursed through her second surgery by that old, frail kitty that loved with a passion and a strength that belied her tiny, arthritic body. We have greatly mourned the loss of our beloved feline companion, but we have also learned so much about the strength of love. And I know that my daughter knows that I would care for her with the same love and patience that I gave Snickle, even when it was not easy, even when I felt I could barely go on. And I learned that about myself as well..."


Other Family Cats


Many people have more than one cat, and sometimes this may make dealing with CKD even harder. You may find it tricky trying to feed your CKD cat a different food to the others (see Which Foods to Feed for more on this). You may feel guilty for giving so much of your time to the cat who is ill, perhaps feeling you are neglecting your healthy cats.


Your healthy cats will probably sense that something is not right, and may start to act differently. This is fairly common when the sick cat has been hospitalised and returns home the other cats may hiss and spit and not accept the sick cat. This is usually only because the sick cat smells differently, and of the hospital to boot. If you can make all the cats smell alike, perhaps by rubbing each cat with a piece of your clothing or dabbing them on the nape of their neck with a tiny amount of vanilla, this behaviour usually disappears.


If you can, try to find a little time each day for your healthy cats it can be very comforting spending time with a cat who doesn't need much care, and of course it is good for your cat too. But if you simply cannot find the time, do not worry too much, you can always spend time with your healthy cats later on, but your CKD cat's needs must take priority for now. 


I am sometimes asked whether people should get another cat to keep their CKD cat company. This question often arises if another family cat dies, and the CKD cat becomes an only cat. It does partly depend upon the personality of your CKD cat some cats are simply more sociable than others. However, cats are solitary predators, which means they will need time to adapt to a newcomer; and to expect an elderly sick cat to suddenly accept another cat in his/her territory can be very stressful. A 16 year old cat is 80 years old in human terms, so being asked to suddenly share the home with a baby or teenager (a kitten or young cat) can be really hard. For this reason I would be particularly reluctant to adopt a kitten in such circumstances, but if you do decide to do so, please adopt two kittens so they can play with each other and leave your CKD cat in peace.


Creating Memories

It can often be very helpful to create memories of your cat, in the form of photographs, video recordings, collecting locks of hair etc. whatever appeals to you. My husband arranged for portraits of Tanya and Harpsie to be painted for me as a birthday present one month before Tanya was diagnosed, and I find them enormously comforting now both of them are gone.


I had also happened to start videoing Tanya a few weeks before her diagnosis, and I continued to film her even when she was ill. Before she died, I felt sure I would never be able to watch the videos after she was gone; but in fact, only a few days after she died, I felt the urge to watch them, and I sat there, with tears streaming down my face, yet at the same time finding the images tremendously comforting. I had begun to worry that I had kept her with me for too long, but watching the video taken only two weeks before she died, when she actually looked relatively well and happy despite being very thin, reassured me about her quality of life during those last few weeks; while seeing her before her diagnosis enabled me to remember her at her best. I still watch those videos even now, and they never fail to lift my spirits. Of course, I also have videos of my other cats which are equally cherished.   


One Last Thing...


Please try to remember that living with CKD is not always doom and gloom. The first few weeks after Thomas crashed when we were trying to stabilise him were certainly very hard emotionally, with us wondering every day if he would last another week; but after the first few weeks it was really quite simple. Giving him his medications took only 15-20 minutes a day and for the rest of the time he acted like a healthy cat, eating, sunbathing, grooming himself - and it delighted us to see it.


When you reach some level of stability like this, then it really does make the emotional rollercoaster worthwhile. In addition, many people on Tanya's CKD Support Group find that their bond with their cat is deepened as a result of the joint effort in fighting CKD. If you'd like some support, come and join the group.



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This page last updated: 11 November 2020

Links on this page last checked: 29 August 2020







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.



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