Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

According to Colorado State University College of Veterinary Medicine, fluid therapy is given for three purposes. As a person with a CKD cat, you will usually only be concerned with the first two stages:

the replacement phase: the goal is to correct dehydration, which may be very severe in some cases. Intravenous fluids (IV fluids) are commonly used for this purpose. A CKD cat who has crashed is usually given IV fluids;
the maintenance phase: the goal is to keep the cat hydrated, so s/he does not revert to the replacement phase. Subcutaneous fluids (sub-Qs or sub-cuts) are commonly used for this purpose, which you can usually do yourself at home.
the emergency phase: the goal is usually to stabilise a critically ill animal who has lost a life-threatening amount of body fluids, e.g. because of a road accident. Intravenous fluids are commonly used for this purpose.

Types of Fluid Therapy

There are a number of different types of fluid therapy. Your vet will decide which is the best method for your cat.

Oral Fluids

The most natural way for cats to take in fluids is of course orally, both from the food they eat and the water they drink. Canned food is a good choice for a CKD cat because it contains about 80% water. Unfortunately, even though CKD cats do usually drink a lot, eventually they will not be able to drink enough to maintain hydration, at which point they will probably need sub-Qs. But for early stage CKD, encouraging your cat to drink more (e.g. with water fountains, or by placing several water bowls around your home), and increasing oral fluid intake e.g. by adding water to food, should be sufficient.

If your cat is in mid-stage CKD and needs help with hydration but your vet refuses to allow you to give sub-Qs, you could consider syringing water into your cat's mouth instead. Discuss this possibility with your vet. You have to be careful because cats can only swallow a tiny amount at a time, and you should always syringe from the side of the mouth, never from the front - see syringe feeding for more information. Don't give too much because if you do, your cat may feel full and then not eat enough. You should never syringe the bags of fluid used for sub-Qs into your cat's mouth - these fluids are for injection, not for oral use.

Oral Rehydration Sachets

If a cat is clinically dehydrated, perhaps from vomiting or diarrhoea, you need electrolytes (body salts) in addition to water. In such cases your vet may recommend oral rehydration sachets - my vet gave me some of these for use when my cat was recovering from dental surgery.

One popular brand used in the USA is Pedialyte, which is designed to rehydrate children with vomiting or diarrhoea. In the UK there is Dioralyte. Only use the unflavoured variety of these products. Do not use without checking with your vet first, and be guided by him/her re dosage.

Veterinary Rehydration Products

Royal Canin sells a product called Rehydration Support.

Lectade

Lectade is a veterinary oral rehydration product available in the UK. However, this does contain glucose, so is not suitable for diabetics. It is also quite expensive. It is not really intended for ongoing use, the manufacturer advises that you can give your cat 100ml of the mixture each day for up to 36 days, but if your vet refuses to allow you to give sub-Qs, s/he may perhaps agree to using Lectade.

These sachets contain citrate, which should not be mixed with phosphorus binders containing aluminium hydroxide because citrate can increase aluminium absorption.

Pet Meds sells Lectade in the UK.

Vet UK sells Lectade in the UK.

Vet UK sells a similar product called Glutalyte which can be used for up to seven days.

Subcutaneous Fluids (Sub-Qs or Sub-cuts) Go to page

Subcutaneous fluids are injected under the skin with a small needle. They are normally used when the cat can no longer drink enough to remain hydrated, which in practice tends to be once creatinine levels are consistently over 300-350 (US: 3.5-4). This equates to high Stage 3 of the IRIS staging system. Sub-Qs are much easier to give than IV fluids and most people are able to learn how to give them at home.

This page explains more about when to start sub-Qs, how much to give and how often, and how to cope with giving them.

Subcutaneous Fluids Tips Go to page

This page discusses the pros and cons of the different fluid types (Lactated Ringers, Normosol etc.). It also gives helpful tips on how to make things go as easily and smoothly as possible for you and your cat.

How to Give Subcutaneous Fluids with an IV Administration Set Go to page

This page is is a photographic guide to giving fluids with an IV administration set (also known as a venoset or a giving set). This method is commonly used in the USA.

How to Give Subcutaneous Fluids with a Syringe Go to page

This page is a photographic guide to giving fluids with a syringe. If you are allowed to do sub-Qs in the UK, you will probably be offered this method.

Winning Your Vet's Support Go to page

Many people outside the USA and Canada will find that their vet is reluctant to allow them to give sub-Qs at home. This page gives suggestions on how to ask your vet to permit you to try sub-Qs if they are appropriate for your cat.

Intravenous Fluids (IV Fluids) Go to page

Itravenous fluids are fluids given into a vein ("on a drip"). This treatment is normally only used for cats who are hospitalised, so it tends to be reserved for cats who are in crisis (which is sometimes referred to as "crashing").

Dialysis Go to page

Dialysis is only available at a limited number of veterinary centres in the USA and is incredibly expensive (it costs literally thousands of dollars). Unlike human CKD patients, who tend to have dialysis regularly on an ongoing basis, cats normally only have dialysis as a short term treatment (e.g. to tide a cat over who is awaiting a kidney transplant).

This page last updated: 28 June 2011

Links on this page last checked: 15 December 2011