Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

Since many CKD cats are older, they may also suffer from arthritis or cognitive dysfunction (kitty Alzheimers or senility).
This page discusses which treatments are the safest in light of the CKD diagnosis.
There is also a discussion about the pros and cons of vaccinating CKD cats.

Flea Treatments Back to Page Index

Many flea treatments are fairly powerful, which makes using them on a sick cat a big decision. However, fleas can make a cat uncomfortable and a severe infestation may even cause anaemia, so the problem must be addressed.

Natural remedies
Over the counter products
Prescription products (Advantage, Frontline, Capstar, Revolution)

Mar Vista Vet gives the history of flea control products and an overview of them all.

Mar Vista Vet discusses flea control.

Virginia-Maryland Regional College of Veterinary Medicine has an overview of flea control.

Natural Remedies

Sometimes garlic added to food is recommended to control fleas, but since garlic is associated with Heinz body anaemia (see Which Foods to Feed), I would not follow this advice. Kansas State University quotes Dr Michael Dryden, associate professor of parasitology and a well-known flea researcher, who states ""There is no data available to substantiate the efficacy and safety of herbal flea preventatives. There's been one study on the use of garlic as a flea preventative and it showed nothing."

Over The Counter Products

Don't waste your money on over the counter treatments - they rarely work but may still have severe side effects. The US Environmental Protection Agency has investigated thousands of problems arising from the use of Hartz products, for example. In 2010 The US Environmental Protection Agency increased restrictions on flea and tick products in the USA and Canada.

In the UK, the Feline Advisory Bureau reports that there have been hundreds of cases of cats being poisoned by permethrin-based flea treatments intended for dogs. Never use a product containing permethrin on a cat.

Flea collars in particular are useless, plus they expose the cat to toxins 24/7 - not a good idea for a sick cat. Products containing essential oils should also be avoided - essential oils are toxic to cats, who lack the pathways to metabolise them.

Prescription Products

I suggest you obtain an effective treatment from the vet; if you do this, you can also take the added precaution of asking your vet if it is safe to use the product on your particular cat. The four most commonly recommended products are Frontline, Advantage, Revolution and Capstar. Use the weakest product you can that will do the trick. I have always used Frontline, and have found it very effective, but my cats only get fleas very occasionally so I have never needed to use any product on an ongoing basis.

The manufacturer of Revolution (known as Stronghold in the UK) specifically cautions against using Revolution (Stronghold) on sick cats. Bayer, the manufacturer of Advantage, offers a similar warning for its product. In Seizure disorders in dogs and cats, Dr RM Clemmons from The Neurology Service at the University of Florida's Veterinary Medical Teaching Hospital mentions that Advantage and Program "appear to lower the seizure threshold and make seizure disorders more difficult to control", so I would not use them on a cat who has had a seizure or who is ar risk of seizures.

Capstar is given in pill form and is safe enough to give to very young kittens, so you could ask your vet if it might be suitable for your CKD cat. Unfortunately it only kills existing fleas, it does not act as a preventative.

In fact, you don't necessarily have to apply flea products directly on your CKD cat. If you have other, healthy companion animals, try applying the commercial preparation you choose only to the other family animals, and use a flea comb on all the animals every day, including the CKD cat; be sure to treat your carpets too with a cat-safe preparation, since the fleas will live in them and can re-infest your cat. Eventually you should find all the animals are free of fleas, even the CKD cat. I did this using Frontline, and we did get rid of the fleas, though we do not get fleas often anyway, only about every eighteen months (yes, despite having long-haired, indoor-outdoor cats!). Because of this, I do not treat my cats month in, month out, I only treat them when they actually have fleas; if you live in a relatively flea-free area, you may wish to consider this approach.

However you treat your cats, you should also treat the environment in order to get completely rid of the problem. University of Kentucky Entomology explains more about this. In the UK I have used Acclaim without any problems.

Veterinary Partner compares Revolution (Stronghold), Advantage and Frontline.

Arthritis Treatments Back to Page Index

Since CKD cats tend to be older, some of them also have arthritis. Below are a few possible treatment options, and information on treatments to avoid.

Harpsie's Website has additional information on treating arthritis.

Glucosamine and Chondroitin (Cosequin)

Treatments containing glucosamine and chondroitin, such as Cosequin, are usually safe for CKD cats; I found Cosequin did help Harpsie's arthritis to some extent, although according to The Mayo Clinic, it has been known to raise blood pressure temporarily in some human patients, and some patients have developed proteinuria. The increase in blood pressure may be because some of these products have a sodium base. Be careful about using such products in a CKD cat and try to obtain a product without a sodium base if possible.

Adequan

Some people have also had success with Adequan, which is an injectible treatment, although this is is a relatively new treatment for cats (it is actually only approved for dogs) and many vets will not be familiar with using it in this way. Mar Vista Vet reports that when large doses were given to dogs, the dogs developed large kidneys. They therefore recommend being cautious when using Adequan in patients with CKD.

Metacam (Meloxicam)

Metacam (meloxicam) is a non-steroidal anti-inflammatory drug (NSAID) available in both injectible and liquid (oral) form. It is not recommended for CKD cats because it may cause kidney failure. You can read more about it on the Causes of CKD page.

Acupuncture

Longer-term, we had extraordinary success treating Harpsie's arthritis with acupuncture. There is more information on acupuncture on the Holistic Treatments page. Harpsie's Website has additional information on treating arthritis, including more about his acupuncture sessions.

Heat Pads

Heat pads are a good idea for arthritic cats, particularly in cold or damp weather. A heat pad is a small flat heated pad with a fleecy cover - it looks like a little flat cat-sized bed. You just plug the heat pad into the mains and then the pad stays at the chosen temperature constantly, unlike a hot water bottle. You must of course keep an eye on your cat while he or she is using this since it is electrical equipment, but certainly we never had any problems with overheating, and Harpsie used his almost constantly in winter.

Drs Foster and Smith sell a number of heated beds in the USA.

Boots the Chemist in UK sells a heatpad for £21.99 - this is the one we used for Thomas when he had anaemia.

Cognitive Dysfunction (Senility or Feline Alzheimers) Back to Page Index

Howling, especially at night, is quite common in CKD cats. There are a number of possible causes, see Index of Symptoms and Treatments.

Unfortunately this may sometimes be a symptom of an old-age related problem known as cognitive dysfunction (sometimes referred to as feline Alzheimers). My vet told me that sometimes old cats wake up and feel a little confused, are not sure where they are, so they howl for reassurance; once they hear your voice, they feel comforted and will usually stop howling. Certainly both Tanya and Thomas were night howlers with no obvious reason for it (apa rt, in Thomas's case, from a keen desire to go outside at all hours!), and if we spoke to them they usually stopped.

A drug called selegeline or selegiline (Anipryl) is sometimes used to treat cognitive dysfunction in dogs, but the treatment is still experimental in cats, and may be contraindicated for cats with CKD.

Aktivait, a nutraceutical containing essential fatty acids and antioxidants, has been found in one trial to help dogs with cognitive dysfunction. I have heard from one vet who has also found it helpful in cats with this condition. A couple of people on Tanya's CRF Support Group have found it helpful too.

Vetscriptions in the UK sells Aktivait and will ship to other countries. Make sure you buy the feline version, the canine version contains alpha lipoic acid, which is toxic to cats.

Vet on the Web has an article by Sarah Heath, a veterinary behaviourist, who explains more about cognitive dysfunction and the use of Aktivait.

American Association of Feline Practitioners Senior Care Guidelines (2008) has some information about cognitive dysfunction on p17.

Cognitive dysfunction in cats: clinical assessment and management (2010) is a presentation by Dr DA Gunn-Moore to the 2010 Nestle Purina Companion Animal Nutrition Summit which discusses cognitive dysfunction in cats (go to page 104).

Geriatric cats and cognitive dysfunction syndrome (2008) Gunn-Moore DA, is a presentation to the 33rd World Small Animal Veterinary Association Congress about the diagnosis and treatment of cognitive dysfunction in cats.

Feline Advisory Bureau has some information about senility in cats.

Mar Vista Vet has some information on the use of selegiline in animals.

Pet Place has an overview of cognitive dysfunction.

Pet Place also has information about selegiline use in animals (no need to register to read the article, just click on Close at the bottom of the irritating pop-up).

The Cat Site talks about the experiences of one cat who participated in a study into the use of selegiline in cats.

Vaccinations Back to Page Index

The caution details on a feline vaccine packet state that the vaccine is for administration to healthy cats only. CKD cats are by definition not healthy, so I would not recommend vaccinations. Once Thomas had been diagnosed, my vet said she did not recommend giving him vaccinations, so we stopped.

If you are in the USA, the American Association of Feline Practitioners now recommends that the standard FVRCP vaccination only needs to be given every three years; so if your cat has been vaccinated in the last three years, you probably do not have any decision to make.This does not apply to Europe, Australia or New Zealand, where normally different vaccines are used which are only valid for a year.

As far as rabies is concerned, although a few US states only require the rabies vaccine to be given every three years, in others you may be required by law to have your cat vaccinated against rabies annually. In these states, you may be able to obtain an exemption if your vet confirms your cat should not be vaccinated for health reasons, so I suggest you begin to make enquiries about this some weeks or months before the next rabies vaccination is due.

Of course, you may not be so much concerned about meeting legal requirements as anxious that your cat should have some protection against the diseases in question, particularly since s/he will be making regular visits to the vet, and may be exposed to illnesses there which could be of concern in view of the weakened immune status of a CKD cat. Most cats who have received vaccinations in the past will have some degree of residual benefit anyway, but if you are particularly concerned, you could have their vaccine titres checked (blood is taken and sent away to a specialist laboratory) to see how much protection they still have; although it should be remembered that titres only show a level of antibodies, and it is not always easy to know what level of antibodies can provide sufficient protection from a practical perspective. I suggest you discuss with your vet the best approach for your particular cat.

Choosing not to vaccinate in the UK can be problematic if your cat ever goes to a cattery, because catteries usually insist upon vaccinations. I asked my vet to write a letter to say vaccinations were not appropriate for Harpsie, and the cattery accepted this and allowed Harpsie to stay without recent vaccinations.

Colorado State University is currently working on a new test which will determine whether a cat needs to be vaccinated or whether previous vaccinations are still offering protection.

There is some research that indicates a very tentative link between standard vaccinations and the development of CKD; please see the Causes of CKD page for more information on this and about the recommendation that intranasal vaccines be used where possible.

The vexing vaccine issue: controversy, confusion continue to surround vaccination guidelines (September 2004) is an article in the Journal of the American Veterinary Medical Association.

American Veterinary Medical Association discusses the benefits and risks of vaccination.

Cornell University College of Veterinary Medicine also discusses the benefits and risks of vaccination.

Feline vaccination protocols (2002) is a paper presented by Dr Richard Ford to the WSAVA Congress 2002 which mentions the risk of using rabies vaccines containing adjuvants, which have been associated with a particular form of cancer.

Pet Place discusses which vaccine to choose.

Heska has information about its intranasal vaccines.

Heska also has a presentation by Dr Lappin about the current vaccination debate (this is rather technical).

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This page last updated: 27 October 2011

Links on this page last checked: 18 December 2011