Although we do not currently have a cure for chronic kidney disease (CKD) in cats, there are many treatments available to alleviate symptoms associated with the disease. Dietary therapy and medications can promote longer and higher quality of life for cats who suffer from CKD, especially when the disease is caught early.
Your veterinarian may recommend a diet that is specially formulated for cats with CKD. These therapeutic diets are lower in protein and phosphorus and higher in potassium and B-vitamins—dietary elements that are crucial for slowing down the progression of CKD. For example, when your cat consumes protein, toxins are created during protein metabolism that CKD-compromised kidneys struggle to remove from the body. When these toxins build up, your cat will likely experience symptoms such as nausea and vomiting.
Many cats with CKD also suffer from acidosis (the buildup of too much acid in the body), which can lead to nausea and and/or loss of appetite. Specialized diets for kidney disease are more alkaline and help to neutralize this acid. Always consult with your veterinarian first before putting your cat on a special diet, because some diets that are meant to prevent kidney stone formation are more acidic and can worsen symptoms of CKD in your cat.
There are three main factors that are essential for effectively managing the symptoms of CKD: (1) dietary content, (2) dietary supplements, and (3) medications and treatment. We offer more details on these in the sections that follow.
Dietary Content
Water intake
Cats with CKD are more likely to become dehydrated through excessive urine loss that occurs when the kidneys’ ability to conserve water is reduced. Maintaining good fluid intake is therefore very important and may help to slow the progression of CKD. Cats should obtain much of their water intake from their food, so as much as possible, cats affected by CKD should be fed canned wet foods rather than dry foods.
Protein
A protein-restricted diet is ideal for a cat with CKD, since high protein intake can lead to toxic buildup in the body. Protein restriction, however, should always be performed in consultation with your vet. This is because it can actually be extremely detrimental to your cat’s health if they consume too little protein.
Phosphorus
The restriction of phosphorus in the diet has been shown to protect the kidneys of cats with CKD from further damage, and studies have shown that it may also help to prolong life.
Medication and Treatment
Phosphate binders
If blood phosphate concentration levels remain high despite the implementation of a low phosphorus diet, a vet may add phosphate binders (e.g., lanthanum, calcium acetate) to the cat’s treatment protocol to further protect the kidneys.
Potassium supplementation
Some cats with CKD develop low blood potassium levels. This can lead to muscle weakness, contribute to inappetence, and worsen overall symptoms associated with CKD. In such cases, a vet may recommend supplementing the diet with potassium gluconate in the form of a tablet, gel, or powder.
Controlling blood pressure
Cats with CKD are at risk of developing high blood pressure (hypertension). Hypertension can have damaging effects, such as blindness, and can worsen a case of CKD. Blood pressure should be monitored in all cats with CKD and hypertension should be treated with vasodilators—drugs that enlarge or widen the blood vessels to allow for more blood flow. Amlodipine is a particularly effective vasodilator for cats, but other drugs may also be recommended by a vet.
Treatment of anemia
Anemia is quite common in the advanced stages of CKD. This may be due to lack of erythropoietin (EPO) hormone production by the kidneys. EPO stimulates the production of red blood cells in the bone marrow. Anemia can also be due to other factors, such as loss of blood in the intestines. Severe anemia can cause lethargy and weakness, which greatly affect a cat’s quality of life. Depending on the cause and severity of the anemia, treatment options may include anabolic steroids, iron supplementation, checking for and managing gastrointestinal ulcers, and in some cases, supplementation with EPO.
Treatment of nausea and vomiting
Nausea and vomiting are more common in advanced CKD and can cause inappetence. Veterinarian-prescribed drugs such as maropitant, famotidine, and ranitidine can be used to control these symptoms.
Use of ‘ACE inhibitors’ and ARB
Blocking the activation of angiotensin (a hormone) may benefit cats affected by CKD. This is achieved with ACE-inhibitors (angiotensin-converting enzyme inhibitors) such as benazepril or enalapril, or with an angiotensin receptor blocker (ARB) such as telmisartan. These drugs are also vasodilators which support better blood flow through the kidneys, may help lower blood pressure, and can significantly reduce protein loss through the kidneys. The elevated loss of protein through the kidneys is a risk factor for the further progression of CKD, so it is thought that the lowering of protein loss with ACE-inhibitors or ARBs may improve the chances of survival for some cats experiencing CKD.
Kidney transplant
Kidney transplants are sometimes offered by some veterinary specialists as a means of treating cats with CKD. Although this can be a successful approach, it has raised ethical questions such as how and from where a donor kidney is sourced. Additionally, the procedure is not invariably successful, and cats who receive a new kidney may not necessarily survive any longer than cats managed with good medical supportive care.
What should I do if I suspect CKD in my cat?
With the specialized diets and medical treatments available today, cats with CKD can live longer, healthier lives. You can play an important role in your cat's health by learning to recognize the warning signs of kidney disease. If you have an adult cat and have noticed these signs and symptoms we’ve mentioned in this post, you should schedule an appointment with your veterinarian right away.* Find out if your cat has signs of CKD with this checklist.
Free cat parent webinar with esteemed veterinarians Margie Scherk, DVM, DABVP (Feline Practice) and Julie Churchill, DVM, PhD, DACVN, (Nutrition) October 26, 2021. RSVP on Eventbrite.
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