Welcome! This site shares the basics of what I’ve learned about feline chronic kidney disease (CKD) after my CKD cat Mama experienced her first crisis—known as a “crash”—due to ureteral obstruction.
Much of what I’ve learned about CKD has been from the invaluable and comprehensive website and book Tanya’s Comprehensive Guide to Feline Chronic Kidney Disease, and the associated online forum, a place of amazing generosity and collective wisdom. In particular, I was inspired by a new forum member’s question: What do you wish you’d known from the beginning?
That question got me thinking about the first things I would share with a friend with a recently diagnosed cat and also with friends who simply have older cats, since a large percentage of senior cats will develop CKD. While the Tanya site is the definitive resource (and I hope everyone will make good use of it), I wanted to offer something much more basic: a brief list-style overview of the most important things I’ve learned during our crash course, so to speak.
Below, you’ll find four short sections:
- Hindsight: five things I wish I’d known
- Experts: finding a proactive, supportive vet
- Feeling good: developing a care regime
- Knowledge: the importance of labwork
In addition, on the resources page, you’ll find places to go for further information and supplies. The page “Mama’s Drama” tells Mama’s rather unusual CKD story, with its kidney stones, seizures, and feeding tubes.
HINDSIGHT: FIVE THINGS I WISH I’D KNOWN
It’s easy to look back and think “I should have noticed something was wrong,” but of course I didn’t know then what the signs of CKD are. I just thought Mama was getting a bit ornery because, well, aging can be rough. I also had no idea how common CKD was and that there was so much I could do to manage it. In fact, that’s the top item on my hindsight list:
#1 Kidney disease affects an estimated 30%–50% of senior cats, and there is a lot you can do to help your cat live a long and comfortable time with CKD. Of course, the earlier you catch it, the earlier you can intervene to slow the progression of the disease.
That brings me to
#2 Common early signs of CKD include drinking lots of water, bigger and more frequent pees, decreased grooming, hiding, finicky eating, and weight loss. Some of these symptoms, like hiding or not grooming, aren’t specific to CKD. But awareness of the symptoms makes it easier to be observant of your cat’s behaviors and prepared to investigate any concerning changes.
In case the eating issue got lost in the above list of symptoms, it’s worth saying again loud and clear:
#3 Eating is so, so important. Even though I’ve lived with cats all my life, I didn’t fully grasp until our “crash course” just how dangerous it is for a cat not to eat and just how significant inappetence is as a sign of trouble. When a cat isn’t eating—including acting hungry but then sniffing and walking away from food (a classic CKD move, see “feeling good” below)—they are telling you something is wrong. And it’s not something to wait on: because of the way the feline liver works, it can quickly go into failure when the starving body releases large amounts of fat (fatty liver disease, or hepatic lipidosis). Just a few days of significantly reduced eating puts your cat at risk for developing this potentially fatal condition. Although if it is caught early enough, it can usually be addressed with good results, it’s much better, it should go without saying, to avoid this complication altogether!
Sometimes, however, even when you are doing all the right things, your cat will have a crisis simply because
#4 Cats with chronic kidney disease will “crash,” that is, take a sudden turn for the worse. Many cats don’t get diagnosed with CKD until they get taken to the vet in the midst of their first crash. In Mama’s case, we had the diagnosis of early stage kidney disease before the crisis, but I didn’t know about crashing and so it took me over two days to recognize Mama’s first crash. By the time I brought her to the emergency clinic her kidney values had spiked to three times higher than they had been just a month prior at diagnosis. You can read more about Mama’s story in “Mama’s Drama.” The important thing to say here is that here is that if you suspect your cat is crashing, it is a medical emergency and you should take them to the vet, without delay. The vet will most likely treat them with IV fluids for two to three days, possibly longer. There may also be diagnostic tests to see whether there was a particular cause for the crash that can be addressed.
IV fluids can be very effective in stabilizing a crashing cat. The numbers may not come down to as low as they were before the crisis, but they usually do come down quite a bit and your cat’s body will adjust to the new level of creatinine as its new “normal.” Sometimes, after discharge from the hospital, the level will continue to come down even further, given the right regime of at-home care.
Because IV fluids can strain the heart, I would recommend doing IV fluid therapy only at a 24-hour facility where your cat will be constantly monitored. Many CKD cats have heart issues and still get IV fluids when in crisis; it is simply something to be aware of and take proper precautions for.
Sometimes a crash will be the result of an acute kidney injury on top of the CKD, which is why it’s also important to know about
#5 The causes of acute kidney injury (AKI). In Mama’s case, the injury was the result of bloodstones obstructing her ureter. Kidney stones, made of calcium oxalate, are a more common cause of obstruction. Another cause of AKI is ingestion of toxins. Lilies, for instance, are fatally poisonous to cats. Even if your cat just brushes up against a lily and gets pollen on their coat and later licks it off, that can cause kidney trauma. A bad kidney infection can also lead to acute injury.
While some CKD cats, like Mama, develop an acute-on-chronic condition, for other cats the order is reversed: the acute injury comes first, and is followed by chronic kidney disease. If your cat is relatively young and displaying signs of kidney disease, it may be due to an acute injury. AKI is very serious but with swift veterinary intervention, it is not insurmountable.
EXPERTS: FINDING A PROACTIVE, SUPPORTIVE VET
We were lucky. Our nearby 24-hour emergency clinic has an excellent team of internal medicine (IM) specialists. And when IV fluids, the standard treatment for crashes, wasn’t working—Mama’s case was unusual in that regard—the IM vet overseeing her case knew to refer me to a teaching and research hospital where a new procedure that could address Mama’s issue had recently been developed.
Hopefully, your cat’s story won’t be nearly as complicated and dramatic as Mama’s, but my point is that a knowledgeable and proactive vet can make all the difference. It is also important that your vet is willing to let you be a partner in your cat’s care. In fact, your vet doesn’t have to know everything about CKD; they just have to be honest about the limits of their knowledge, open to information you bring them (the Tanya site is a great source for peer-reviewed scientific studies), and ready to refer you to a specialist when needed.
It can feel uncomfortable to question or challenge our vets. After all, they are experts in the field and we are not. But our job is to advocate for our cats, and a good vet will appreciate that commitment. So if something doesn’t feel right, don’t be afraid to push back and/or seek out a second opinion.
In my view, which is based on both my experience and the collective experiences of Tanya forum members, a proactive and supportive vet will facilitate a “feeling good” care regime, as outlined in the next section.
FEELING GOOD: DEVELOPING A CARE REGIME
There is a lot you can do to improve your kidney cat’s quality of life and slow the progression of the disease. Below is my take on six common issues to address. There are links to more information on all of these topics in the resources section of this site.
#1 Controlling nausea and stomach acid to ensure eating. One of the main reasons CKD cats don’t eat is that they feel nauseated. The nausea may be caused by excess stomach acid, which is very common with CKD, or for other reasons. It’s important to know that cats don’t always vomit when they are nauseated, though you may see white foamy vomit with stomach acid issues. Mama typically shows her nausea by asking for food but then when I give it to her, she smells it and maybe takes a few bites, then turns away. This behavior, I have learned, is a classic sign of CKD nausea.
For some cats, an acid blocker is enough to control the nausea. Other cats might need an antiemetic (antinausea drug) in addition to the acid blocker. If your cat has both kinds of medications in place and still has a poor appetite, then you can also add in an appetite stimulant.
It can be difficult to assess how well your cat is eating by observation. Mama lost over two pounds—20% of her total body weight!—before I realized her weight loss was significant. While observation of eating habits is useful, the most reliable way to ensure your cat is eating sufficiently is by weighing them. Many people use baby scales for this purpose.
#2 Giving subcutaneous fluids (subQs) at home for hydration. At some point, it will be time to give your cat subcutaneous fluids at home. Doing so will ensure they are hydrated and will all-around help them feel so much better. It may seem like a daunting task; I myself used to get queasy just looking at a needle. But if I can do it, so can you! And if at first it doesn’t go so well, don’t despair: it gets easier with practice and some experimenting to discover which methods work best for your cat.
#3 Keeping phosphorus levels in check. CKD cats often have high phosphorus, which can make them feel lousy. It is important to note that phosphorus can technically be in the normal range, but still be too high for a CKD cat. Your cat will probably feel best if the phosphorus level is between 3.5 and 5 mg/dl, with around 4 being a good target number.
You can control phosphorus through diet. Renal food is very low phosphorus (usually 0.5% or less). But if your cat won’t eat renal food or you prefer not to use it—there are many debates about best diet for CKD cats, which I will not get into here—you can find certain commercial foods that have relatively low phosphorous (1% or less).
If your cat is very picky about foods and the only food they will eat is high in phosphorus, you can also add a phosphorus binder to the food, which will bind with the phosphorus so that the body does not absorb it. If your cat is hypercalcemic (high calcium levels), you want to avoid calcium-based phosphorus binders. Aluminum hydroxide (ALOH) is a widely used binder and is more effective than calcium-based ones, though some are concerned that the ALOH may prevent absorption of other nutrients. If you use a renal food, you generally will not need a binder, but in the unusual event that you do, take care that if you use ALOH that the renal food does not contain potassium citrate (a common ingredient in renal foods), since these two substances can have a negative interaction.
#4 Ensuring regular bowel movements. CKD cats can get constipated, which also makes them very uncomfortable, especially if it reaches a point where toxins are accumulating in their system. In addition to making sure your cat poops regularly, you also want to be on the lookout for straining at the litterbox and small, dry poops.
There are a variety of remedies for constipation, including pumpkin (real pumpkin, not the pie filling), psyllium husks, or Miralax, among other options.
#5 Monitoring for and properly treating infection. In addition to just making your cat feel lousy, infections can cause big spikes in creatinine and BUN. Unfortunately, CKD cats are particularly prone to urinary tract infections (UTIs). Also unfortunately, UTIs can be hard to detect in CKD cats because their urine is so dilute, and so often no bacteria will show up in a urinalysis, not even when cultured. But if you can get a bacteria to culture, that is great because then you can select the antibiotic that is best matched to fight that bacteria.
Oftentimes, however, your clues to the presence of infection will be in your cat’s behavior, such as urinating outside the litterbox, or even just a drop in energy level. If urine doesn’t show bacteria, bloodwork can often give clues, even if they’re not definitive. Sometimes the biggest clue may simply be that your cat is showing a sudden spike in creatinine and there is no other apparent explanation. In such cases, ideally your vet would agree to try a broad-spectrum antibiotic and see if that turns things around.
It is important to note that CKD cats generally need a longer course of antibiotic than healthy cats in order to completely wipe out an infection. Mama got a six-week course for her UTI; many people would consider four weeks the minimum, and some even treat for eight weeks or more.
Antibiotics can make cats feel nauseated, so if your cat isn’t already on an antinausea medication, you may want to give one for the duration of the course. You can also give probiotics to ensure that the good bacteria in the gut don’t get depleted.
Dental infections can also strain the kidneys and cause a spike in creatinine. Plus dental problems, such as abscesses and resorptive lesions, are extremely painful. Cats are very, very good at hiding pain, but sometimes the pain is so great that the cat will even stop eating. Thus, although it may be anxiety-producing to put your cat under anesthesia, dental problems must be addressed. While many general veterinary practices offer dental services, you can also use a veterinary dental specialist.
#6 Monitoring for and properly treating other health issues commonly seen with CKD. Often, CKD is not an isolated health problem. Mama, for instance, has hypertension (high blood pressure), which is very common among CKD cats, and pancreatitis, which may be more common than is recognized. Another very common—and also very dangerous—issue for CKD cats is anemia. Fortunately, there is a lot you can do to address these issues. For example, many people have found that B12 methylcobalamim has helped boost red blood cell production, or at least slow the rate of decline in production.
Hyperthyroidism, diabetes, and inflammatory bowel disease (IBD) can also be present alongside CKD. If your cat has diabetes, a diet to manage the diabetes takes precedence over a renal diet.
Senior cats also frequently have heart problems, such as hypertrophic cardiomyopathy (HCM). It is worth noting that although a murmur does not always mean there’s HCM, it can be a sign of it, so if your vet does detect an audible murmur in your CKD cat, it is a good idea to get further testing, usually an echocardiogram, which is performed by a cardiologist. Knowing whether your cat has heart problems will potentially influence decisions about the amount of fluids to give.
As you can see, there is a lot to monitor—and in fact, I’ve touched upon only a few of the many things you’ll learn to look out for. That brings me to my final big point before sharing Mama’s story . . .
KNOWLEDGE: THE IMPORTANCE OF LABWORK
Regular check-ups will provide information vital to improving your cat’s quality of life and extending their lifespan. Because of the particular care Mama’s SUB device requires, she gets full check-ups every six weeks, but that is unusual. More common is a quarterly check-up, and some cats that are stable in early stage CKD go only twice a year.
Three tests, in my view, constitute the standard labwork that you will want done at each regular check-up: an extended/full chemistry panel, a complete blood count (CBC), and a urinalysis with culture. You may have to ask for these three things explicitly, since some vets will otherwise just run a limited renal panel. But if you want to monitor for infections, electrolyte imbalances, and anemia, among other issues, then this more extensive set of tests is important.
If hyperthyroidism or pancreatitis is suspected, you can also get tests run to check for indicators of these specific diseases. The spec fPL is a common one for pancreatitis (though Mama got something called the PLI test), and the T4 test is usually the first screen for thyroid levels.
Unfortunately, a blood pressure check is not considered a standard part of a check-up and will need to be requested separately. As discussed above, CKD cats often develop hypertension, so it is a good idea to monitor blood pressure. Some vets may object that the cat will be too stressed to get an accurate reading, but if your cat is stressed, the typical rule of thumb is to deduct 20 points for “white coat syndrome,” as such stress is known. Of course, it is best to give the test in as calm a situation as possible—so ideally before, not after, the cat has been prodded and stuck with needles—and multiple readings should be taken and averaged out.
Diagnostic imaging can be expensive, but it can also provide valuable information about the state of the kidneys and overall organ health. Pancreatitis and inflammatory bowel disease, among other issues, can often be detected through ultrasound. Ultrasounds are painless, but the cat does need to fast in advance. Also, an ultrasound is only as good as the person reading it, so do look for a board-certified sonographer or a vet with a lot of experience with this diagnostic tool.
An echocardiogram gives an image of the heart, which can be lifesaving information to have if your vet detects an audible murmur or otherwise suspects there may be heart issues. Echocardiograms are performed specifically by cardiologists and usually require a separate appointment.
So, that’s a lot of information! Part of managing CKD is also managing all the information that goes along with monitoring it. Many people create a spreadsheet where they track lab results over time. Note that most vets don’t expect people to want copies of the full lab reports, so you will have to ask for them. My vet now knows that I will always want a copy and makes sure one is sent to me.
I also keep a health log where I note any changes or unusual events (for example, diarrhea, vomiting, changes in medications or food). The log allows me to notice any connections or patterns, and reminds me of issues to bring up with the vet at our visit. Prior to a visit, I’ll review the spreadsheets and log and jot down any questions or requests I may have. There is something about those exam rooms that makes me quite distracted and forgetful, so I find it helps to be prepared.
I suppose I shouldn’t be surprised I get worked up in vet exam rooms, given all the drama we’ve had there.