I hear quite regularly from people who are worried that they could have
prevented their cat developing CKD but failed to do so.
In many cases, these people have just lost their cat and are overcome with
grief and guilt; in other cases their cat has just been diagnosed and they
too are feeling guilty.
Others have lost a cat and are now adopting a new cat, and are terrified
at the thought of having to go through CKD again in the future.
In most cases you cannot prevent CKD. However, there
are a few steps you can take to reduce the risks, which this page
discusses.
Could I Have
Prevented It?
I must say, we humans do have an amazing capacity to beat ourselves up.
People worry about everything they did or didn't do. Many focus in
particular on the foods they have been feeding, convinced that they made
wrong choices.
Let me spell
this out loud and clear: it is highly unlikely that anything you did or
didn't do caused your cat to develop CKD. In truth, CKD is rarely
avoidable, particularly in older cats - as the
What
Happens in CKD page mentions, around 10% of cats over the age of ten will
develop CKD, with as many as 30% of cats over the age of 15 having the
disease. The Causes of CKD
page discusses the various causes in more detail.
On the one hand, this is
reassuring. On the other hand, it means, of course, that this page is
necessarily short, because it is not usually possible to prevent CKD.
We all know of people who eat healthily and exercise, only to drop dead at
the age of 40. We all also know of people who eat whatever they like,
smoke like chimneys, drink like a fish, and live to 98. It is the same
with cats. Many factors
determine a cat's fate, including luck. Some are dealt a better genetic
hand than others. Pedigree cats tend to have shorter lives because of
inbreeding; but if, like me, you like a particular breed, you may have to
accept that as one of the risks you take.
Which Steps to Take
Having said all that, there are a few things you can
do. These are
the steps I would take to reduce the risks of CKD developing. None of
these steps is particularly onerous, and you will note
the food suggestions are also not too gruesome - there is simply no evidence
that diet plays that big a role in the development of CKD.
Start Young If Possible
Ideally you want to implement all these steps when your
cat is young. It is usually easier for cats to accept new routines when
they are young, and it increases your chances of success. Still,
implementing many of these even at a more advanced age can still be
beneficial, for example cleaning your older cat's teeth regularly.
Insurance
Starting young can be particularly beneficial if you
wish your cat to have health insurance, because you will have few or no
exclusions if your cat is young and healthy. Choose your insurer
carefully: you want one who provides cover for life, rather than one which
pays up the first year a problem arises but then excludes that problem
thereafter, or one who pulls or reduces the cover massively once the cat
reaches a certain age (which may be as young as eight).
If you don't insure your cat, it can be worth
self-insuring if you can. This basically means you put money aside to pay
for future vet bills. Some people believe this is better value than
insurance.
Annual Check Ups
Even if you
don't have your cat vaccinated every year, you should still have your cat
thoroughly checked over by your vet every year. This won't necessarily
prevent CKD (though it may do if, for example, you are able to nip a
urinary tract infection in the bud), but it can help you detect it earlier
so you can be proactive with treatments. It also enables you to establish
a relationship with your vet.
I would try to
get a urine sample checked each year, and I would also have blood tests
run every year starting at the age of eight. This is also a good time to
have your cat's blood pressure checked.
Obviously if
your cat seem ill between annual check ups, I would go to the vet. Monitor
your cat for weight loss, food and water intake and changes in bladder or
bowel habits or in coat condition.
Avoid Toxins
Since cats are unique physiologically, there is a whole
host of items which they should avoid. Antifreeze and
lilies can kill a cat. There is more information
here. I never
allow lilies in my home for this reason, they go straight in the bin
should an acquaintance happen to bring me any.
A surprising number of foods are bad for cats. Grapes
and raisins may damage the kidneys. Garlic and onion can cause anaemia.
Fish can be a problem if you feed nothing else, even if you are feeding a
commercial fish-based food.
The Merck Veterinary Manual states that
"there are reports of
commercial cat food causing severe neurologic disturbances in cats fed an
exclusive tuna diet for 7-11 months."
Pet Education
has a list of foods to avoid.
Most non-steroidal anti-inflammatory medications are a problem for cats,
who can only metabolise them very slowly. In some cases, kidney damage may
result. If your otherwise healthy cat needs to use meloxicam (Metacam) for
some reason, the dosage used is crucial. Please see
Treatments for more information.
Infections and Inflammation
Treat infections promptly, particularly urinary tract
infections, which may rise into the kidneys and cause permanent damage.
Dentals
Take particular care of your cat's oral health. Most
cats develop dental problems by a young age, 3 or 4.
The American Animal Hospital Association
states that "Dental disease doesn’t affect just the mouth. It can
lead to more serious health problems including heart, lung and kidney
disease."
Learn how to use a feline toothbrush and clean your
cat's teeth regularly. If a dental procedure nevertheless becomes
necessary, have it performed promptly. See Dental Problems
for more information on feline toothbrushes and precautions during dental
procedures.
Vaccinations
I'm in two minds about vaccinations. If you've ever had
a cat develop cat flu (feline herpes virus), as I have, you know it is
worth avoiding, and vaccinations can help with this. On the other hand,
there is some indication that there may be a link between vaccination and
CKD.
If you are in the USA, the protocol is that the
standard vaccinations now only need to be given every three years, which
provides adequate protection but may reduce the risks. The frequency for
rabies varies, depending upon the vaccine used. Please read the
Causes of CKD
and
Treatments pages for more information.
Dietary
Issues
Diet is a
tricky area, because feline nutritional needs are complex. Although some people
have strong opinions about which are the best foods for cats,
unfortunately, there is no firm evidence in many areas.
There
is no perfect food out there, so just do the best you can. Please also
read the Nutritional Requirements and
Which Foods to Feed
pages, and above all, make sure your cat eats.
Antioxidants and Essential Fatty Acids
In one
study,
Effect of nutritional interventions on longevity in
senior cats (2007) Cupp CJ, Jean-Philippe C, Kerr WW, Patil AR &
Perez-Camargo G The International Journal of Applied Research in
Veterinary Medicine5(3), healthy older cats fed a diet containing
antioxidants including additional essential fatty acids lived significantly
longer.
Effect of diet and body composition on lifespan in
aging cats (2010) Cupp CJ and Kerr
WW Presentation to the2010 Nestle Purina Companion
Animal Nutrition Summit discusses this study. It found that a diet
which included
antioxidants,
essential fatty acids
and a
prebiotic appeared to extend the lives of the cats in the study, who
were aged between 7-17
(go to page 44). Cats fed a diet with these added supplements lived 1.3
years longer than cats fed a complete adult cat food. The study also found
that "aging cats that lose excess body weight and body condition (fat or
lean) have a significantly greater risk for earlier mortality." Therefore
I would not put your older cat on a diet. If your cat is getting thin, try
to get weight on.
Wet Food
Many people are evangelical about this. Some
of them go so far as to claim that feeding dry food only may actually
cause CKD, although there is no evidence of this.
I certainly am not opposed to feeding wet
food, but unfortunately it is not always as ideal or simple as it first appears - see
Nutritional Requirements for more information.
A possible compromise is to do as I do and feed a mixture of wet and dry
food.
Low
Phosphorus
Phosphorus is a problem for CKD cats
because their kidneys cannot excrete it efficiently, so it builds up in
their bodies. Healthy cats should be able to excrete phosphorus, so in
principle there is no reason to feed a reduced phosphorus diet to healthy
cats. If you do, it is
possible that phosphorus levels might reduce too far (below 3 in US values in bloodwork), which can cause weakness and lethargy.
Personally, I would not be at all
concerned about the phosphorus levels in a food for a younger cat -
kittens in particular, who are still growing, need phosphorus in order to
build healthy bones.
Having said that, since CKD cannot be
detected until at least 66% of kidney function is already gone, it may be
worth
considering feeding lower phosphorus foods to an older cat (over ten years of
age). Discuss this with your vet. Prescription renal diets tend to have a phosphorus level of around
0.5-0.7% on a dry matter analysis basis. Any commercial food in the USA
which is labelled as a complete adult maintenance diet will have a minimum
phosphorus level of 0.5% on a dry matter analysis basis. I would aim to
feed a food with a phosphorus level of 0.5-1.0% on a dry matter analysis
basis; but remember, the most important thing is that a cat eats. You can
check the phosphorus levels in various foods
here.
free feeding with Factor-2 (a composite variable composed of fiber,
magnesium, protein, sodium and ash);
and fibre alone.
The researchers
concluded that free feeding was associated with increased odds of
developing CKD. However, they did not simply free feed the cats; they also
gave them additives. It is therefore not known whether free feeding alone
would give similar results.
I myself have always free fed, and will continue to do so. In the wild,
cats naturally feed multiple times a day. See
Nutritional Requirements for more information on this topic.
High Quality Foods
This is another
hot potato. Many people appear to be obsessed with feeding high quality
foods, particularly high quality protein. What is high quality protein for
a CKD cat does not mean what you probably think it means (see
Nutritional Requirements).
What is high
quality food for a healthy cat is debatable. Many people buy "premium",
"high grade" foods, but what does that mean exactly? Why do so many of
this type of food contain fruits and vegetables which cats do not need?
Many people hate corn in foods, yet corn gluten meal is actually a protein
that is almost as bioavailable to cats as chicken.
Please read the
Nutritional Requirements
page for more information on a cat's physiological needs and
Which Foods to Feed
for more information on commercial foods. Although these pages are geared
towards a CKD cat, they do contain some information on feline nutritional
needs generally.
What Not to Feed
Low Protein
I hear from people who have
recently lost a cat and who want to try to ensure their remaining cats do
not develop CKD. They have heard that low protein may help CKD cats, so
they sometimes are considering feeding prescription CKD foods in the hope
that feeding such foods may also prevent CKD.
I do not recommend this,
because it is not going to help, but it may cause problems. Healthy cats have a requirement
for relatively high amounts of protein (see
Nutritional Requirements).
In fact, it is commonly recommended that even cats who already have CKD
should not have protein restricted in the early stages of CKD.
I would therefore not recommend feeding a low protein diet to a non-CKD
cat, because it may eventually lead to malnutrition. In
Nutritional management of renal disease
(2008) Presentation to the World Small Animal Veterinary Association World
Congress Dr K Sturgess states "From studies performed in
dogs and cats, it can
be concluded that there is no evidence in
these species to suggest feeding high protein diets to normal animals is
harmful."
Acidified Diets
Many commercial
diets over the last ten years have been re-formulated to promote "urinary
tract health", or words to that effect. Essentially, these diets are
acidified, so as to reduce the risk of cats developing
feline lower
urinary tract disease (FLUTD). Cats with FLUTD tend to have urine that is too alkaline, and are therefore
at risk of developing struvite crystals, which develop in an alkaline
environment. Feeding an acidified diet reduces this risk.
Unfortunately, feeding these diets to cats who are not at risk of FLUTD may lead to urine that is too acidic.
It is speculated that acidified diets may be a factor in the increase in
renal
calculi (kidney stones)
i.e. calcium oxalate stones, which develop in an overly acidic
environment, and
which in turn are a risk factor for
developing CKD. These stones, unlike struvite,
cannot be dissolved by diet - they can only be removed by surgery.
Acidified diets
may also contribute to low potassium levels (see below).
Potassium Supplements
In
Chronic renal failure in cats Dr D Chew
mentions that low potassium levels (hypokalaemia) "can both
initiate and perpetuate chronic renal damage."
This does not automatically mean that every cat would benefit from
potassium supplementation. At the moment there is no evidence that giving
potassium supplements to healthy cats would be beneficial. In fact,
it could potentially be very
dangerous. I would, however, avoid feeding potassium-restricted acidified diets (see
above) to cats who do
not need an acidified diet.
