Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

This is another of those questions which virtually everybody asks themselves as soon as they get the diagnosis.
In most cases, the answer to this question is yes.
This page tries to explain the various scenarios you may be facing and how to increase your cat's chances in each of these varying situations.

So Is There Any Hope? Back to Page Index

Whilst I can't promise that your cat will pull through a crisis or survive for years, I can tell you firstly, the numbers are not the whole story; and secondly, that not being proactive is definitely going to reduce his or her chances.

In Prolonging the life of the renal failure patient (2000), Waltham Focus 10 (3), Dr Jonathan Elliott states that "in a retrospective study, the correlation between plasma creatinine and survival in cats who presented with signs of stable CKD was very poor, with only 5% of the variation in survival time being predicted by the initial plasma creatinine concentration". However, Survival in cats with naturally occurring chronic kidney disease (2000-2002) (2008) Boyd LM, Langston C, Thompson K, Zivin K & Imanishi M Journal of Veterinary Internal Medicine 22(5) pp1111-7 found that "median survival for cats in IRIS stage IIb at the time of diagnosis was 1151 days (range 2-3107), and was longer than survival in stage III (median 778, range 22-2100) or stage IV (median 103, range 1-1920)." But the median is a halfway point i.e. 50% of cats lived less than the median, and 50% lived longer than the median. So sadly 50% of the cats in Stage 4 at diagnosis lived less than four months, but that means that 50% of Stage 4 cats lived for longer than four months. What I find interesting is that at least one cat in Stage 4 lived for 1920 days after diagnosis, or more than five years!

If I had to generalise, I would say that cats who are diagnosed early with low numbers have the best chance. Many of them live for years. But as the Success Stories page shows, some cats with high numbers also live for years. The longest surviving CKD cat I know of lived for sixteen years after diagnosis, having been diagnosed at six months of age. The next longest surviving lived for twelve years, having been diagnosed at three years old. So yes! In many cases there is hope.

Much depends upon your particular cat, how sick s/he is at diagnosis, how much s/he wants to fight, how well s/he copes with being handled, how good the veterinary care is that s/he receives, and, sadly, to some degree how deep your pockets are (though many treatments probably cost less than you think, see Obtaining Supplies Cheaply). This is not only my opinion: In Renal disease (2006) Dr D Polzin says "With appropriate therapy, cats with stages 2 and 3 CKD commonly survive 1 to 3 years...however, many survive much longer. A host of factors influence prognosis of CKD, both favorably and unfavorably. Included among these factors are the quality of medical care provided to the patient, the degree of interaction between the veterinarian and pet owner, and the level of owner commitment."

Some vets seem to recommend euthanasia almost immediately, but CKD is not generally considered to be a painful disease (dehydration feels a bit like a hangover, uncomfortable but not agonising), so there is no need to rush into an irrevocable decision.

I do not understand vets who take an arbitrary "if s/he's not better by tomorrow/within three days/whatever period the vet mentions, you have to put to sleep" approach. In the vast majority of cases, you need to treat your cat properly for at least two weeks before you can make an informed decision. Plus deciding on euthanasia is your decision, not the vet's, and you have to live with the feelings of guilt and loss which often follow. So do not be talked into euthanasia on the day of diagnosis or if your cat's numbers do not improve after a day or two on IV fluids, because in many cases there is room for hope; the cat just needs some time to stabilise with proper treatments tailored to his or her particular needs.

Cat Not in Crisis Back to Page Index

If your cat has been diagnosed early and/or is stable, you are fortunate in many ways because with careful monitoring and a proactive approach, your cat may stay relatively well for months or years. For cats who are stable but who have relatively high bloodwork values, perhaps at the top end of Stage 2 (see above), there is still hope: the values may fall with treatment, but even if they do not, there is a possibility your cat may remain at this level for some time (see below). If your cat is stable despite having numbers in Stage 3 (see above), your cat clearly copes well with CKD, which is usually a good sign, although treatments should still be begun as soon as possible, including possibly a session on IV.

Cat in Crisis: Probably Receiving Intravenous Fluids (IV) Back to Page Index

Since it is so hard to diagnose CKD early (see What is CRF? to understand why), your cat may be in crisis at diagnosis. Please do not be too despondent if this is the case, particularly if your cat has crashed (see Symptoms) and is on a drip, as happened to Thomas. Many cats have horrendous bloodwork at diagnosis, or may experience a sudden crisis after having CKD for a while, which is often a reflection of severe dehydration. The true bloodwork values will not be apparent until your cat is rehydrated and stabilised, either via sub-Qs for less critical cases or via IV for more severe ones. If your cat has an infection, you need to get it under control before you can tell how severe things really are; hypertension may also make bloodwork look worse than it will once the hypertension is under control.

Some cats with very high numbers will actually be suffering from acute renal failure (ARF) rather than CKD, and whilst ARF is difficult to treat, if treatment is successful the cat may actually make a complete recovery.

There are a variety of possible outcomes for a cat who has crashed and is on IV with extremely high bloodwork values:

the cat's numbers improve on IV and the cat looks and acts better, and continues to do well at home;
the cat's numbers do not improve on IV, but the cat nevertheless acts better, and the numbers gradually reduce at home (usually with sub-Q therapy);
the cat's numbers do not improve on IV or with sub-Qs, but the cat acts better and continues to do well at home despite the high numbers;
the cat's numbers do not improve on IV, and the cat continues to act ill once s/he is home, and is put to sleep;
the cat's numbers do or do not improve on IV, but the cat crashes again once at home.

Obviously I cannot predict to which category your cat might belong, but it is usually worth trying treatments, particularly if your cat has a kidney infection, where the numbers may improve once the infection is under control.

I am growing increasingly concerned recently at the number of vets who offer just one day on IV, tell the person their cat's numbers have not improved after that short stint, and recommend euthanasia. In most cases this is inappropriate in my opinion. Yes, not every CKD cat can be saved; but euthanasia is an irrevocable decision so you need to be very sure, and for most people that means giving their cat every chance. Dr S DiBartola says "Don't pass judgement on a lethargic dehydrated cat with markedly abnormal laboratory results. 2 to 3 days of conscientious intravenous fluid therapy can produce remarkable results."

For a severely ill cat, one or two days on IV are simply not going to be long enough. Thomas was on IV for four solid days and nights, and only began to eat a little on day 3. Also, Thomas's numbers did not improve at all on IV fluids. He had urea of 89 (BUN: 241) at diagnosis, and it was the same after four days and nights of IV. Some cats will actually have numbers which worsen while on IV fluids. Try not to panic! Your cat did not get this sick overnight, and s/he won't necessarily get better in only 2-3 days. In Thomas's case, my vet suspected he would fall into category 5, but in fact he was in the second category. He was acting a little better by the end of the four days on IV fluids, and with home treatments over a few weeks we eventually reduced his numbers to urea 27 (BUN: 76) and creatinine 316 (US: 3.57), where they stabilised for some months.

So even if you are dealing with category 4, I would recommend that you make sure that your cat is given a reasonable stint on IV, and is given a reasonable chance of success at home. Being at the vet's is very stressful for most cats, and they often need a few days at home convalescing before they begin to act better.

If Bloodwork Worsens After a Period of Stability Back to Page Index

If we take the analogy of a CKD cat falling over a precipice, what seems to happen to quite a few CKD cats is that the cat's bloodwork deteriorates in stages, like moving one step closer to the edge of the precipice; but the cat may remain stable at each step for some time. Thomas, for example, was in Stage 2 (see above) with a creatinine level of 318 (US: 3.57), nearly double what it should be, for six months; and he then moved a step closer, but still managed a couple of months with creatinine of 627 (USA: over 7) and had a very good quality of life during this period. Other cats may not show such extreme changes, with gradual falls that may be a year or more apart.

If your cat already has high numbers, and these worsen, try not to be too discouraged. Creatinine is not a linear measurement, so a worsening of creatinine that is already relatively high is not as sinister as it might first appear. The Diagnosis page explains more about this.

So if your cat's bloodwork has suddenly worsened, don't give up hope - if you review your treatment programme and add new treatments as appropriate (including a period on IV if the bloodwork values are high and your vet agrees) and work closely with your vet, you may well find your cat stabilises once again, albeit at the higher bloodwork values. If your cat's phosphorus levels worsen, it is particularly important to get these under control, because high phosphorus levels may make the CKD progress faster and also make many cats feel bad.

If Bloodwork Worsens Suddenly

Please do not panic if your cat's bloodwork worsens suddenly. Whilst this may indicate that the CKD is progressing, there are a number of other possible causes. Infections, particularly kidney infections, may cause a spike in bloodwork, as may kidney stones. An ultrasound can help determine if these issues are present.

Many cats with uncontrolled hypertension may have worsening bloodwork, which may improve once the hypertension is brought under control.

If your cat's phosphorus levels are high, it is particularly important to get these under control, because they may make the CKD progress faster and also make many cats feel bad.

If A Cat with Low Bloodwork Values Acts Sick

I would expect a cat with low bloodwork values (creatinine below 3.5, Stages 1, 2 and the lower part of Stage 3 of the IRIS classification system) not to appear too sick. These cats may have the occasional bout of vomiting or diarrhoea, and may sometimes not want to eat, but overall they should be doing quite well as long as they are not dehydrated and are eating enough.

Therefore if your low numbers cat is consistently off colour (lethargic and exhibiting general malaise) even after treatment for obvious problems, I would ask your vet about other possible causes. Many cats with hypertension feel off colour, but improve greatly once their blood pressure is back to normal. My Ollie had low kidney values (creatinine of 2.8) but had fairly regular diarrhoea. It turned out this was caused by hyperthyroidism and it disappeared once the hyperthyroidism was under control.

Some CKD cats who persistently exhibit general malaise despite treatment for obvious problems may have some kind of gastro-intestinal problem. Pancreatitis is a common cause in CKD cats; other possible causes include inflammatory bowel disease (IBD) or cancer (lymphoma). It would probably be worth considering an abdominal ultrasound in order to rule out such problems.

Treat the Cat, Not the Numbers

In Prolonging the life of the renal failure patient (2000), Waltham Focus 10 (3), Dr Jonathan Elliott states that "in a retrospective study, the correlation between plasma creatinine and survival in cats who presented with signs of stable CKD was very poor, with only 5% of the variation in survival time being predicted by the initial plasma creatinine concentration". So the bloodwork matters, but it is not the whole story. This leads us to the mantra of the Tanya's CRF Support Group: "treat the cat, not the numbers". Of course, it is still important to do what you can to improve the bloodwork and to treat whatever issues arise, because this will both make your cat more comfortable and increase his/her chances of survival. This mantra is simply a way of pointing out that many cats do astonishingly well despite their bloodwork results being poor. There are no guarantees and it is a fine line to tread, but it is usually worth trying treatments, although you must also consider your cat's temperament when deciding how much to fight the CKD.

Some vets consider levels in Stage 3 to indicate high numbers and therefore to carry a very poor prognosis; but on Tanya's CRF Support Group, these are actually considered to be "medium numbers", and in fact many list cats have lived three or four years or longer with Stage 2 levels. Cats with numbers in this range should really be considered as having renal insufficiency rather than kidney failure.

Dr Katherine James has mentioned that most people seem to opt for euthanasia when creatinine remains consistently in the 660-900 (US: 7.5-10) range, and the cat is doing badly. However, this is just a rough guide; cats in Stage 3, with very high numbers despite IV therapy and rehydration, may sometimes respond very well to treatment and enjoy several months of quality life, particularly if their numbers have worsened gradually over time, giving their bodies time to adjust to the reduced levels of kidney function. Even if a cat is in crisis at diagnosis, there may still be hope: Vet Info mentions a cat they treated who lived for eight years with CKD despite initially presenting in crisis (click on Kidney Failure - Daily Fluid Treatment). The Success Stories page tells the stories of some CKD cats who have managed to lead happy and in many cases, lengthy, lives at various stages of the disease, including one cat, Paris, who survived for over sixteen years.

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This page last updated: 3 November 2011

Links on this page last checked: 15 November 2011