TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

PERSUADING YOUR CAT TO EAT

 

ON THIS PAGE:


Why Getting Food Into Your Cat is So Important


Reasons for Loss of Appetite


Average Feline Calorie Needs


Additional Nourishment


Tempting Your Cat to Eat


Assisted Feeding


Appetite Stimulants (Mirtazapine, Cyproheptadine, Diazepam, Steroids)


Volunteers Wanted For US Appetite Stimulant Study


 

 

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SYMPTOMS


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Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


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Renomegaly (Enlarged Kidneys)


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TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


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Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


UK Dry Food Data


UK Cat Food Manufacturers


2007 Food Recall USA


 

FLUID THERAPY


Intravenous Fluids


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Home > Diet and Nutrition > Persuading Your Cat to Eat

 


Overview


  • 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 lipidosis.

  • Treating any underlying cause of the inappetance, such as Nausea, Vomiting or Excess Stomach Acid, is essential, and may solve your problem. Check the Index of Symptoms and Treatments for more information on possible causes of inappetance.

  • Although 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                                        Back to Page Index


 

In 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. 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 remember your new mantra: my cat is going to eat!

 


Reasons for Loss of Appetite                                                                          Back to Page Index


 

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 Index of 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.

 

However, your cat needs to eat whilst you are sorting out the possible causes of inappetance. Plus even 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, and 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                                                                                              Back to Page Index


 

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 calorie needs of CKD cats here.

 


Additional Nourishment                                                                                    Back to Page Index


 

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.

Eggs


If you want to provide your cat with additional nourishment, the best choice is probably eggs. Washington State University College of Veterinary Medicine has stated: "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. A human study, Organic and inorganic dietary phosphorus and its management in chronic kidney disease (2010) Noori N, Sims JJ, Kopple JD, Shah A, Colman S, Shinaberger CS, Bross R, Mehrotra R, Kovesdy CP, Kalantar-Zadeh K 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 Information Center, 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 white voluntarily, 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 in Renal and Urology News (2008), found that 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 onion. However, a brand called All White consists of nothing but egg whites. Amazon sells a 100% egg white product called Just Whites. Amazon also sells a product by Now Sports.

 

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


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 feeding tube, 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 Agri-Med or Vet America in the USA.

 

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 Pet Meds.

 

Hill's a/d and Iams Maximum Calorie Prescription Foods


Hill's a/d 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 syringe feeding.

 

This food 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 (1% on a DM basis); but it is excellent for short periods of crisis and/or convalescence. 

 

Once opened, a can of Hill's a/d should be kept for a maximum of 36 hours.

 

Contrary to what many people assume, a/d actually has fewer calories than k/d. In recent times, I've been hearing from people who are using Iams' version of this sort of food instead, Iams Maximum Calorie, which is also mushy and easy to use for syringe feeding. However, it is lower in phosphorus than a/d, with only 0.8% phosphorus on a DMA basis, and it is more calorific, with 333 calories per can (56 calories per ounce) versus 180 per can for a/d. 

 

Milk


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 be thin.

 

If your cat is lactose intolerant, there are special lactose-free milks available for cats, such as Catsip, which also has added taurine.

 

Baby Foods


Baby foods 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 labels. 

 

My 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.

 

Gerbers 2nd 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 here.

 

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. Ulula sell baby foods online in the UK, including the organic Holle brand which is water, pure meat and rice flour. It is available in beef and turkey varieties. Amazon UK also has a seller who sells Gerbers 2nd Foods in packs of 12 for around £45-50 for a pack of twelve jars including shipping.

 

Do not feed baby foods exclusively long-term, because they have an imbalanced phosphorus:calcium ratio (Pet Education explains more about this), plus like other human foods they lack taurine, 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. 

 

Human Food


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 taurine, 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 Which Foods to Feed).

 

Nutri-Cal


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.

 

Vet UK sells NutriCal in the UK.

 


Tempting Your Cat to Eat                                                                                 Back to Page Index


 

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 on 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 food bowls.

 

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.

 

Feeding Location


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 the night.

 

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 be helpful.

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 difference.

 

Food Presentation


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 Medicine 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 instead.

 

Warming Food


Many cats, including mine, do not like food 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 kidney disease patients is impaired.  Smell and taste function in children with chronic kidney disease (2010) Armstrong JE, Laing DG, Wilkes FJ & Kainer G Journal of Pediatric Nephrology 25(8) pp1497-504 found that this can occur early on in CKD in children, and that it tends to worsen as the disease progresses, 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 to eat. 

 

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 International Cat Care 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.

 

Sleepy Eating


Several members of Tanya's CKD 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.

 

Food Texture


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 from 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 below).

 

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 onions) 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 sodium and onion. 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 excess stomach 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. 

 

Amazon 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.

 

Kitty Smorgasbord


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 above).

 

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.

 

Tempting Extras


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.

 

Fishy Extras


Fish can be a bit of an issue for cats (see Which Foods to Feed), but a little sprinkled on the food each day to tempt your cat to eat is probably OK.

  • As mentioned below, sometimes adding a little of the water in which tuna is packed to food can make it more attractive to cats.

  • Alternatively you might want to try powdered tuna which you sprinkle on the food and mix in - this appeals to many cats. One brand is called Tuna Dash and is available at Cat Claws in the USA. Petco sells savory tuna flakes.

  • Another option is Kitty Kaviar, which is dried mackerel, available at Vir Chew All.

  • Dried bonito flakes, which are similar, 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. Japanese Kitchen sells these in the UK.

  • In the UK Zooplus sells the Cosma brand of freeze-dried treats. They are available in tuna, chicken, duck and 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.

Meaty Extras


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.

 

  • A similar product called Beefeaters is available from Petsmart.

  • You could also try Pure Bites, available in four varieties.

  • 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 protein. Entirely Pets has detailed information on the ingredients and charges US$5.99.

  • Zooplus in the UK (and probably elsewhere in Europe) sells Beaphar kidney friendly cat treats.

Yeasty Extras


  • 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 garlic, 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 helpful.

Catnip


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 genetic trait.

 

Cats International has some information on catnip.

The International Cat Care also has information on catnip.

 

Tuna Water


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 sodium, 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 CKD 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.

 

Acupuncture


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 acupuncture.

 


Assisted Feeding                                                                                                Back to Page Index


 

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 Index of 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 situation.

 

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 eat. 

 

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 it gently into the cat's mouth. Hill's a/d in particular can be made into a mush with water and syringed in easily. Alternatively, you can use a pâté-type food such as Fancy Feast (Gourmet 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 your cat.

 

If you assist feed, you may as well aim to feed a reasonable amount of food to your cat, bearing in mind your cat's calorie needs. 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: hold your cat upright, 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, as does Cornell University College of Veterinary Medicine.

 

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 CKD 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 assist 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).

Sandy and Boo's story has detailed instructions on how to assist feed. 

Lambert Vet Supply in the USA sells Baxter syringes with an "O-ring", which last longer and which some people find easier to push than standard syringes.

Pet Supplies 4 Less also sells Baxter syringes.

Pippins Roost sells ringless syringes which are supposed to last the longest.

Amazon sells packs of two Easy Feeder syringes, one of which is for giving water, the other is good for assist feeding.

Pharma Systems sells ringless 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. 

 

Feeding Tubes


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 CKD 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.

 

In 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."

 

Long 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 feeding tubes.

Zora's feeding tube shows how her human, Shoshannah, tube fed her. Zora is now eating without a tube.

 

Oesophageal Tube


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.

 

Naso-Gastric Tube


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 this period.

 


Appetite Stimulants                                                                                           Back to Page Index


 

Since it is important that cats eat regularly because of the risk of hepatic 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 feel 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 Index of Symptoms and Treatments), particularly excess stomach acid, and try the other tips mentioned above, rather than only opting for appetite stimulants.

B Vitamins


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 here.

 

Cyproheptadine (Periactin)


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 reduced 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 or lethargic.

 

Cyproheptadine 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 CKD 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 (1998) Norris CR, Boothe DM, Esparza T, Gray C, Ragsdale M, 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.

 

Possible Interactions


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.

 

Pet Education has information on the use of cyproheptadine in cats. 

Pet Place also provides an overview.

Mar Vista Vet also has helpful information.

 

Mirtazapine


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 (anti-vomiting) properties. 

 

Mirtazapine must be used with caution in anyone with kidney problems. It should also be used with caution in cats with hyperthyroidism or liver problems.

 

A commonly used dose in CKD cats was to ¼ of a 15 mg tablet every 3 days. However, a 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.

 

A later study, Mirtazapine as an appetite stimulant and anti-emetic in cats with chronic kidney disease: a masked placebo-controlled crossover clinical trial (2013) Quimby JM & Lunn KF Veterinary Journal pii S1090-0233 found that "the oral administration of 1.88 mg [⅛ of a 15mg tablet] of mirtazapine every other day for 3 weeks to cats with CKD resulted in significantly increased appetite. Additionally, significant weight gain, increased activity and decreased vomiting were demonstrated."

 

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 CKD Support Group as meowzapine), although around 50% of human patients on mirtazapine feel sleepy.  

 

Most people I have heard from have not had problems with mirtazapine, but I 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 from 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 dose. Mar Vista Vet mentions that the risk of serotonin syndrome is higher if you are using a painkiller called tramadol at the same time.

 

The antidote for serotonin syndrome caused by mirtazapine is actually another drug commonly used as an appetite stimulant in cats, cyproheptadine. 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.

 

Mirtazapine 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 pressure.

 

The US National Library of Medicine explains more about serotonin syndrome.

Veterinary Partner has information about the use of mirtazapine in cats. It mentions that it may help with nausea as well as appetite.

Net Doctor has some information about the use of mirtazapine in humans.

Medicine Net also has information about the use of mirtazapine in humans.

 

Steroids (as Appetite Stimulants)


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.

 

Corticosteroids


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  (2004) Graham-Mize CA & Rosser EJ Veterinary Dermatology 15 (s1), p10 supports this view.

 

However, 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 impaired.

 

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 result.

 

See Treatments for more information about corticosteroids.

 

Anabolic Steroids


Anabolic steroids can help stimulate appetite, and may also be beneficial for CKD cats with muscle wasting and mild anaemia. 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 are Nandoral (Ethylestrenol in  tablet form) or Laurabolin (injectible Nandrolone). Winstrol-V (stanazole) 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. Pet Education 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.

 

See Treatments for more information about anabolic steroids.

 

Diazepam (Valium)


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 causing aggression.

 

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.

Wedgewood Pharmacy 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!

  

Back to Page Index

This page last updated: 26 June 2014

Links on this page last checked: 10 April 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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