WHAT YOU NEED TO KNOW FIRST
This page is a summary page. The goal is to explain:
This page has links to more detailed information about each issue that is mentioned. However, I recommend that the first time you visit this page, you read it in its entirety without following any of the links, so as to obtain a general overview of what lies ahead.
Feeling Overwhelmed? Let's Get Started Back to Page Index
You've just been told your cat has CKD and you are scared and frightened. So you found this site, and now, to add to your woes, you feel overwhelmed by all the information here. Clearly this is a complicated disease and you are not sure you can deal with it!
Well, take a deep breath because, honestly, it is not that bad. I had no scientific training at all when I first began dealing with CKD, in fact I was a linguist who was intimidated by scientific subjects, which I absolutely hated at school. But I did manage to learn about CKD, because it was essential if I was going to save Thomas's life; and you can do the same. Remember, knowledge is power! You need to be able to understand what is going on with your cat so you can obtain the most suitable treatments for him/her.
The primary goal when treating CKD is to help your cat feel better. Fortunately in most cases this is an achievable goal.
The secondary goal is to prolong life. This goal is secondary because there is not much point prolonging life if there is no quality to that life. However, since it is usually possible to help the cat feel better, obviously you want to then keep your cat with you as long as you can.
The good news is, you won't need to learn everything at once; and you certainly won't need to learn as much as I have. This site aims to cover every eventuality regarding CKD, because each cat presents with a different set of symptoms, so including them all helps new readers spot the issues that apply in their particular case; but you are highly unlikely to be faced with all the symptoms or need to use all the treatments. Here are some possible scenarios:
Whatever problem you are facing, in most cases it will be treatable. Yes, CKD is scary at first, but given time you should find that it becomes a manageable part of your lives. Most people find they quickly get into a routine and only need to find maybe 10-20 minutes a day to help their cat, including time needed to give fluids at home if necessary.
If even this page looks too overwhelming, try the Key Issues page instead. This page talks about what the tests mean, what symptoms you might be seeing and which treatments help. The Key Issues page simply gives a short overview of the most important things to focus on to help your cat feel better and increase his/her chances of survival. After you've read it, you can always come back here for more detailed information or dip into the other pages of the site.
Is There Any Hope? Back to Page Index
CKD is a progressive disease of the kidneys. This means the kidneys gradually get worse, they do not suddenly seize up and stop functioning, it can take years. Also, don't panic if your vet says your cat has lost a massive amount of kidney function - it is not usually possible to diagnose CKD until at least 66% (two thirds) of kidney function has gone, and many cats are not diagnosed until 75% or even more has gone. Some cats manage quite well on extremely limited kidney function (less than 10%), so take a couple of weeks to see if your cat is one of them.
If your cat has high blood test results at diagnosis, there could still be hope. Cats often have off the scale test results when first diagnosed, but these results may not accurately reflect the true situation. Numbers can be artificially elevated if the cat is dehydrated, has an infection, has kidney stones or has high blood pressure. So again, take a couple of weeks to treat any problems that are present and then see how things stand.
Below I give an overview of which tests will help you spot possible problems, which symptoms are commonly seen, and which are the most helpful treatments.
I Don't Know What the Test Results Mean or Which Are Important Back to Page Index
The tests which your vet runs will confirm the existence of CKD, and give some idea of how bad your cat's case is. Most people don't have the faintest idea what most of the test results mean, so to get you started, here is a summary which tells you what the main test results mean and what sort of symptoms they may cause. If you would prefer a very short summary, The Cat Practice has a brief overview.
You should ask your vet for a copy of all the tests that are run, because these are helpful if you join Tanya's CKD Support Group. However, you can still join even if you do not yet have a copy of your cat's test results.
Your vet will probably run :
You will probably have 1-2 pages of results, but the six items discussed below are the most important for you to understand at the beginning. If your cat's results show other items that are out of range, such as calcium, you should be able to find more information about these in the Diagnosis section.
If your vet has not addressed any results which are out of range, be sure to ask them why. Not everything needs treating (high cholesterol, for example, is not a worry in cats as it is in humans) but the items mentioned below do need treating.
The USA uses a different measuring system to the rest of the world. Tanya's CKD Support Group tends to use the US measurement system, so if you join, you will get more responses if you convert your international values to American ones. The Veterinary Information Network converter will do this for you. Scroll down the list to find what you want to convert (e.g. creatinine) and enter your cat's value in the "Enter SI Units to Convert to US Units" box. There is no need to convert potassium or PCV/HCT, which are the same in both systems.
If you are in the USA, you should see blood urea nitrogen (BUN) on your cat's bloodwork. In Europe, you will probably see urea listed instead, which is not exactly the same thing but very close.
BUN is one of the two main measures of kidney function (the other one is creatinine). In a cat with CKD, BUN will normally be elevated. BUN is a by-product of the breakdown of dietary protein during the digestive process. The kidneys filter it out of the blood and excrete it via urination. BUN rises in CKD because the damaged kidneys are no longer able to excrete it efficiently, so it builds up and makes the cat feel poorly. BUN is not a toxin in itself, but if it is elevated, then the chances are high that actual toxins (which are difficult to measure, but which make the cat feel poorly) will also be elevated. BUN can also rise for other reasons though, such as dehydration, stress or a high protein diet, so it is not an entirely accurate measure of kidney function by itself.
It is important to try to control high levels of BUN because they can cause lack of appetite, excess stomach acid, nausea and vomiting.
You can read about BUN in more detail in the Diagnosis section.
Creatinine is another waste product excreted through the kidneys. It is generally considered to be a more accurate measurement of underlying kidney function than BUN or urea because it is less affected by diet, stress and dehydration.
Because creatinine is the basic measure of kidney function, you will probably not be able to reduce it to within normal range in a CKD cat, but that does not mean that it cannot reduce from the level you see at initial diagnosis. If you treat CKD effectively, it may well lead to improvements in creatinine levels, so try not to panic if your cat has high levels to start with.
You can read about creatinine in more detail in the Diagnosis section..
Phosphorus and calcium are minerals which are important for nerve function, muscle contraction and bone formation. A healthy body has a natural balance between levels of phosphorus and calcium. CKD kidneys can no longer excrete phosphorus properly so levels of phosphorus rise (hyperphosphataemia), which can then adversely affect the cat's calcium levels, with potentially serious consequences (see secondary hyperparathyroidism). Not only that, but high phosphorus levels may make the CKD progress faster and can make a cat feel lousy. So controlling phosphorus levels is one of the most important steps in managing CKD and helping your cat feel better.
Symptoms of high phosphorus levels may include weakness, an unsteady walk, itching and scratching, loss of appetite, twitching and weight loss.
Your vet may say that your cat's phosphorus levels are within normal limits, but the high end of the normal range actually applies to kittens rather than to adult cats, particularly those with CKD. You should aim to actively control phosphorus levels once they are above 1.9 mmol/L (US: 6 mg/dl). This can be done by feeding a low phosphorus food (usually a prescription diet) or by adding odourless, tasteless phosphorus binders to your cat's food, see below.
You can read about phosphorus in more detail on the All About Phosphorus page.
Potassium is an electrolyte (a type of salt), which the body needs in order to function properly at the cellular level. If potassium is out of balance, it can affect the muscles, including the heart.
Cats with CKD usually urinate a lot, and may also vomit, and this can cause loss of potassium, leaving levels low in the cat's body. However, a few CKD cats have the opposite problem of too high levels of potassium, particularly if they have high creatinine levels.
Low potassium levels (hypokalaemia) can have various effects, such as weakness (especially in the back legs), twitching, hoarseness or constipation. Severe cases may be unable to lift their heads or have a stiff neck.
Although the range for potassium often starts at around 3.5, for CKD cats it is often recommended to treat low potassium levels when they fall below 4.0 mmol/L (US: 4.0 mg/dl). The goal is to have a level of around 4.4 mmol/L (US: 4.4 mg/dl) or a little higher. The usual treatment method is a supplement in the form of a pill, though it does come in other forms too if your cat is difficult to pill.
Not all CKD cats have low potassium levels. Cats with a level of 4.4 or higher do not usually need supplementation of potassium. Cats with high levels of potassium (over 6.0) may experience twitching, seizures, and in the worst case scenario, even a heart attack.
There is information below about treating high or low potassium levels.
You can read about potassium in more detail on the All About Potassium page.
Acidity levels in the body tend to rise in CKD cats i.e. the bodyís pH becomes too low Ė this is known as metabolic acidosis. It is not the same thing as stomach acid, which is excess production of acid in the stomach only.
Unfortunately many vets do not watch for metabolic acidosis routinely, which is partly because it can be hard to measure. TCO2 or total carbon dioxide in the blood is the most accurate way to diagnose metabolic acidosis but TCO2 has to be measured on a special blood gas machine, which not many vets and not all laboratories have. If your vet or his/her laboratory cannot measure TCO2 at all, your vet may be able to test for carbon dioxide (CO2) levels instead - if they are low, they may also indicate metabolic acidosis.
Metabolic acidosis can have a variety of effects, including muscle wasting, a bony spine, back leg weakness, vomiting, mouth ulcers, twitching and seizures, so it is very important to diagnose and treat it if it is present.
Treatments may include fluid therapy, potassium citrate or bicarbonate of soda.
You can read about metabolic acidosis in more detail on the Metabolic Acidosis page.
The kidneys produce a hormone called erythropoietin, which stimulates the bone marrow to make red blood cells. Damaged CKD kidneys may no longer perform this task properly, and if red blood cells are not made, anaemia is the result.
PCV and HCT are both used to measure anaemia. Your vet will run one test or the other. PCV is not quite the same thing as HCT; but the difference between the two is too small to be concerned about.
Technically, a cat is anaemic if his/her PCV level is below 30% (or with some laboratories, 25%), but you may not start to see any differences in your cat's behaviour until the level is in the low 20%s. Dehydration will make PCV look higher than it really is, so once a cat is rehydrated, PCV will often have fallen.
Symptoms of anaemia include weakness, loss of appetite, heavy breathing, feeling cold, eating litter or licking cement.
It is essential to treat anaemia. Cats with a PCV or HCT below 20% have severe anaemia, and you have to treat it quickly, because untreated severe anaemia can be life threatening. Cats who are severely anaemic may appear very ill (though some of them adapt to the anaemia if it happens gradually, and cope quite well), but you should see a dramatic difference once the anaemia is under control. Treatments include iron or vitamin B supplements for milder cases, or the use of a synthetic hormone replacement known as ESAs (trade names are Epogen, Procrit or Eprex) for more serious cases.
You can read about anaemia in more detail on the Anaemia page.
Hypertension (high blood pressure) is very common in CKD cats, because the kidneys produce renin, which controls blood pressure, but damaged kidneys may not do this effectively.
High blood pressure is very dangerous - it can cause strokes, seizures and blindness, and may even kill; but since it has few visible symptoms until a crisis occurs, it really needs to be measured with a blood pressure monitor.
Unfortunately, many vets do not have the equipment to measure blood pressure (even though it only costs about US$1000). Do ask your vet if s/he has this equipment, and if so, make sure s/he uses it to check your cat's blood pressure. If they do not have it, politely ask them to consider investing in it, and then call around other vets in your area (or ask your vet to do so) to see if you can find somebody who can measure your cat's blood pressure. If you cannot find anybody to measure it, check the All About Hypertension page for alternative checks, though they are far from ideal.
If blood pressure is consistently over 160, it should be treated. This is easily managed through the use of a medication called amlodipine (known as Norvasc in the USA and Istin in many parts of Europe).
This is a test of your cat's urine. It may include a check of urine specific gravity (USG), which tells your vet how dilute your cat's urine is (CKD cats usually have very dilute urine). It often will also give the vet some information on whether your cat has a urinary tract infection (UTI). Urinalysis also can show if a cat has proteinuria (protein leaking into the urine).
You can read about urinalysis in more detail in the Diagnosis section.
Sometimes vets want to run an ultrasound of a cat's kidneys. This can be helpful if a cat has larger than expected kidneys (which may indicate cancer, a blockage of some kind or a genetic disease known as PKD), or if you suspect a kidney infection. However, in many if not most cases of CKD, an ultrasound merely confirms that a cat has CKD and adds nothing to the overall treatment plan. If this is the case for your cat, it is probably worth passing on an ultrasound and saving your money.
You can read about ultrasound in more detail in the Diagnosis section.
There are a number of other tests which are occasionally offered, and you can find more information about them in the Diagnosis section.
So Just How Sick is My Cat? Back to Page Index
Most people panic if their cat's results are out of normal range, especially if they are many times higher than they should be. They are not exactly reassured when their vet then says "your cat only has x% of kidney function remaining." If the vet then uses the old style terminology, chronic renal failure, the word "failure" also terrifies most people when they first hear it.
Take a deep breath. Here are some crucial points to remember:
The How Bad is It? page gives you some idea of how serious your cat's bloodwork results are but remember, these are not the be-all and end-all. How sick your cat is depends upon whether s/he is in crisis or not at diagnosis, and also on how well your cat copes with CKD - some cats can cope astonishingly well with horrible bloodwork.
Below I talk a bit more about some common scenarios when you first get the diagnosis:
Many cats who are diagnosed with CKD are in crisis (known as "crashing"), often because of severe dehydration. CKD cats tend to urinate more as their kidneys deteriorate. They then drink more to compensate for the increased urination, but eventually they can no longer drink enough to keep up with the fluid lost from dehydration, and they crash.
Before you go to the vet (which you should do as soon as possible if you think your cat is crashing), here are some of the signs you may see:
When you reach the vet, and bloodwork and other tests are run, you will usually be told that your cat's bloodwork values are very high. This occurs because severe dehydration artificially inflates most of the values.
I cannot emphasise this enough: it does not matter how bad your cat's values are at initial diagnosis, particularly if s/he is severely dehydrated. You have to wait and see what they look like when the cat has been stabilised. My Thomas's BUN was 241 mg/dl at initial diagnosis (the top of the range was 36) yet he pulled through.
If your cat is in crisis, the first thing to deal with is the dehydration. This will usually be treated via intravenous (IV) fluids (a drip), which requires hospitalisation for a few days. Personally, I would want to put any cat of mine with creatinine of over 6 on IV for 3-4 days (one day is not enough). As the cat becomes rehydrated, s/he should gradually start feeling and acting a little better, though some cats do not do well as in-patients and will only turn the corner once they return home.
The cat may continue to exhibit a loss of appetite, so it is essential that sh/e eats, via assist feeding if necessary. Since cats with high BUN tend to have problems with excess stomach acid, ask the vet to treat this (the excess stomach acid) too.
A cat with high bloodwork will almost certainly have high phosphorus levels, and may also have anaemia, though anaemia may not be apparent in blood tests until the dehydration has been corrected. Hypertension (high blood pressure) may also be present. Treatment needs to be started for all of these as appropriate. I do not advise starting benazepril (Fortekor) treatments for cats with high creatinine levels.
Your cat may still have high numbers when you bring him/her home, but don't panic, they may continue to fall with a home treatment programme, as happened to our Thomas. Once your cat is home, you can follow the advice for the stable cat below.
If your cat is not in crisis, then creatinine levels will usually be 300-350 or below (USA: 3-3.5 or below). Yes, those numbers are still a lot higher than they should be but really, they are considered medium level numbers. They may even be higher - some cats cope better with high numbers than others.
Whatever the level, if your cat is not in crisis and dehydrated, then it is highly unlikely that your cat needs IV fluids. I have heard recently of some vets putting non-crashing cats with creatinine of 300 (USA: 3) or lower on IV fluids, which seems like overkill to me - chances are these cats do not even need regular subcutaneous fluids, let alone IV fluids; plus it is much cheaper for you and less stressful for your cat if you can avoid IV fluids.
However, you will probably need to begin a home treatment programme. This need not be particularly complicated if your cat has been diagnosed early enough. In that case, you will probably merely need to focus on the things that will keep your cat stable (e.g. controlling phosphorus levels, and, for cats with creatinine over 300 (USA: 3.5), perhaps giving sub-Q fluids regularly to prevent dehydration), and comfortable (e.g. controlling constipation or excess stomach acid). Basically, you need to check the bloodwork and symptoms, see what issues may be a problem, and take the appropriate action.
Most people find they only need to spend 10-20 minutes a day dealing with their cat's additional CKD needs, and that includes time spent giving fluids (which not all cats need immediately). If you focus on any problems that are present and have a bit of luck on your side as well, you should soon see a big improvement in your cat's wellbeing. For more detailed information on the symptoms which you might be seeing, see the Index of Symptoms and Treatments page.
Even when a CKD cat is stable, it is normal for him/her to have the occasional bad day, particularly when first diagnosed. Try not to panic if this happens, just try to treat anything that may be contributing to the problem (e.g. if your cat is constipated, s/he won't feel great) and with luck you will find that once any problems are under control your cat will have a reasonable quality of life overall.
However severe your cat's case may be, if I were to give you only one piece of advice, it would be to make sure your cat eats. Cats who go just a short time (a day or two) without eating are at risk of a condition called hepatic lipidosis, a potentially life threatening liver problem. Not eating can also worsen dehydration and make the cat very weak; whereas food in the stomach can often make a cat feel better and stronger. See below and the Persuading Your Cat To Eat page for information on getting food into your cat.
Recently I have been hearing from more and more people whose cats have only just been diagnosed, yet the vet is already recommending euthanasia. I hear things like "the vet said my cat has anaemia and it's untreatable, so I should put him to sleep", or "the vet says his bloodwork is so high that it can never reduce to a reasonable level" (this even for cats with creatinine of around 300, or 3.5 in US terms), and of course the classic "he's very sick, and it would be the kindest thing to do".
Often these vets do not even offer any IV (intravenous fluids) treatment for high number cats, or if they do, they only offer one day, tell the person their cat's numbers have not improved after that short stint, and recommend euthanasia. In some cases people are told even before their cat is placed on IV that if s/he does not respond within 24 hours, they have to put their cat to sleep.
I'm not in the business of vet-bashing, but this trend does give me pause for thought. No vet has a crystal ball. And CKD cats can look horribly ill when they are first diagnosed, particularly if they are dehydrated. I was dehydrated myself one time following surgery, and I definitely looked as bad as I felt. Note I say that I felt bad; but I was not in actual pain. CKD is not generally considered to be a painful disease (although end stage PKD, a genetic kidney disease, may be painful if some of the cysts rupture, but this is rare). Dehydration basically feels like a bad hangover, with a bad headache and a queasy stomach. CKD cats often have excess stomach acid, so that feels like stomach ache. They may be constipated, and may have anaemia which makes them feel weak. But none of these things is outright painful. And all of these things are treatable, in fact often relatively simple treatments can soon make a CKD cat feel and act much better.
So I would say that in most cases, you should definitely try treatments, for a period of two weeks if not longer, before opting for euthanasia. And if your cat has high bloodwork levels, then one day on IV fluids is simply not long enough to decide whether a cat is going to turn the corner or not! Read the rest of this page, particularly the Cat in Crisis section, see what problems your cat is experiencing, and do your best to treat them. I cannot promise that treating your cat is going to work. But there is a pretty good chance that it will. And even if it doesn't, at least you would have the peace of mind of knowing that you tried your best. And remember: it is not the vet's decision to put your cat to sleep, it is yours.
Commonly Seen Symptoms Back to Page Index
This is a short list of symptoms which may be seen in CKD. Some of these problems, such as constipation, are not life threatening, but they can make a big difference to how well a cat feels. Others, such as not eating, can cause severe problems if left untreated.
The classic symptom for a CKD cat is to vomit clear foam, which is usually caused by excess stomach acid. Other causes of vomiting include metabolic acidosis, or using certain types of antibiotics. Occasionally vomiting is caused by constipation, particularly if your cat vomits immediately after using the litter tray. If you are giving your cat sub-Q fluids and s/he regularly vomits after fluids, this may because of the type of fluids used.
Many CKD cats suffer from excess stomach acid or, in severe cases, stomach ulcers. If creatinine and particularly BUN/urea are elevated, itís quite likely your cat has this problem too. If your cat's stomach gurgles a lot, or if your cat has little appetite or vomits clear foam, or grinds his/her teeth, or rests his/her head over the water bowl, then you should suspect that stomach acid is present. Sometimes the cat will appear to want to eat, but will sniff the food, then walk away (this may also be a sign of mouth ulcers).
The toxins produced by the body can cause ulceration. Mouth ulcers may also be a sign of metabolic acidosis. You may see ulcers in the cat's mouth if you look inside, or in severe cases your cat may vomit blood (which may also be a sign of bleeding from further down the gastro-intestinal tract).
Mouth ulcers are painful for the cat and often lead to a lack of appetite, or a desire to eat coupled with an inability to do so - the cat may approach the food bowl and sniff the food, then walk away.
Many CKD cats are weak at initial diagnosis. This may be because they are dehydrated, or anaemic. Other possible causes include high phosphorus levels, low potassium levels, metabolic acidosis, constipation and calcium imbalances. If you and your vet can work out what the cause is and treat it appropriately, you should find that this symptom improves greatly.
The dehydration that accompanies CKD may cause constipation. Symptoms - apart from the obvious one of no poop in the litter tray - may include an ungainly walk, vomiting after using the litter tray, loss of appetite, pooping outside the litter tray, and, surprisingly, diarrhoea. Constipation can usually be treated easily and quickly.
CKD cats often howl, especially at night. Howling is commonly caused by high blood pressure. It may also have other causes such as toxins, deafness, hyperthyroidism, or occasionally just old age and possibly cognitive dysfunction (senility). Certain medications such as periactin (Cyproheptadine) or mirtazapine (Remeron), both appetite stimulants, or anabolic steroids, can make a cat become vocal.
This is really common in CKD cats. Common causes include excess stomach acid, high phosphorus levels, dehydration, constipation, fluid retention and loss of sense of smell. Many cats refuse to eat the CKD prescription diets in particular. Treating the cause will usually help, though some CKD cats will always need encouragement to eat.
This is a classic sign of anaemia, though it may also occasionally be seen in cats with calcium imbalances. It should stop once the anaemia is under control.
Twitching is relatively common in CKD cats. Causes of twitching include high phosphorus levels, high or low potassium levels, calcium imbalances (especially head twitching), hyperthyroidism or Vitamin B deficiency. Twitching may also be caused by toxin levels. If your cat only twitches while you are giving fluids, it is probably caused by either the type of fluid used or by giving cold (room temperature) fluids.
Sometimes CKD cats go blind, and this may happen suddenly. Look at your cat's pupils and check whether they are enlarged or very black, even in bright light. If so, don't panic. The most common cause of blindness in a CKD cat is hypertension (high blood pressure), but if you start the correct treatment (a drug called amlodipine - Norvasc or Istin) as quickly as possible, your cat has a reasonable chance of regaining his/her vision.
If the symptom you are interested in is not here, check the lengthy list of possible symptoms on the Index of Symptoms and Treatments page, together with detailed links to possible causes and appropriate treatments. And don't panic, you are not going to be faced with all these problems!
Commonly Used Treatments Back to Page Index
The following is a list of some of the treatments which you may be offered. If you are in the UK, I can virtually guarantee that you will only be offered a prescription diet, Fortekor, and occasionally Renalzin or Ipakitine; but many of the other treatments are equally, if not more important, depending upon your cat's condition.
Diet is a popular way of trying to treat CKD. Your vet may prescribe a prescription diet, which is a food that is relatively low in protein and phosphorus, and has other benefits. If your cat will eat these foods, then by all means feed them, though try to introduce them gradually, which increases the chances of your cat accepting any new food.
Unfortunately, loss of appetite is very common in CKD cats, and these foods can be a little dry and many cats find them lacking in flavour. Your vet may tell you it is essential that your cat only eats this food, but cats who go just a short time (a couple of days or so) without eating are at risk of hepatic lipidosis (fatty liver disease) where the liver starts to function abnormally; this can happen after just a day or two of not eating, and can be life-threatening. Mar Vista Vet has more information about this. So if your cat refuses to eat the prescription food, don't panic - not eating is far worse for him/her.
If you are in the middle of a crisis, feed whatever your cat will eat Ė baby food (without onion), Hill's a/d. Anything to get some nourishment into him/her. See the Persuading Your Cat To Eat page for tips.
Also try to treat any possible problems, such as excess stomach acid, anaemia, etc., - once these are under control, you may well find that your catís appetite returns.
You can look into getting your cat onto a better diet once s/he is more stable, but be sure to introduce any new food gradually. If you do not succeed, you don't need to despair: it is still more important that your cat eats than that he/she eats prescription foods. In fact, the current thinking is that feeding a low protein diet might not be appropriate for cats in the earlier stages of CKD (see Nutritional Requirements). However, once BUN (urea) is consistently over 60-80, most cats tend to feel better with less protein in the diet to process.
your cat refuses to eat any prescription foods, aim at least to feed a food
low in phosphorus. There is a lot more information on the
Which Foods to Feed
Cat To Eat pages.
Vitamin B is a water-soluble vitamin, and is often lacking in CKD cats, who lose much of their Vitamin B through urination. A lack of vitamin B may be related to a lack of appetite, or occasionally may cause twitching or itching. Vitamin B deficiencies are also known to cause non-regenerative anaemia. Your vet may therefore suggest a supplement in order to avoid these problems. British vets often give Vitamin B injections, but you can also give Vitamin B orally.
In contrast, additional doses of Vitamins A, C and D are not appropriate for CKD cats.
Please see Nutritional Requirements for more information about vitamins.
The most effective treatments for excess stomach acid are slippery elm bark, from health food stores (see Holistic Treatments) and/or a drug called famotidine, trade name Pepcid AC (not Pepcid Complete).
With Pepcid AC, you usually start with a quarter of a 10mg tablet once every other day, but if necessary you can go up to a quarter of a 10mg tablet twice a day (all with your vet's approval, of course).
In some cases, you will also need anti-nausea medications.
The All About Stomach Acid page has more information about excess stomach acid, nausea and vomiting
If your cat's phosphorus level is above 6 mg/dl US or 1.9 mmol/L international, and you are not feeding a prescription diet, you should ask your vet about using a phosphorus binder. Phosphorus binders bind with the excess phosphorus in cat food and therefore reduce the load on the kidneys. They must be given with food in order to bind properly, and ideally an hour or so apart from other medications.
The phosphorus binder which binds best is aluminium hydroxide. Many vets are not aware that this can be obtained in odourless and flavourless formulations and simply added to the cat's food without the cat knowing.
In the UK, you may also be offered a binder called Renalzin, which is relatively new but it seems to be effective.
You may be offered a binder called Epakitin or Ipakitine but this is not always the best choice. Another common choice by vets is Alternagel, but this is peppermint-flavoured, which most cats hate.
In some cases, you will also need a phosphorus binder even if you are feeding a prescription diet if the levels do not reduce far enough, but I would try the diet two weeks on its own first to see if it is sufficient.
The All About Phosphorus page explains more about phosphorus control.
This is present in up to two thirds of CKD cats, so do ask your vet to monitor your cat's blood pressure; many do not do so routinely. If your cat has suddenly gone blind, the most common cause is hypertension; and if you act quickly enough, your cat may be able to regain some or all of his/her sight.
Even if your cat has not gone blind, if hypertension is present, it must be treated. The treatment of choice for CKD cats with hypertension is a drug called amlodipine (trade names are Norvasc or Istin) This is very well tolerated by the majority of cats, is less likely than some other treatments to cause the opposite problem of low blood pressure, and is the only treatment which gives your cat a chance of regaining his/her sight if it has been lost.
You can read about high blood pressure in more detail on the All About Hypertension page.
If you are in any country other than the USA, your vet will almost certainly prescribe a drug called benazepril (Fortekor, or Lotensin in USA). Occasionally in the USA vets prescribe a similar medication called enalapril (Enacard).
These drugs are actually heart medications known as ACE inhibitors. Some recent studies into the use of benazepril in particular indicate that these drugs may help with CKD, at least in the early stages, and therefore benazepril is approved in Europe and Canada for the treatment of chronic renal failure in cats.
There are pros and cons in using ACE inhibitors to treat CKD. My main concern is that when first used, these medications may cause an increase in creatinine, which might be enough to push a cat with high bloodwork over the edge.
If your cat has hypertension, particularly if s/he has gone blind, ACE inhibitors are not what you need: a drug called amlodipine (Norvasc or Istin) is the drug of choice for CKD cats with hypertension, and may enable your cat to regain his/her sight.
For more information about using ACE inhibitors, please see the Treatments section.
If you are in the UK and other parts of Europe, you may be offered steroids. If you are in the USA, most vets do not seem to use steroids routinely.
Steroids are intended either as an appetite stimulant or as a general pick me up, but they do have possible risks. I did find Thomas did better overall on steroids but he was extremely ill when first diagnosed; cats who are diagnosed early probably would not benefit particularly. You should familiarise yourself with the possible risks before deciding whether to use them.
For more information about using steroids, please see the Treatments page.
If your cat is severely dehydrated with high blood values at diagnosis, then regardless of your location, your vet will probably offer intravenous (IV) fluid therapy (a drip) to rehydrate your cat.
If your cat has lower numbers upon diagnosis or following IV treatment, but the creatinine is over 300 (US: 3.5), you will probably find that he/she does better with regular subcutaneous fluids (known as sub-cuts in the UK) to help prevent dehydration. Unfortunately, whilst subcutaneous fluids (sub-Qs) are routinely offered in the USA, they are very uncommon and hard to obtain in Europe.
Most cats receiving sub-Qs need about 100ml a day, no more. Your vet can show you how to give sub-Qs to your cat yourself at home, and they can really help to make your cat feel better, although you do need to be sure that your cat does not have a heart condition before using them.
If your cat has creatinine below 3-3.5, the chances are that s/he can maintain hydration without sub-Qs. Sub-Qs are a strain on the kidneys, so there is no point giving them before the benefits outweigh the risks. If your vet recommends them for a cat with creatinine below 3-3.5, ask why.
See Fluid Therapy for more information.
Slippery elm bark, which as mentioned above can help with stomach acid, can also be made into a syrup and used to help heal mouth ulcers - this has been found to be a very effective treatment by many people. See Holistic Treatments for more information about slippery elm bark and how to make the syrup.
For severe mouth ulcers, antibiotics may be necessary; while for really obstinate ulcers, you may need to consider using a treatment called sucralfate, which forms a protective coating over the ulcers and allows them to heal. Trade names for this drug include Antepsin in the UK, Carafate in the USA and Ulcogant in Germany.
The Treatments page has more information about treating mouth ulcers.
If your catís level is 4.0mmol/L (US: 4.0mg/dl) or lower, ask your vet for a potassium supplement Ė the most common one is Tumil-K. However, do not give potassium supplements without your vet's knowledge and approval - high potassium levels can be dangerous. See All About Potassium for more information.
If your cat's potassium levels are high, the first thing to do is to run another blood test because the most common cause of high potassium levels is an error in the measurement. If your cat really does have high potassium levels, the All About Potassium page has more information on how to deal with this.
This means the cat's pH levels are out of balance, causing excess acidity. If your catís bloodwork contains something called TCO2 or CO2 and this is below 15, ask your vet about using bicarbonate of soda or potassium citrate to help with this problem. See Metabolic Acidosis for more information.
There are two commonly used appetite stimulants in cats, cyproheptadine (Periactin) and mirtazapine (Remeron). They are usually very effective, but may have side effects, such as making the cat agitated, causing howling etc.
Whilst these medications may stimulate your cat to eat, it is better if you can find the cause of your cat's inappetance and treat it. But appetite stimulants can certainly be a useful tool for inappetance at initial diagnosis.
The Persuading Your Cat To Eat page has more information about appetite stimulants.
Azodyl is essentially a type of probiotic. Probiotics are commonly used to re-balance the bacteria in the gut, particularly after using antibiotics - there is more about them in the antibiotics section.
Azodyl contains strains of three patented types of bacteria, and the manufacturers of Azodyl claim that their strains of these bacteria have a particularly high affinity for some of the major uraemic toxins found in CKD. Azodyl is intended to bind with and reduce the levels of these uraemic toxins in CKD cats.
I have heard reports from several people who have used Azodyl. Most people seem to think it has helped their cats, though one person said that it made his cat vomit, and some people think it did not make any difference.
Azodyl is currently only available in the USA and Canada, although it can usually be shipped to other countries if required.
There is more information about Azodyl in the Treatments section.
Antibiotics are not routinely used in CKD, though some vets appear to prescribe them routinely. However, they may well be necessary for cats with urinary tract or kidney infections, dental infections or severe mouth ulcers.
The Treatments section has more information about antibiotics.
If your catís PCV or HCT level is below 30% (25% for some laboratories), your cat has anaemia. Treatment depends upon how severe the anaemia is:
Meloxicam is a non-steroidal anti-inflammatory drug (NSAID). It is a very effective painkiller, but unfortunately when given in too high a dose, in some cases it may lead to acute kidney injury. If your cat is taking meloxicam when or shortly before CKD is diagnosed, ask your vet about stopping it with immediate effect. There is more information about meloxicam here.
Financing Treatment Back to Page Index
It is all very well knowing about the treatment options available, but that can be very depressing if money is a factor, as it is for most people. It can be particularly horrifying if your cat crashes and requires hospitalisation - some large city hospitals charge a fortune for such services.
The good news is that you should not need all the treatments described above; and for home treatments, it is usually possible to purchase most of the supplies you require cheaply online. For the average cat who needs sub-Q fluids, phosphorus binders and treatments for excess stomach acid or constipation, it is often possible to spend as little as US$5 a week treating your cat once s/he is stable. Other treatments, including Epogen which many vets believe costs up to $300 a vial, can also be obtained cheaply - a vial of Epogen bought online, if you know where to look, costs as little as US$30.
The Coping with CKD page gives tips on coping with the financial burden and finding ways of paying for your cat's care, whilst the Obtaining Supplies Cheaply page gives details of reasonably priced suppliers in UK, Canada and USA.
Pat's Great Advice for Those New to CKD Back to Page Index
That is your crash course in CKD. Unfortunately I know you are probably still feeling overwhelmed, so here is some advice for you from Pat, who has been in your shoes. Pat cared for her cat SEM when he had CKD. In early 2006, she wrote a wonderful message to a person with a newly diagnosed CKD cat. She says it all so well here, far better than I could, that I asked her if I could repost her message here.
"I am sorry you have a need to be here but you have come to a good place. First, I can't think of a single individual who hasn't landed here in an emotional heap. It seems not to matter the numbers of the cat or the circumstances of the individual, everyone is devastated.
"So... your sweet cat is exactly the same cat the day before the diagnosis as the day after. The only thing that has changed is information in your head. These cats set such very fine examples for us - if they're feeling well, all is well. If they're not feeling well, they need some help. My advice is to face the fear squarely, see it for what it is, and know that it has now moved in with you. But it doesn't require your attention, let it simmer away on the back burner with the lid on and do as it will. In the meantime, you can educate yourself by reading the overwhelming CRF site bit by bit so you can get a jump on anything that develops. That old stitch in time saves nine :-)
"There is no cure for CRF (at present). And life itself is a terminal condition. There's simply nothing to be done about that. But there is something to do about cats and CRF and that something is to learn about kidneys and their function and what helps and what doesn't and what shouldn't be done. In the meantime, your girl will not be worrying her pretty head, she will be doing normal cat things :-)
"Do get a copy of your blood work and post the numbers to the group (with normal ranges included), and keep copies of all tests and lab reports etc. It is hard dealing with a chronic condition, which is why I urge you to deal with the crux of the matter now and set it aside. There's no way to avoid going up and down emotionally with these cats, that will happen as a matter of course, but if you can, see your cat as very much alive because she is and should remain so for a good long time to come with your attention and love. And her heart is doing the beating, her lungs the breathing, her tongue the washing up. Life still courses through her. If you go crazy, she will have lost a loyal and articulate ally. We surely don't want that to happen:-)"
One Last Word Back to Page Index
One last word from me, Helen.
I know CKD is a scary diagnosis - I've been there three times. The first time, with Tanya, I was not online and although I tried to help her, in retrospect there was so much more I could have done to help her.
It is different for you. You have this website. By all means feel frightened, but then tell yourself you are going to do your best to help your cat. Read the site. Educate yourself about the basic issues above. In the vast majority of cases, there is hope. You can do it!
This page last updated: 06 February 2012
Links on this page last checked: 06 February 2012
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.
I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.
If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.
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