When people first receive the CKD diagnosis, they usually have two main
How bad is my cat's case?
How can I best help my cat
How Bad Is It?
page can help you with the first question. This page aims to help with
I have written this page because although this website is relatively simple in its design, it is also
extremely comprehensive, and sometimes people feel overwhelmed at
initial diagnosis and just want a CKD primer. Here I am giving you the
key issues on which to focus in order to help your cat feel better and
give him/her the best chance of survival.
Don't be concerned when you see how many key issues there are.
Many cats will not need all of them to be managed immediately, and indeed they may
never have problems with some of them, such as kidney stones. However,
any problem that is listed here needs to be taken seriously if present.
There are many treatment options
competing for your money. If your cat has just been diagnosed, or
his/her condition is worsening after a period of stability, you may be
tempted to buy some of these products, hoping for a miracle cure.
Unfortunately, although many of these treatments are quite
expensive, very few of them are essential, and most of them are
unproven. Please see the
page to ascertain which treatments are essential.
So take a deep breath, and start learning about CKD. The page is divided
into two categories (some do overlap):
I suggest you read
this page all the way through the first time, so you get an overview of
the main issues that you may need to deal with. Then you can go through
it all again and click on the links which take you to more in depth
information on the topics which affect you at the moment.
Helping Your Cat Feel Better
The goals of this website are to help your cat feel
better and ideally to live longer. I have deliberately put feeling better
first: who wants to live longer if they feel terrible? Fortunately CKD is
not generally considered to be a painful disease, but there are still
things to try to make your cat feel more comfortable and therefore
Think about that for a moment.
Many CKD cats do not die because they have CKD. They die because they are
allowed to starve to death! Are you going to allow your cat to starve to
death? I doubt it!
Food is life. Nobody can live
long without it. So the first rule is:
GET FOOD INTO YOUR CAT!
Now by food, you may think I mean a
therapeutic kidney diet. I know your vet may have told
you that your cat simply must eat such a food, that anything else
will kill him or her. Eating that food is certainly the ideal. If your cat
will eat it, fabulous! Feed it to your cat happily.
However, if your cat falls into the
extremely large category of cats who would rather starve (literally) than
eat therapeutic kidney foods, then don't force the issue. You may
eventually be able to get your cat onto a diet appropriate for a CKD cat,
but it takes time, and you don't want your cat to not eat in the meantime.
if you allow a cat to go without eating, s/he can quickly develop a
condition called 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.
The American Animal Hospital Association
recommends that you should contact your vet if your cat has not eaten for
one or two days.
Mar Vista Vet
has some information about hepatic lipidosis, and mentions that a cat who
has eaten only half to three quarters of his or her normal food intake for
two weeks is also at risk.
So if your cat has not eaten today,
then right now, right this minute, I would like you to go and give your cat
some food s/he is
prepared to eat. Just make sure it doesn't contain any
garlic or onion.
If you are in the USA, there is a good
chance your cat will be prepared to eat Fancy
Feast Classic. This food is too high in phosphorus to feel long term, but as
a one day thing, it should be fine. Or try
food - many cats will eat this when they will eat nothing else. Or
simply feed your cat's favourite food. Most cats will eat Hill's a/d
If you are in the UK, Fancy Feast is
known as Gourmet Gold in the UK and is available from most supermarkets -
try the pate types. Alternatively you can nip out to the chippy and buy some
cod and give it to your cat without the batter.
It does not matter what you
feed (within reason), as long
as it is meat- or fish-based and gets eaten. The
Persuading Your Cat to Eat page has more suggestions on choosing a
tempting food. Your stress levels will immediately go down if your cat
eats something. Your cat will feel better with something in his/her tummy.
Longer term there are a lot of
things to learn about food and nutrition for CKD cats, and ways to encourage
your cat to eat the therapeutic kidney diet. Here are links with
more detailed information on dietary and nutritional issues:
But always, the most important
thing is that the cat eats.
Vomiting, Loss of
Appetite, Weight Loss
Vomiting and weight loss are
often the symptoms that lead to the initial diagnosis of CKD. The vast majority of CKD cats will vomit a lot, at least
This will usually be combined with a loss of appetite.
Many CKD caregivers are tearing their hair out trying to get their cats to
eat. It is stressful for you, it is stressful for your cat.
Why do CKD cats stop eating
and/or vomit a lot?
There are a number of possible causes. The site will help you work out if
there is a particular reason why your cat won't eat, and help you find a way
to solve that problem. The most common causes are dehydration, excess
stomach acid, nausea, high phosphorus levels and anaemia.
If you are seeing both loss of appetite and
vomiting, particularly vomiting white foam, plus other symptoms such as
resting the head on the water bowl or teeth grinding, then the most likely
explanation is increased stomach acid caused by the CKD. If you focus on
treating this, which is usually pretty manageable, it will help your cat
feel much better.
The best treatment for
vomiting caused by excess stomach acid is a type of medicine called histamine H2
antagonists. Examples of such medications are Pepcid AC (famotidine) and
Zantac 75 (ranitidine). Essentially what these medicines do is block the
production of stomach acid, so the cat doesn't feel so queasy. The good news
is, these medicines are available over the counter in most countries
(although you should of course obtain your vet's approval to use these
treatments) and are not expensive, and they usually work fast. If you like a
more holistic approach, a cheap, effective treatment is slippery elm bark.
If these treatments don't
work, there are other possible causes of these symptoms. But the majority of
CKD cats do have excess stomach acid and will benefit from having it controlled.
CKD cats usually urinate more and so
they drink more too, but eventually they
cannot drink enough to keep up and they become dehydrated.
Some cats who become
dehydrated will "crash".
Dehydrated cats who crash usually have extremely high blood test results. Don't worry about this,
because you cannot assess how severe the CKD is until the cat has been stabilised and rehydrated.
Usually cats who crash will
need to be treated in hospital and placed on a drip (intravenous fluids or
IV) for a few days to help them become stabilised. One day is unlikely to be
long enough, and even after a few days, their numbers may not improve
immediately. Do not be talked into euthanasia at this point, give your cat a
chance to come home and gradually improve.
Many CKD cats will not crash
and will not need to be hospitalised, but they may still be experiencing
dehydration. For these cats, giving subcutaneous (under the skin) fluids at
home, known as sub-Qs in the USA and sub-cuts in the UK, is a very helpful
treatment. However, it is best not to start this treatment too early, or to
be too aggressive with the treatment. Sub-Qs may be risky for cats with
Generally speaking, cats with
creatinine over 3.5 mg/dl (US) or 300 µmol/L (international), will benefit from sub-Qs.
The usual amount to give is around 100ml of fluid a day. Unfortunately,
sub-cuts are relatively uncommon in the UK, so you may need to persuade your
vet to allow you to give them.
A lack of vitamin B may cause a number of symptoms,
including loss of appetite, or
occasionally non-regenerative anaemia.
B vitamins are water-soluble, so are often lacking in CKD
cats, who lose much of their vitamin B through increased urination. Cats who are not eating much will also probably not be
taking in enough B vitamins.
B vitamin supplements are safe and can often help a CKD
cat feel better. Vitamin B12 in the form of methylcobalamin may be
particularly helpful. These products are widely available over the counter
at reasonable prices, but do not use without your vet's knowledge and
Constipation can be a problem for CKD cats. Constipation can be really uncomfortable and can cause
vomiting, weakness and loss of appetite, so if your cat has it and you get
it under control, your cat should feel a lot better and a lot happier.
Constipation is not difficult
to treat in most cases. A commonly used treatment is a medication called
though some people use a different medication called Lactulose. Lactulose
requires a prescription in the USA but is over the counter in most other
countries. Alternatively you can use a natural product called slippery elm
All these treatments will start
working quickly, though if the cat is severely backed up, the vet may need
to perform an enema first; but these treatments should then keep the
constipation under control.
You can read more about
constipation on the Constipation page:
treatments can be very effective at making your cat feel more comfortable.
The following treatments may also help your cat feel more comfortable, but
most importantly, getting these problems under control may also slow the
progression of CKD in your cat.
What is different about chronic kidney disease in
cats? (2007) Polzin DJ Supplement to Compendium: Continuing
Education for Veterinarians30(3A) pp41-43 says "All patients
with CKD are potentially at risk for progressive kidney disease.
Progression may occur as a consequence of the primary renal disease, in
association with a variety of secondary factors that may promote
progressive renal disease, or both. An important therapeutic goal for
managing patients with CKD is to minimize or prevent progressive loss of
renal function. Treatment designed to limit progression of kidney disease
may involve a variety of interventions, including diet therapy, minimizing
proteinuria, controlling hypertension, and modulating the
Control of Phosphorus Levels
Healthy kidneys excrete
phosphorus from the body. The damaged kidneys of a CKD cat are unable to do
this as effectively as they should, so phosphorus levels in the body
increase. High phosphorus levels will make a cat feel horrible, and may
make the CKD progress faster, so it's really important to get them under
control. Symptoms of high phosphorus levels include loss of appetite,
itching and weakness.
Therapeutic kidney diets contain
reduced levels of phosphorus, and if your cat's phosphorus levels are only
mildly elevated, feeding such a diet may be sufficient to reduce them to the
If your cat has high phosphorus levels
(over 6 mg/dl US or 1.9 mmol/L international) even after feeding a
therapeutic kidney diet for 3-4 weeks, you will need to speak to
your vet about using phosphorus binders.
What are phosphorus binders?
Well, as the name suggests, they are products which are intended to bind
with the excess phosphorus in food in the intestine and thus stop the
phosphorus being absorbed into the cat's body. There are several products
which can be used for this purpose. They usually take 7-10 days to start
working, and once your cat's phosphorus levels are at the desired
level, your cat should be feeling and acting a lot better, and problems
caused by the high phosphorus levels should disappear.
The following pages
have information about high phosphorus levels and controlling phosphorus
levels with diet. The phosphorus binders page explains
more about the various types of binders, which to use and how much:
Hypertension is quite common in CKD
cats, and may even arise in cats with mild CKD. It's even more
likely if your cat has hyperthyroidism (an overactive thyroid).
Cats whose bloodwork rises suddenly may have hypertension.
Unfortunately hypertension can
be hard to detect. It may cause a cat to be lethargic or to twitch, but not
every cat will show symptoms, or will not show any symptoms until more
severe ones become apparent, such as seizures, blindness or a stroke. If
your CKD cat has recently gone blind, the most likely cause is hypertension.
The good news is, if you start treatment as quickly as you can, your cat may
regain some or all of his vision. If your CKD cat is having seizures because
of hypertension, getting it under control should stop the seizures.
Ideally you want to get your
cat's blood pressure checked regularly. Unfortunately not all vets have the
equipment to measure blood pressure in cats. If your vet cannot test your
cat's blood pressure, but your cat has gone blind, I would ask to start
Here is a guide as to when to
Damage to Organs
No treatment necessary
at this time, scratch it from your list of worries for
Treatment is not normally necessary. However,
it may be appropriate to begin or increase blood pressure medications if
ocular or neurological signs are present.
160 - 179
Begin or increase blood
Begin or increase blood
Some vets (especially those in
Europe) prescribe drugs called ACE inhibitors (a common one is benazepril,
trade name Fortekor or Lotensin) to treat hypertension. However, a medication called amlodipine (trade
names are Norvasc in the USA and Canada and Istin in Europe and Australasia)
tends to be a better choice in most cases. Why is it the best treatment?
It has very few side effects.
It is unlikely to cause blood
pressure to fall too far, which is an important consideration if your vet is
not 100% sure if your cat has hypertension because s/he lacks the equipment
to measure blood pressure, or your cat is too agitated to get an accurate
If your cat has gone blind
because of hypertension, amlodipine may help the retinas re-attach and your
cat could regain some or all of his/her vision. Fortekor will not help with
It is not too expensive.
Amlodipine takes about a week
to get blood pressure under control, and some cats may become lethargic for
a few days until their bodies get used to the medication, but after that the
cat should start feeling and acting better.
Anaemia is also relatively common in CKD cats.
It makes a cat feel
really tired and weak, and can also cause loss of appetite and
breathlessness. In the worst case, it can cause heart problems, so it is very important to treat it if it is present.
Anaemia can have a number of possible
causes, such as
bleeding, or infection or inflammation, and treating any such problems
which are present should resolve the anaemia.
The most common reason for anaemia in CKD cats
is because the kidneys produce a hormone called erythropoietin which regulates
the production of red blood cells; but damaged kidneys can no longer produce
this hormone properly, so fewer red blood cells are produced and anaemia
results. This type of anaemia is known as non-regenerative anaemia.
In most cases, this type of
anaemia does not occur until the CKD is relatively advanced i.e. when creatinine is over 5
mg/dl (US) or 450 µmol/L (international), although there are
exceptions to this rule.
The degree of anaemia is
determined by the levels of PCV or HCT in your cat's blood work. The
following table shows the degrees of anaemia and the best treatments to use
for each stage, assuming this is anaemia caused by a lack of erythropoietin:
PCV or HCT
Severity of Anaemia
You need to start ESAs. If symptoms are present, you may also need to consider
a blood transfusion to tide your cat over until the ESA kicks in. Also use B vitamins and iron (as long as no
infection is present)..
15% and 19%
You will probably have to
start using ESAs, plus B vitamins and iron (as long as no infection is
Between 20 and 25% (or
bottom end of normal range)
Begin using B vitamins
and iron (as long as no infection is
Within normal range
No treatment necessary
at this time, scratch it from your list of worries for
What do I mean by ESAs? This is an abbreviation for
erythropoiesis stimulating agents, artificial forms of erythropoietin.
Commonly used ESAS include darbepoetin (Aranesp),
epoetin alfa (Epogen or Procrit) in the USA, and darbepoetin (Aranesp),
epoetin alfa (Eprex) or epoetin beta (NeoRecormon) in Canada or
Europe. ESAs are a very effective
treatment, but some vets do not like to use them because, since they are
designed for humans, there is a possibility of cats developing antibodies to it.
However, this does not happen that often (certainly not as often as many
vets seem to think it does), and when it does, it simply means that the
anaemia gradually returns and you are back where you started. Also it does not normally happen for 4-5 months, during which
time your cat will have regained a good quality of life. It is also much
less likely to happen with Aranesp.
Make no mistake, anaemia can kill. Fortunately, it can be
treated. If a cat has
severe anaemia (PCV or HCT between 15% and 19%) caused by a lack of
erythropoietin, in most cases you will need
to start using an ESA, though you could simply try B vitamins and
iron for a week or two instead and see if they help. However, this can be a
bit of a risky approach because ESAs take a couple of
weeks to kick in, during which time your cat could be getting sicker.
Some vets think ESAs costs hundreds of dollars but that
is nonsense. Aranesp is relatively expensive, at around US$200 a
vial (which contains several treatments), but it does not need to be given
too frequently, every 7-10 days to start with, but this soon reduces to only
once every 2-4 weeks. Epogen or Procrit cost as
little as US$50 a vial, and a vial contains approximately 4-5 treatments,
depending upon how much your cat weighs. In the UK you will pay around
Here are pages which tell you all you need to
know about anaemia in CKD cats, including where to obtain ESAs at reasonable
Healthy cats only have tiny
amounts of protein in their urine because their kidneys do not allow the
protein to leak through. If this mechanism is not working properly for
there will be excess levels of
protein in the urine. This is called
make the CKD progress faster, and is also used for staging the CKD.
Unfortunately it can be difficult to treat but certain heart medications
(ACE inhibitors or ARBs) may help.
Urinary Tract Infections and kidney Infections (Pyelonephritis)
Urinary tract infections are relatively common in CKD cats
because the dilute urine seen in CKD allows bacteria to thrive.
In the worst case, the bacteria may travel up to the kidneys and cause
Cats whose bloodwork rises suddenly may have such an infection.
It is extremely important to treat these infections because they may make
the CKD progress faster (in some cases, they may even cause CKD), and may
make the cat feel very uncomfortable or downright ill. CKD cats should
receive a lengthy course of antibiotics (4-6 weeks).
These are very common in CKD
cats. In most cases, the cat will have potassium levels that are too low.
This is because the body loses potassium via the increased vomiting and
urination usually seen in CKD.
The main symptom of low
potassium levels is weakness, especially in the back legs (there are other
causes of this but low potassium levels are a very common cause). It may
also cause constipation and cause problems holding the head up.
Reference ranges for potassium
vary from lab to lab but as a general rule the magic number at which action
is required is 4. Take a look at your cat's blood test results or ask your
vet what the level is. If you cannot see a measurement for potassium, look
for K or K+, the chemical symbol for potassium.
(mEq/l or mmol/l)
Ask your vet about
using a potassium supplement.
Between 4 and 4.3
Treatment is not essential. However,
discuss with your vet and be
prepared to take action if the level falls below 4, or if your cat already
has symptoms of potassium deficiency.
4.4 or above, and still
within lab range
Relax - you don't need
to do anything. Scratch potassium from your list of worries for now.
Worryingly high. Ask vet to
re-check level because with luck it is a false reading.
Treating low potassium levels
is pretty easy. You simply use a potassium supplement. These come in oral or
injectable forms, and they work fast. When I adopted him, my Ollie was
unable to walk properly because of low potassium levels. Within two doses
(an evening dose and another dose the next morning), I could see a dramatic
improvement. After 48 hours he could walk normally again!
One thing to bear in mind:
many vets do not realise that you need potassium to be above 4, preferably
around 4.4. Ollie's level was 3.5, and for the lab my vet uses, that was the
bottom end of normal, so she didn't think he needed a supplement because
technically it was normal. But I asked her to humour me, and we were both
thrilled to see how well it worked. Being within normal range was simply not
enough for Ollie and many other CKD cats.
But please do not rush to use a
potassium supplement unless it is truly needed, and never use it without
your vet's knowledge and approval. High potassium levels can be very
Occasionally a CKD cat will have high
potassium levels, or the cat will develop them if too much potassium
supplementation is given, or if it is given when it is not needed. If your
cat's level is above 6, then you need to do something about it because it is
potentially very dangerous (high potassium levels can cause seizures or even
a heart attack). Fortunately, in the majority of cases, if the potassium
level is 6 or over, it is a false reading. So the first thing to do is to
ask your vet to run bloodwork to check your cat's potassium levels again.
acidosis means the
levels of acid in the cat's body are too high. It is not the same thing as
excess stomach acid.
Metabolic acidosis is relatively common in
CKD cats. Unfortunately it can be difficult to measure metabolic acidosis,
so many vets do not bother to check for it. It is important to treat it if
it is present though, because it can cause a number of symptoms, such as weight loss,
particularly muscle loss, a bony spine and mouth ulcers (all of these
symptoms may have other causes too). Fortunately metabolic acidosis is relatively easy to treat.
bloodwork rises suddenly may have kidney stones. These may cause acute
kidney injury, but some cats will be left with CKD. Kidney stones are
difficult to treat, but newer treatments offer some hope.
Your cat has to eat. You will make
sure s/he takes in some food, no matter what it is. You will work on
switching to a therapeutic kidney diet later if necessary.
If your cat is vomiting
(especially white foam) and/or has a poor appetite, you will try
treating for stomach acid to see if that helps.
If your cat is at risk of
dehydration, you will speak to your vet about starting sub-Qs.
Speak to your vet about giving your
cat a B vitamin supplement, especially Vitamin B12 in the form of
If your cat has constipation, you will speak to your vet
about using a treatment such as lactulose, MiraLAX or slippery elm bark.
If your cat's phosphorus level
is above 6 mg/dl or 1.9 mmol/L, you will ask your vet about using a phosphorus binder.
If your cat's blood pressure
is above 160, or if your vet cannot measure your cat's blood pressure but
there are serious symptoms such as blindness, you will speak to your
vet about starting a medication called amlodipine.
If your cat has anaemia, you
will speak to your vet about treating it. If your cat's PCV or HCT
is above 20% but still below normal, you will ask about using a vitamin B
and iron supplement. If your cat's PCV is 15-19%, in addition to these
treatments you will speak to your vet about whether to use an ESA such as
Aranesp or Epogen. If your cat's PCV or HCT is below
15%, you will also ask your vet whether your cat might need a blood
transfusion to tide him/her over until the other treatments kick in.
If your cat has protein in the urine,
you will speak to your vet about treatment options.
If your cat has a urinary tract or
kidney infection, you will ensure your vet treats it with a lengthy (4-6
week) course of antibiotics.
If your cat's potassium level is below
4, you are going to ask your vet for a potassium supplement. If your cat's
potassium level is above 6, you are going to ask your vet to re-run the test
because most probably it is a false reading.
If you suspect that your cat has
metabolic acidosis or kidney stones, you will talk to your vet about how
best to treat these problems.
CKD can be very complicated,
but the above issues are the most critical. Getting any of these issues
which are present under control will greatly increase your cat's comfort and
chances of living a long, happy life despite the CKD.
Try to treat your cat
for at least two weeks and see how things go. With the proper treatments and
a bit of luck on your side, your cat should be doing a lot, lot better two
weeks from now.
In the meantime, continue to explore this site, but don't be too discouraged if your cat's numbers seem high
- the numbers only tell part of the story.
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE
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.
This site was
created using Microsoft software, and therefore it is best viewed in
Internet Explorer. I know it doesn't always display too well in other
browsers, but I'm not an IT expert so I'm afraid I don't know how to
change that. I would love it to display perfectly everywhere, but my focus
is on making the information available. When I get time, I'll try to
improve how it displays in other browsers.
You may print
out one copy of each section of this site for your own information and/or
one copy to give to your vet, but this site may not otherwise be
reproduced or reprinted, on the internet or elsewhere, without the
permission of the site owner, who can be contacted via the
This site is a labour of love on my part. Please do not steal from me by taking credit for my work.
If you wish to
link to this site, please feel free to do so. Please make it clear that
this is a link and not your own work. I would appreciate being informed of