> Diet and Nutrition
> Persuading Your
Cat to Eat
Many CKD cats have a poor appetite, and it can be a
struggle to get them to eat.
It is essential for cats to eat because lack of
food may cause a potentially fatal liver disease called hepatic
Treating any underlying cause of the inappetance,
or Excess Stomach Acid, is
essential, and may solve your problem. Check the
Symptoms and Treatments for more information on
possible causes of inappetance.
many CKD cats have very poor appetites, it is possible to
keep your cat eating, or at the very least to get food into him/her, despite
the CKD, and this page aims to help you do that.
It provides tips on using foods to help your cat
maintain or gain weight, tempting your cat to eat, how to assist feed if
necessary, and the pros and cons of appetite stimulants.
Why Getting Food Into Your Cat is So Important
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11 guidelines for conservatively treating chronic
kidney disease (2007) Polzin D,
Veterinary Medicine December 2007, Dr Polzin states that "in
many or most dogs and cats with chronic kidney disease, death or euthanasia
results directly or indirectly from starvation."
This is truly shocking, not least because it is so unnecessary. Are you
really going to let your cat starve to death? I doubt it!
There is another major concern with cats who are not
eating. This is that cats who do not eat may 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.
Mar Vista Vet
has more information about this.
The American Animal Hospital Association
recommends that you should contact your vet if your cat has not eaten for
one or two days.
So remember your new
mantra: my cat is going to eat!
Reasons for Loss of Appetite
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If your cat does not want to eat,
please do try to find the cause (such as excess stomach acid, dehydration
and/or anaemia). You can check the
Symptoms and Treatments for more information on
possible causes of inappetance. Treating whichever of these potential causes
is present is essential, and may even solve the problem for you.
your cat needs to eat whilst you are sorting out the possible causes of inappetance.
after treating whatever problems
may be present, since cats eat to live rather than the other way
round, you may find your cat has got out of the habit of eating and has to
be tempted into doing so again. Therefore this
page contains suggestions on helping your cat to
eat. The good news is, once you have got your cat eating again, he/she may
feel better for it and soon get back into the habit.
If a cat is truly dying, the digestive process will cease to function and
the cat will not need food. If you fear this time has come, you will not
only see a refusal to eat but many other symptoms as well - check out
The Final Hours for
more information. But please don't assume your cat is dying simply because
s/he won't eat! Not eating is one of the most common symptoms in CKD cats,
appetite can come and go, so don't fear the worst just because you see this
symptom. For the vast majority of CKD cats, food is essential and part of
the treatment plan, and many people are amazed when they see how much better
their cat looks and feels once s/he has taken in some food.
Please see the
Nutritional Requirements page for an
explanation of your cat's physiological needs and a discussion of the low
protein debate, and the
Which Foods to Feed
page for what to do if your cat refuses to eat the prescription diet which
your vet recommends.
Feline Calorie Needs
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Whilst it is hard to be precise, a cat
needs approximately 30-35 calories per day per pound of body weight, or
possibly more if the cat is particularly active. As an example, a 9 lb cat
would need 270-315 calories a day. Therefore, as you can see, feeding a
teaspoonful of food a day is not going to be enough to maintain your cat's
weight, let alone increase it if your cat is too thin.
Calories matter. If you are just trying
to get food into a cat who isn't eating much voluntarily, it makes sense to
use a calorie and nutrient dense food if at all possible. There is
information below about foods that your cat may be prepared to eat which
provide additional nourishment.
Please read more about the
of CKD cats here.
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This section covers foods that taste good to many cats
(so they may be prepared to eat them on their own) but which also can help
keep them going at times of crisis, or enable them to gain weight if they
need to do so.
Meat or fish pastes
If you want to provide your cat
with additional nourishment, the best choice is probably eggs.
Washington State University College of Veterinary
"Proteins with high biologic value can be readily converted to body proteins
with minimal waste production. Animal proteins have a higher biologic value
than vegetable proteins. Eggs have the highest biologic value."
You can try
scrambling the eggs, some cats enjoy these. Some people choose to
only feed the white, because this provides additional
protein but does not contain high levels of phosphorus.
Organic and inorganic dietary phosphorus and its management in chronic
kidney disease (2010)
Iranian Journal of Kidney Disease 4(2)
pp89-100, reports that "fresh (non-processed)
egg white (phosphorus-protein ratio less than 2 mg/g) is a good example of
desirable food, which contains a high proportion of essential amino acids
with low amounts of fat, cholesterol, and phosphorus."
According to the
US Department of Agriculture's Food and Nutrition
one large egg white weighs about 33g and contains 17 calories, 3.6g protein,
no fat and 5mg of phosphorus. This is a lot less phosphorus than a chicken
breast, and the protein in eggs is more digestible. However, it is important
to cook egg whites until they are hard, because uncooked egg white contains
something called avidin, which combines with one of the B-complex vitamins
(biotin) to make it unavailable, and CKD cats do need their B vitamins.
Cooking the egg whites destroys the avidin. Some cats will eat cooked egg
but it tastes a little bland that way, so most people
simply mix it into their cat's other food.
One human study,
Dietary egg whites for phosphorus control in maintenance haemodialysis
patients: a pilot study (2011)
Taylor LM, Kalantar-Zadeh K, Markewich T, Colman S, Benner D, Sim JJ &
Kovesdy CP Journal of Renal Care 37(1) pp16-24, and discussed
Renal and Urology News
(2008), egg white even
helped lower phosphorus in patients who ate six cooked egg whites in place
of a meal each day. Obviously I'm not suggesting you feed six egg whites a
day to your cat, but 1-2 eggs each day might be appropriate, if your vet
agrees, as long as your cat also eats a complete cat food.
In the USA you can buy cartons of
egg white in supermarkets, but be careful because some brands contain
However, a brand called All White consists of nothing but egg whites.
Amazon sells a 100%
egg white product called Just Whites.
In the UK,
Two Chicks Free
Range Liquid Egg Whites are available from Sainsbury's, Waitrose and Tesco.
Fifteen free range egg whites
cost around £2.89.
Holland & Barrett sell Tropicana 100% egg white powder. Whichever brand of
dried egg white you buy, make sure it is pasteurised.
Since the cartons
contain quite a few egg whites, you may not use them up quickly enough, but
it should be fine to cook some of the egg whites, then freeze them.
Clinicare RF is a
nutritionally complete liquid supplement
formulated for CKD cats, which is relatively high in fat and low in protein
and phosphorus (phosphorus is 0.46% on a dry matter analysis basis).
Not all cats like it, it is quite
expensive (about US$5 a can, but often you have to buy an entire case), and
it is not stocked by many vets, but it may be helpful if you are feeding
your cat via a
or if you want to get more calories into your cat. It could be useful if
your cat is not eating normal cat food (e.g. if your cat is only eating baby
food) because it is nutritionally complete.
It is available from
Vet America in the
I have not been
able to find Clinicare RF in the UK, but Catty
Vet will ship to Canada or UK as well as
within the USA, though shipping is expensive (sending up to 18 cans to
the UK costs around US$46.50). Within the UK
Liquivite is a
possible alternative. It is a canned liquid food made from chicken, liver,
beef and eggs, with a relatively low phosphorus content (0.75% on a dry
matter analysis (DMA) basis. It is available from
Vet UK or
Hill's a/d Prescription Food
This is a food specially formulated for
convalescent cats: it has high levels of liver, is very mushy and extremely
smelly. Quite frankly, the smell makes me feel ill; so
naturally, all my cats adore it. Once Thomas gave up on ham, we were
at our wits' end; but Hills a/d kept him going through his crisis and was a
real lifesaver. Because it is so mushy, it is very easy to use for
is a prescription food, so it is only available
from vets, and should not be fed to a CKD cat long-term because it contains
a lot of liver (too high in
Vitamin A) and is high in phosphorus; but it is
excellent for short periods of crisis and/or convalescence.
Incidentally, contrary to what many people assume, a/d
actually has fewer calories than k/d.
Once opened, a can of Hill's a/d should be kept for a maximum of 36 hours.
Hill's is the
It is estimated that
around 80% of cats are lactose intolerant, which can cause diarrhoea and
vomiting. For this reason, it is usually recommended that cats are not fed
milk. If your cat is not lactose intolerant, it is usually safe to feed
milk, though it does contain protein and phosphorus, so is best kept as an
occasional treat. Full fat milk actually contains less phosphorus than
skimmed milk, around 0.84% (skimmed milk contains over 1% phosphorus), and
the additional fat in full fat milk may be helpful to CKD cats who tend to
If your cat is lactose intolerant,
there are special lactose-free milks available for cats, such as
Catsip, which also
has added taurine.
can be helpful if you are trying to tempt your CKD
cat to eat in the short-term.
Aim to buy the simple meat-based foods rather than those
containing veggies and fruit. Please
also ensure you purchase a food without any onion
or garlic or onion powder (see
Which Foods to Feed).
In principle baby foods sold in the USA have to list every single ingredient
on the jar, so if the ingredient is not listed, the food should not contain
it. Gerber Stage 2 meat and Beechnut
meat baby foods in the USA are safe
at the time of writing, but formulations can change, so do check the
cats were not keen on the Beechnut brand. The best baby food I found in the
USA was the Gerbers 2nd Foods Meats range. There are six different flavours,
Beef & Beef Gravy, Turkey & Turkey Gravy, Ham & Ham Gravy, Chicken & Chicken
Gravy, Veal & Veal Gravy and Lamb & Lamb Gravy. All my cats liked these
foods, and they kept Indie going when she had largely lost her appetite
after extensive dental surgery. They are runny and she was able to lap them
up with her tongue.
Foods contain around 90 calories a jar and although they can be relatively
high in protein, they are low in phosphorus - they contain 69mg per jar,
about the same as a portion of prescription food containing the same number
of calories. Gerber's 2nd Food Ham with Ham Gravy is currently the lowest in
phosphorus and protein, and although people worry that ham baby food will be
high in sodium, it actually contains less sodium than virtually all
prescription kidney diets. There is information about the levels of
phosphorus, protein, sodium and fat in a number of US baby foods
When I tried
using baby foods in the UK with Tanya, I
had great difficulty finding anything
suitable because most of the UK baby foods
seem to have large amounts of carbohydrate rather than the meat which cats
usually prefer and need. Fortunately Heinz have
recently introduced a food called Four Month Mum's Own in Beef Puree flavour
which appears to be suitable.
sell baby foods online in the UK,
including the organic Holle brand which is water, pure meat and rice flour.
It is available in
Do not feed baby foods
exclusively long-term, because they have an
imbalanced phosphorus:calcium ratio (Pet
explains more about this), plus like other human foods they lack
an amino acid which cats need to obtain from their food.
A lack of taurine in a cat's diet can cause serious heart and eye
problems. If you feed baby food exclusively for longer
than a few days, add 500mg of taurine to it, which is not perfect but it
will reduce the risks somewhat. However, it is OK to feed a little baby food
each day without taurine e.g. when giving pills, as long as it is in
addition to a more balanced (usually a commercial) cat food.
Wholesome Baby Food has some recipes for
making your own baby foods.
Meat or Fish Pastes (Potted Meat)
If you are in the UK
and are having difficulty getting hold of suitable baby foods, you could
consider using meat or fish pastes instead. I used these for Tanya, and they
were one of the few things she was prepared to eat. I have found Marks and
Spencer Potted Salmon to be very popular with most of my cats but Chicken
and Beef flavours are also available if required, though check the
ingredients list for onion or garlic (the Salmon version does not contain
either). These products are very smooth, so are easy to get your cat to lick
off your finger if necessary. I haven't tried to syringe them but imagine
they would be suitable.
If you are outside the
UK, supermarkets in many other countries also sell potted meats.
This is certainly not the best food for a
CKD cat, but if your cat is recovering from a crisis or being extremely
pernickety, you may have to resort to offering tasty human foods to tempt
your cat back into eating.
Chicken or lightly cooked fish are possibilities. If
you're in the UK, you can also go to the chippy - my cats will almost always
eat fish from the chippy (with the batter removed).
Thomas would only eat ham for two weeks when his anaemia
was at its worst; even though the levels of sodium and
nitrates in the ham were very unhealthy, eating ham was better than
not eating anything at all.
Many commercially sold chickens have a
lot of salt too.
Do not feed these sorts of foods
long-term, because they lack the nutrients which a cat needs, particularly
an amino acid which cats cannot manufacture themselves, and a lack of which
can cause heart and eye problems; but in order to kick-start eating, they
can be helpful. Please do not feed your cat
anything containing onion or garlic and be careful about feeding tuna (see
You may be offered a high calorie
supplement called Nutri-Cal,
which comes in a tube. Many vets stock it, and
although it is relatively high in carbohydrates and has some additives,
which mean it is not the best choice for a cat, it
does help tempt some cats to eat, so it might be of help during a
crisis. Nutri-Cal appears to contain a relatively high amount of Vitamin A,
so do check with your vet before using this, because too much
Vitamin A is not good for CKD cats.
is the manufacturer's website.
Vet UK sells NutriCal
in the UK.
Tempting Your Cat to Eat
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Since CKD cats often have poor
appetites, this section has tips on how to encourage your cat to eat. Some
of these methods take seconds, so they are definitely worth a try.
If you can persuade your cat to eat of
his/her own accord, it is usually much less stressful for both of you.
Also check out the previous section
additional nourishment, because some of the
suggestions there may help.
Raising the Food Bowl
Do this first. It takes seconds and really works for
some cats. Just use a thick book or a flower pot, or you can buy proper
raised food bowls if you wish. I have raised food bowls for my cats, who are
healthy but I noticed they started to eat more once they were given raised
For more information on why this can be helpful, how
to create temporary bowls and where you can buy proper raised bowls, see
Nausea, Vomiting, Appetite Loss and Excess Stomach Acid.
Where you serve food
can make a difference. If your cat is weak, don't place the food bowl miles
away from his/her favourite resting place. Novelty may also help: I used to
feed my cats in the kitchen but once one of them became ill and needed a lot
of encouragement to eat, I had food bowls all over the place. The place
looked a bit like a kitty restaurant, but I didn't care.
I also have found that
a cat may refuse to eat a plateful of food in one room but will eat that
self same plateful of food in another room.
Many people find having a plateful
of dry food out on their bedside table can encourage their cat to eat during
How to encourage senior cats to eat
(2012) Dr S Little is a video which gives tips on persuading older cats to
eat. It mentions that feeding an older cat away from other family cats can
The feeding behavior of the cat
(2010) Horwitz D, Soulard Y & Junien-Castagna A Encyclopaedia of Feline
Nutrition pp439-477 mentions
(on page 8) that in food tasting
trials, manufacturers have discovered that many cats have a definite
preference for the side their food is on, and will eat from that bowl
regardless of food choices available. This is worth experimenting with if
you place the food bowl in such a way that your cat can only approach it in
one way. Move it to the left or the right and see if that makes a
How you store and serve food can make a difference
to some cats. If you use canned food, be sure to store any leftover food
in glass containers in the fridge rather than in the cans themselves.
The Food Standards Agency
has more information about why this is a good idea.
Catwatch, the Newsletter of Cornell University College of Veterinary
also has some information about food storage.
I use flat plates to serve
food. It is thought that cats do not like their sensitive whiskers to
touch the bowl while they are eating, and whilst healthy cats may not
mind this so much, it is worth trying flat bowls to see if this helps,
particularly if you have Persians, as I do.
It can also be helpful to avoid washing cat bowls
with any type of soap and detergent, but simply to use very hot water
Many cats, including mine, do not like
straight from the refrigerator - it seems to be
too cold for them. Try taking the food out of the fridge half an hour before
feeding it. Alternatively, you can try actually warming your cat's food. The
sense of smell (and sometimes of taste) in human renal patients is impaired,
and it is thought that this happens to CKD cats too. Warming the food makes
it smell stronger, which may filter through to the cat and encourage him/her
We microwave the food on a plate for about 4-5 seconds on High, but your
oven may vary. If you use the microwave, stir
it thoroughly afterwards and make sure it is not too hot - food cooked
in the microwave may cook unevenly and contain "hot spots" which could burn
your cat if you are not careful.
We have also tried warming the
food by adding hot water - again, be sure it is not too hot. Some cats
prefer the mushy texture of food that is watered down.
The Feline Advisory Bureau
mentions that cats tend to prefer food at a temperature of around 35° C,
which happens to be the same temperature as freshly killed prey.
Several members of
Tanya's CRF Support Group have found that they stand
more chance of getting their cat to eat if they wave a plate of food under
the cat's nose as soon as s/he wakes up from a deep sleep. It's as if the
cat is on automatic pilot and eats instinctively.
Some people have found
that cats who are off their food seem to prefer pâté-type foods to more
lumpy foods. If you offer more solid foods, you will often find that your
cat merely licks off the gravy. You can either buy pâté-type foods, or you
can use a liquidiser or blender (or a fork, if you don't have a blender) to
make any food smoother.
A popular choice
in the USA is the Magic Bullet, which costs around US$40-50. It is available
Costco and also from
Bed, Bath and Beyond.
Amazon sell a cheaper
blender, the MaxiMatic, for US$16.99. In the UK,
Amazon sells the
Kenwood CH180 mini chopper for £18.
Depending upon what
you are feeding, you may be able to blend larger quantities and freeze some
of the portions.
Some people have had
success by squashing small portions of canned food into little balls and
feeding them to their cats by hand (see
Homemade Broth/Puréed Food
Some people have found homemade
chicken broth (just boil the chicken in water, there is no need to add any
vegetables, definitely not
very helpful for their CKD cats. It can either be added to food,
particularly prescription food, to make it more appetising, or simply given
to the cat to drink.
When buying chicken to make the
broth, make sure that it does not contain added broth, which may contain
Many commercially sold chickens
have a lot of salt,
The Center for Science in the Public Interest
has more information about this.
You can check how much sodium is in
a chicken by looking for sodium in the nutritional information on the
packaging: anything over 100mg of sodium means that broth has been added.
Some people have tried a simpler
approach and simply add lots of water to their cat's tinned food in order to
make it soupy. You can use a blender if necessary to make it fairly smooth.
Cats with mouth ulcers in particular may prefer food with this texture.
Feeding Little and Often
Many CKD cats no longer routinely ask for
food, or not frequently enough to maintain their weight,
so they need your help. Try to offer your cat small amounts of fresh
food at regular intervals, if necessary taking the food direct to your cat
(we used to have a rule that cats eat in the kitchen but that soon went out
the window once we were faced with a sick cat). Just
offer a spoonful at a time. If your cat eats it, offer a little more.
If you do
have the time to offer food frequently, you can find that although your cat
only eats a little each time, over the course of a day it can add up to a
reasonable food intake. You may also find that this reduces the build up of
acid in your cat.
If you are out at work all day, you could
try using a timed automated feeder which opens separate compartments at
times of your choosing so that your cat can have access to fresh canned
food. These are also useful at night.
in the USA
sells the PetSafe two meal feeder for US$24.53.
Drs Foster and Smith
in the USA sells a number of feeders.
Mighty Pets sells
several types of automatic feeder.
Pet Planet sells an
automatic feeder in the UK for £29.99.
Until your cat is
stable, you may have to resign yourself to having a "kitty smorgasbord"
available for a while. This means you have a selection of foods for your cat
to choose from, which you rotate to suit your cat's current preferences.
When Harpsie (non-CKD but he had a severe kidney infection) was sick and off
his food, we ended up with eighteen different foods on offer. We had to
build a shelf just to hold them all!
We found he might eat
one of the foods one day, then refuse it the next. Sometimes we would offer
him five or six foods before we found one he would eat. Then a week or so
later, a food he had previously turned down might be back in favour.
We also found
that he might refuse a food in the kitchen but be prepared to eat the same
plateful of food in the lounge. Or he might eat the food if we moved it back
into the middle of the plate. The plate mattered too: he seemed not to like
plastic plates but preferred china (well, he was an English gentleman...).
Flat plates were also important (see
You can also mix
foods, e.g. put a little baby food or a low phosphorus food on top of the
food you really want your cat to eat.
These are items which
you can sprinkle on your cat's food in order to make it more tempting for
your cat. I have had good luck with Salmon Liv-a-Littles in particular.
Fish can be a bit of an issue for cats
Which Foods to Feed),
but a little sprinkled on the food each day to tempt your cat to eat is
Dried bonito flakes, which are
often available cheaply at Asian markets.
Bonito flakes shows
the composition of one brand of bonito flakes. Try to buy a brand free of
additives and without added salt.
these in the UK.
In the UK
Zooplus sells the
Cosma brand of freeze-dried treats. They are available in tuna, chicken, duck
beef varieties, and you can also buy a mixed taster pack to see
which your cat prefers. Zooplus also sells other brands of dried fish,
search for dried fish.
Although these tend to be pure meat and are therefore
relatively high in protein and phosphorus, you use so little when you
sprinkle them on food that it should not be a problem.
In the UK
Zooplus sells the
Cosma brand of freeze-dried treats. They are available in chicken, duck,
beef and tuna varieties, and you can also buy a mixed taster pack to see
which your cat prefers.
IVD feline treats are a more
complicated treat based on catfish meal and other ingredients, but IVD
claims they are suitable for CKD cats, with low levels of phosphorus and
Entirely Pets has detailed information on
the ingredients and charges US$5.99.
Some cats like brewer's yeast, which is relatively
high in phosphorus but as a treat this should not be a major issue. Some
brands of brewer's yeast contain added
which you don't want, so check before buying.
Stewart's Pet Food Flavor Enhancer
is one type of
brewer's yeast which several members of Tanya's Support Group have found
I am sometimes asked if it is acceptable
to give catnip to a CKD cat. It is fine, and in fact may act as an appetite
stimulant in some cats. However, not all cats react to catnip - this is a
has some information on catnip.
The Feline Advisory Bureau
also has information on catnip.
Whilst tuna itself is not
appropriate for cats (see
Which Foods to Feed),
one possible compromise is to add the water in which tuna is packed to your
cat's prescription or other diet in order to moisten it and make it more
palatable. Tuna packed in water may actually be packed in a type of broth,
which may contain
onion; and other brands may contain high levels of
so you need to be very sure the brand you use is acceptable.
Starkist Low Sodium Tuna contains
only tuna and water and is popular with
Tanya's CRF Support Group
members in the USA. Starkist
have recently introduced an even lower sodium product called Starkist
Selects. Trader Joe's sell their own brand Low Sodium Tuna packed in water,
and other chains may do the same.
When my cat began having
acupuncture (for his arthritis), there was a noticeable improvement in his
appetite. I don't know if this was a direct result of the acupuncture
itself, or whether being in less pain from the arthritis made him feel
better generally; but I know of
several CKD cats who receive acupuncture solely
for appetite stimulation, and it seems to work for them.
Holistic Treatments has more information on
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You will probably have times when
your cat refuses to eat. Naturally, you must try to address all possible
causes of inappetance, such as excess stomach acid, mouth ulcers and nausea (see
Symptoms and Treatments), and the suggestions
above to make the food seem more appetising. But if all else fails, there
are a couple of other things you can try.
Company While Eating
We found this helpful with both Tanya and
Thomas. We would sit by them encouraging them to eat, praising each
mouthful. It does work for some cats. If Harpsie was lying near us on the
sofa, we also used to place a plate of food nearby, also on the sofa, so he
did not have to move far to eat.
Feel free to be inventive. I remember
hearing from one lady some years ago who was trying in vain to get her cat
to eat. She failed, and lay down on the floor feeling miserable. Her cat
promptly climbed on her stomach and lay there, so she gently reached for the
food bowl and placed it in her torso. Her cat ate! From then on, she found
she could always get her cat to eat of his own accord if she did this. It
didn't require much effort on her part, in fact it gave her a chance to
relax, happy in the knowledge that her cat was eating, so it was a win win
Feeding by Hand
This is the next stage, where you lift
the food out of the bowl and encourage your cat to lick it off your finger
or a spoon. It can take hours, and your cat will probably drop lots of
the food, but we found this really helped persuade both Tanya and Thomas to
Some people have had
success by squashing small portions of canned food into little balls and
feeding them to their cats by hand.
Syringe (Assisted) Feeding
Finally, you can try what many
people refer to as force feeding, but what I prefer to call assisted
feeding. This entails placing your cat's food into a syringe and syringing
gently into the cat's mouth.
in particular can be made into a mush with water and syringed in easily.
Alternatively, you can use a pâté-type food such as
Gold in the UK) or some other canned food and purée it
using a mixer or blender.
Add water to make it more liquidy if it is too hard to squeeze out of the syringe, then draw it up into a syringe.
Using warm water can make the food more attractive to
assist feed, you may as well aim to feed a reasonable amount of food to your
cat, bearing in mind your cat's
However, just as a cat doesn't eat a day's worth of food in one meal, so you
don't need to assist feed in one big session - if you can, spread the food
over several smaller sessions a day. I used 10ml syringes and would only
give one syringe full at a time, but doing this every 2-3 hours added up to
a reasonable amount of food. If you're out at work for most of the day, you
will have to give more at one time, but should be able to feed three times a
day (before work, after work and before bed). Yes, it is a commitment, but
in some ways it is less time-consuming than following your cat around with
platefuls of food.
It is also important to assist feed properly:
make sure the food is reasonably mushy so it flows
smoothly, go slowly, try to stay calm. Insert the syringe in the side
of the mouth, not directly in the front, so as to reduce the risk of the
food going down the wrong way; and give your cat time to swallow each
mouthful. You must also only
syringe in a little food at a time and give your cat time to swallow it. All
this is in order to avoid the risk of aspiration pneumonia.
Pet Place has more
information on this.
Don't worry if your
first session doesn't go too well, you and your cat both need time to get
used to this new routine. It may be more comfortable for your cat if you
warm the food but be careful not to have it too hot, you don't want to burn
your cat's mouth.
You can feel
really mean when you
assist feed, and it doesn't help that some vets claim
that if a cat stops eating, it's time to let go. All I can say is, I'm glad
that doesn't apply to humans too because I would have been dead years ago if
so! I saw in the new millennium with a nice bout of flu during which I was
unable to eat a thing.
We had to assist feed Tanya
occasionally at our vet's suggestion; luckily it was usually only necessary
for a day or two, although some people on
Tanya's CRF Support Group
do this on an ongoing basis.
If you are doing this on an ongoing basis, you may as
well assist feed prescription food. However, don't assist feed a food you
would like your cat to eat in the future, because some cats may develop an
aversion to a food they eat while they are sick.
Tanya was a very independent cat, but
she coped far better with
feeding than we would have expected, and your cat
might be the same.
Assist feeding can actually reduce
stress for both of you. You know your cat
has eaten enough rather than watching anxiously and trying to ascertain if
his/her food intake has been sufficient that day.
Your cat is not being hassled by you waving twenty
different foods under his/her nose. Plus you will also save money by
not having to throw away twenty different rejected foods each day.
Kathy assist feeds Toady is a helpful video
on how to assist feed a CKD cat.
Syringe feeding Coco is a good, clear video showing Marga feeding
Coco (this is in Dutch but you will be able to see what Marga is doing).
and Boo's story has detailed instructions on how
to assist feed.
in the USA sells syringes with an "O-ring",
which last longer and which some people find easier to push than standard
Pippins Roost sells
ringless syringes which are supposed to last the longest.
sells packs of two Easy Feeder syringes, one of which is
for giving water, the other is good for assist feeding.
syringes in Canada.
The size syringe you should choose
depends upon how strong your hands are - the smaller and weaker your hands
are, the harder it is to push a larger syringe. I have weak hands and found
a 10ml one worked best for me with Tanya.
If all else fails, your vet may
suggest a feeding tube. This is a device which is implanted into your cat
and you then simply pour food and medications into it. These tubes can last
for up to a year. My vet is opposed to them for CKD cats, believing that if
a cat reaches this stage, it is cruel to keep them alive; but some people on
Tanya's CRF Support Group
have had good results with them. One advantage of a feeding tube is that you
can give water (not the fluids usually used for sub-Qs) orally rather than
having to give sub-Qs.
The kidney patient: what's for dinner?
(2010) A Presentation to the World
Small Animal Veterinary Association World Congress, Dr T Francey states
"The initial reluctance of most owners to accept feeding
tubes that they view as artificial life support, is often overcome when
truly exposed to them. Esophagostomy tubes or PEG tubes are commonly used
for other indications and they can also markedly improve the quality of life
of small animals with advanced CKD. Administration of water in sufficient
amounts to help maintaining optimal hydration, ease and reliability of
administration of medications, and administration of the qualitatively ideal
food in sufficient quantity are the main benefits of feeding tubes. The use
of this type of nutritional support is the only way to push the limits of
the medical management of small animals with CKD without compromising their
quality of life."
Beach Animal Hospital has more
information on feeding tubes.
Dr Wendy Blount has information about the
different types of feeding tube.
Feeding tube placement(1999) Seim HB
Presentation to the Waltham Feline Medicine Symposium discusses the pros
and cons of the different types of feeding tube.
Kitty Kollar sells special collars to use with oesophageal
Zora's feeding tube
shows how her human, Shoshannah, tube fed her. Zora is now eating without a
There are three main types of feeding tube.
The oesophageal tube, which can normally be inserted with sedation only, is
inserted at the neck and runs down to the oesophagus. Usually food fed
through such a tube must be blended. Your vet can tell
you how much and how often to feed.
Gastrostomy Tube (PEG Tube)
The gastrostomy tube (sometimes called a
PEG tube) is placed directly through the cat’s side into the stomach. It
normally has to be inserted using a general anaesthetic. This tube is less
likely to interfere with the cat’s swallowing mechanism than the oesophageal
tube, but neither type seems to bother cats particularly.
Occasionally vets use a naso-gastric
tube, which can be inserted without anaesthesia. This tube is placed in the
nose and runs down to the stomach. Unfortunately, these tubes are narrow so
can only be used for liquids, plus they are really only suitable for
short-term feeding of several days. If your cat is given
such a tube, the throat can be a little sore for a few days after removal,
so you will need to continue to feed smooth, easily swallowed food during
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Since it is important that cats eat
regularly because of the risk of
lipidosis (see above),
vets may prescribe a drug to stimulate appetite. However, you should not
reach for these alone, because whilst some cats
may eat because of these drugs, they could still
horrible; and some cats who have untreated nausea
or vomiting will not eat even if given appetite stimulants. Appetite
stimulants often do not work on cats who have completely stopped eating;
they tend to be more effective at persuading a cat who is still eating, but
not enough, to eat more.
Appetite stimulants may also have
side effects. Therefore you should definitely try
to treat any possible causes of inappetance (see
Symptoms and Treatments),
excess stomach acid,
and try the other tips mentioned
above, rather than only opting for appetite
All CKD cats
should be given B vitamins, because they can help prevent anaemia and often
act as a mild appetite stimulant. Vitamin B12 in the form of methylcobalamin
can be particularly helpful. You can read more about B vitamins
The most common appetite stimulant
used in cats is cyproheptadine (Periactin), an antihistamine which in cats
may have the side effect of stimulating appetite. Unfortunately it can also
have several other side effects, such as making the cat agitated, causing
howling, making the cat breath faster, or having
the opposite effect of causing lethargy.
In a small number of cats it may cause
urination or an increased heart rate or
temperature. If you see such symptoms, check with your vet - the dosage you
have used could well be too high.
Since cyproheptadine is not really
designed to be an appetite stimulant (and indeed may not work for all cats),
dosage can be rather hit and miss, so you should be guided by your vet.
Since the body of a cat with CKD eliminates cyproheptadine more slowly than
that of a healthy cat, it is best to start with a
low dose, increasing
it only if necessary – you are aiming for a dosage
which stimulates your cat to eat whilst ideally not making the cat agitated
comes in 4mg tablets. Whilst
Plumb's Veterinary Drug Handbook mentions a dose
of 1 - 4mg once or twice a day for a cat, many people on
Tanya's CRF Support Group have found a dose of 0.5mg once per day
works well, so you may wish to ask your vet if you can start at this level,
increasing it only if necessary.
According to one study,
Disposition of cyproheptadine in cats
after intravenous or oral administration of a single dose
American Journal of Veterinary Research 59(1) pp79-81, you may
need to give cyproheptadine for approximately 2.5 days before it reaches a
steady level in the cat, but some people have found that even one dose can
take effect pretty quickly. Once the cat has been on cyproheptadine for a
few days, it should certainly take effect within a couple of hours, although
some cats develop appetite within 15 minutes, so be sure to have fresh food
ready for your cat.
You may choose to use cyproheptadine for
a few days and then see if you can manage without it, but if you find you
need to use it on a longer-term basis, this appears to be safe, though its
effectiveness may gradually reduce, and the cat may sneeze as the effects
wear off. If you use cyproheptadine longer term, monitor
BUN levels (which you are probably doing anyway), because these may
occasionally increase when using cyproheptadine.
Cyproheptadine is available in Canada without a prescription, which is cheaper than buying it
from your vet, but please do not use it on your cat without your
vet's knowledge and approval.
Cyproheptadine is also
available over the counter in the UK, but since
2011 it has been very
hard to find it because of a change of manufacturer (from Merck to Auden
McKenzie). In May 2012, one member of my support group was able to obtain it
from Lloyds Pharmacy, they did not have it in stock but contacted their main
supplier and it arrived within 24 hours, but they wanted a prescription.
Another group member has successfully obtained it from Rowlands Chemists
without a prescription.
Cyproheptadine - from barking dogs to wheezing cats, a
handy helper! (2010) Seavers A The
Veterinarian 260 mentions that the above 1998 study by Norris et
al. found that "medications such as
cyproheptadine, when used in conjunction with oral potassium salts, can
cause slowing of GI transit and increases the local exposure to high
potassium concentrations. High potassium concentrations may lead to GI tract
ulceration or stenosis."
Plumb's Veterinary Drug Handbook mentions that
cyproheptadine may have calcium channel blocking effects and thereby cause
low blood pressure. The Norris study above also
states that cyproheptadine is "contra-indicated in cases of
hypertension." There is a small risk that
using cyproheptadine in combination with a drug used to treat
hypertension, Norvasc, which is also a calcium
channel blocker, may reduce blood pressure too far.
Many people do
seem to use both cyproheptadine and oral potassium supplements with no
problem, and many people also use cyproheptadine in cats with high blood
pressure, but you should discuss these issues further with your vet.
has information on the use of cyproheptadine in cats.
Place also provides an overview.
also has helpful information.
In recent years a drug
called Mirtazapine (trade name is Remeron
in the USA and Zispin in the UK) has become
increasingly popular as an appetite stimulant for CKD cats. Mirtazapine
is actually an anti-depressant but in small doses it can
cause an increase in appetite. It may also have anti-emetic
Mirtazapine must be used with caution in
anyone with renal problems. It
should also be used with caution in cats with hyperthyroidism or liver
A commonly used dose in CKD cats is
⅛ to ¼ of a 15 mg tablet
every 3 days. However, a
recently completed study at Colorado State University,
The pharmacokinetics of mirtazapine in cats with chronic kidney disease and
in age-matched control cats (2011) Quimby
JM, Gustafson DL & Lunn KF Journal of Veterinary Internal Medicine
25(5) pp985-9, found that the half life of the drug (the time it takes
to leave the body after taking it) is shorter than originally thought. The
Veterinary Teaching Hospital at Colorado State University therefore
considers it safe to give mirtazapine every other day, but always start with
⅛ of a 15mg tablet. It usually takes effect pretty quickly, within a
few hours, though it works more quickly for some cats. If you wish to participate in further mirtazapine
studies at Colorado State University, see
As a tetracyclic anti-depressant,
mirtazapine may cause an increase in blood pressure and heart rate.
It may increase cholesterol levels. Like cyproheptadine, it may make some
cats restless, agitated and vocal (to such an extent in some cases that it
is known on
Tanya's CRF Support Group
as meowzapine), although around 50% of human patients on mirtazapine feel
Most people I have heard from have not
had problems with mirtazapine,
have heard from
a couple of people whose cats were on treatment for hyperthyroidism who did
not seem to do well on mirtazapine. This is probably because
methimazole, a commonly used medication for
hyperthyroidism, reduces levels of
a liver enzyme
called CYP2D6 which helps to
clear mirtazapine from the body.
The University of
Maryland Medical Center
(click on Drug Interactions) has some information about this. If your cat is
on methimazole and you want to use mirtazapine, I would talk to your vet
about using a reduced dose of mirtazapine.
A few years ago I heard
a lady whose CKD cat had an extremely severe
reaction to mirtazapine, and since
the medication takes a long time to clear from the cat's body, her
cat's reaction lasted for around three days. A poison centre was unable to
offer any suggestions, so she just had to wait for the drug to work its way
out of her cat's system. I have since learnt that when
cats react badly to mirtazapine, it is often because their bodies are
creating too much of a hormone called serotonin. Mirtazapine is supposed to
stop serotonin being bound to receptors in nerve cells, but this may cause
too much serotonin to accumulate in the cat's brain instead, which leads to
a condition called serotonin syndrome. Symptoms of serotonin syndrome
include a fast heart rate, hypertension (including dilated pupils),
excessive vocalisation (meowing loudly or howling), being "spaced out",
walking strangely, stumbling, pacing up and down, breathing problems such as
panting or breathing very fast, and agitation. Although this reaction is not
common, I have since heard from several other people whose cat experienced
it, so be aware of the possibility, and be sure to start with a really small
Mar Vista Vet
mentions that the risk
of serotonin syndrome is higher if you are using a painkiller called
tramadol at the same time.
antidote for serotonin syndrome caused by mirtazapine is actually another
drug commonly used as an appetite stimulant in cats,
Treatment of the serotonin syndrome with cyproheptadine
(1998) Graudins A, Stearman A & Chan B The Journal of Emergency Medicine
16(4) pp615-9 explains more about this. One possible dose would be 2mg
given twice within the first 24 hours, followed by 1 mg given twice daily
for the next 48 hours; but do not give this without your vet's knowledge and
approval. I would recommend actually taking your cat to the vet if you think
s/he is suffering from serotonin syndrome because other treatments such as
IV fluids may also be necessary.
does seem to
work pretty well as an appetite stimulant in cats
but for most cats
I think I would try cyproheptadine first. If you
do opt to use it with your vet's blessing, please be sure to monitor blood
The US National Library of Medicine explains more
about serotonin syndrome.
information about the use of mirtazapine in cats. It mentions that it may
help with nausea as well as appetite.
Doctor has some information about
the use of mirtazapine in humans.
Medicine Net also has
information about the use of mirtazapine in humans.
Your vet may offer you a steroid if your
cat is not eating very much. There are two classes of steroids,
corticosteroids and anabolic steroids, and both may help stimulate appetite.
Commonly prescribed corticosteroids include prednisone
and prednisolone (often abbreviated as pred),
which usually are used in pill form.
Cats metabolise prednisolone better
than prednisone (they have to convert prednisone into prednisolone in their
bodies anyway before they can use it) so it is usually better to give
prednisolone in the first place.
Bioavailability and activity of prednisone and
prednisolone in the feline patient
CA & Rosser EJ
Veterinary Dermatology 15 (s1), p10 supports
corticosteroids can have serious side effects with long-term use (including
triggering diabetes, fluid retention and resulting hypertension, and masking
infections), and may also increase stomach acid, which is not ideal for a
CKD cat. In one study, some cats
developed a unique form of congestive heart failure seven days
of starting steroids.
In any event,
it is recommended that corticosteroids should not be used in the renally
If for some
reason you are using corticosteroids, these should never be suddenly
discontinued: the dose must be tapered because using corticosteroids may
suppress the adrenal glands' ability to produce cortisone naturally.
Tapering the dose minimises the risk of adrenal insufficiency occurring as a
Treatments for more information about corticosteroids.
Anabolic steroids can help
stimulate appetite, and may also be beneficial for CKD cats with muscle
wasting and mild
If you are using steroids as an appetite stimulant, particularly longer
term, anabolic steroids are a much safer choice than corticosteroids.
Your vet may prescribe anabolic steroids in the form
of either tablets or injections. Commonly used anabolic steroids in Europe
Nandoral (Ethylestrenol in tablet
was popular in the US but unfortunately,
it appears to have been unavailable since September 2004, which apparently
is related to some type of FDA regulation. It may still be obtainable from
some compounding pharmacies.
warns that Winstrol-V may
cause severe liver disease in cats.
Thomas took anabolic steroids
whilst he had CKD. He received a monthly shot at the vet's. We were able to
reduce Thomas's steroid dose, but he still seemed to do better overall when
he was taking his steroids.
If you are using steroids as an appetite
stimulant only, I suggest trying the other ways of encouraging your cat to
eat first, keeping steroids in reserve for later on in the disease. If you
do use steroids, opt for anabolic ones and your vet should monitor liver
values, because these sometimes increase with steroid use, in which case the
steroids should be discontinued.
Treatments for more information about anabolic steroids.
Another drug sometimes used as an
appetite stimulant is diazepam (Valium), a tranquilliser and muscle
relaxant. Diazepam has a number of side effects, including affecting depth
perception which can be dangerous for cats allowed outdoors. It may also
cause ataxia (loss of co-ordination or an unsteady walk). In some cases,
although it is a tranquilliser, diazepam may have the paradoxical effect of
The main problem with diazepam is that
unfortunately a small number of cats develop acute liver failure after
several days of use, so if you do choose to use this drug, your vet should
check your cat’s liver values before starting it and a few days afterwards.
If you are using histamine H2 antagonists to control
excess stomach acid, you should know that one drug in that family, cimetidine
(Tagamet), may increase the effects of diazepam,
so it would probably be safer to control stomach acid using
famotidine (Pepcid AC) or
ranitidine (Zantac) instead.
Fulminant hepatic failure associated with oral
administration of diazepam in 11 cats
(1996) Center SA, Elston TH, Rowland PH, Rosen DK,
Reitz BL, Brunt JE, Rodan I, House J, Bank S, Lynch LR, Dring LA
& Levy JK
Journal of the American Veterinary Medical Association 209
pp618-25 reports on the risks of using diazepam in cats, and concludes that
some cats have an idiopathic (i.e. the precise reason is unknown) response
to this drug. Some cats just appear to be sensitive to it, and it is hard to
know beforehand which cats would react in this way.
Mar Vista Vet has more information on using
diazepam in cats, including a comment that diazepam may have a stronger
effect if used at the same time as cimetidine (Tagamet), and conversely may
heighten the effect of Digoxin, a heart medication.
Pet Place discusses
the pros and cons of using diazepam.
recommends that diazepam should be used with caution in animals with
decreased kidney function.
Although some people have had good
results with diazepam, I personally would not risk it; if you choose to use
it, I would suggest you do so as a last resort.
Thomas and Indie
indulging in their favourite hobby!
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This page last
updated: 22 June 2012
Links on this page last
checked: 10 April 2012