Kidney Disease (Chronic Renal Failure)
Care of cats with kidney disease
Hydration is imperative for maintaining kidney function. Feeding an all-wet diet can do a lot for keeping kidneys healthy and cats with renal insufficiency comfortable. In cases, where an all-wet diet isn't enough to maintain hydration, sub-cutaneous (sub-q) fluids can be beneficial, and typically can be administered at home. There are also medications that may be useful.
Our domesticated cats originated in the desert. They have a low thirst drive, and count on the moisture inherent in their diet for most of their water consumption. Studies indicate cats fed dry food drink more water than cats fed canned, but not enough more to compensate for the lack of moisture in their diet.
Moisture is imperative for kidney health. All cats, but especially cats with renal insufficiency, should consume canned or other wet food.
It was believed that low-protein diets might be beneficial for cats with CRF, but studies indicate that low protein diets actually elevate Creatinine levels and exacerbate the anemia and muscle wastage commonly secondary to renal issues. Feeding a diet containing a high quality protein can improve the quality of life for cats with CRF. High quality proteins are easily digestible proteins such as poultry or rabbit muscle and organ meat. Grains and grain glutens are not easily digestible, and it may be desirable to avoid them.
Limiting phosphorus in the diet may be beneficial. Choice of diets low in phosphorus yet containing high-quality proteins may be limited. Another option is to use a phosphorus binder, as described below.
Sub-cutaneous (or sub-q) fluids can benefit cats for whom an all-wet diet isn't enough to maintain adequate hydration. Fluids can be given at home. Adding injectable B-complex to the fluids can further combat the anemia commonly secondary to CRF. B-vitamins are water-soluble and can be flushed out of the system with excessive drinking or urination, or with the administration of fluids, so replenishing them with sub-q fluids is a good option. Injecting B-complex undiluted can sting, but adding to fluids can keep them comfortable.
Medications and Supplements
As noted above, phosphorus binders can prevent phosphorus from accumulating in the system. Cats with renal insufficiency do best when phosphorus levels , as shown in the bloodwork, are maintained near the lower end of the laboratory's reference range.
Some studies have shown Benazapril, an ACE inhibitor, to improve prognosis of cats with CRF. It may improve blood flow to the kidneys.
Calcitriol, a form of vitamin D, has also shown to benefit some cats. Owners report the activity level and general well-being of their cats seemed to improve on this medication. It may be of particular benefit to cats with both CRF and hyper-thyroidism.
Supplements such as vitamin B-complex and omega fatty acids (salmon oil) may also be beneficial.
Brochure (printable version)
Lynette lost two cats, Monet and Molly, to CRF in 2002. Afer and Meow Meow were both more recently diagnosed with kidney insufficiency - fortunately, she's learned a lot. For one thing, the old "low protein" recommendation isn't in our cats' best interest. And a dry food most certainly isn't and may have contributed to the disease in the first place! Afer was diagnosed in August 2004, Meow Meow in January 2005.
Cost Saving Ideas
Shop around for prices on sub-q fluid and other supplies. Costs may vary significantly between your veterinarian clinic, local drugstores, and mail order. See:
Several medications are available as part of drugstores' low-cost generic drug programs. You may want to consider asking your veterinarian to write a prescription for you to fill elsewhere. For example:
An over-the-counter potassium supplement (such as potassium gluconate) designed for human use may be an alternative to a more expensive veterinary brand. Check the dosage with your veterinarian.
Prescription food may be an unnecessary expense. Cats need proper hydration to maintain kidney health (which is why sub-q fluids are often recommended). Feeding an all-canned diet may benefit your cat. If you are using a phosphorus binder, a low-phosphorus prescription diet may not be necessary, and simple readily-available canned foods may work fine. Low-protein prescription diets may exacerbate the anemia and muscle wastage commonly secondary to kidney disease, and may elevate Creatinine levels.
For futher information, visit:
Chronic Renal Failure
Mythology of Protein Restriction for Dogs with Reduced Renal Function by Kenneth C. Bovée, DVM, MMedSc
Feline CRF Information Center
Current Guidelines for Managing Feline Renal Failure
Recent Advances in the Dietary Management of Chronic Renal Failure in Cats
Pet Health Library - kidney failure
Canned Cat Food Nutritional Information by Janet & Binky
Canned Cat Food Chart frequently asked questions
Canned Food Nutritional Information by Kat Karma
Yahoo! Feline CRF-FD group
Kidney Disease in Older Cats by Dr. Jean Hofve
About Phosphorus Binders
Dealing with Kidney Failure in Cats and Dogs by Dr. Larry Siegler
Protein in Diet for Humans with Kidney Failure
Calcitriol for Cats & Dogs - Reference Page
Chronic Renal Failure in the Cat by Andrew H. Sparkes, BvetMed, PhD, DECVIM, MRCVS. WSAVA 2006
About Vitamin B Complex
Tanya's Feline Chronic Renal Failure Information Center
Current Concepts for the Management of Chronic Renal Failure in the Dog and Cat--Early Diagnosis and Supportive Care WSAVA 2005; Sherry Sanderson, BS, DVM, PhD, DACVIM, DACVN
Protein and calorie effects on progression of induced chronic renal failure in cats Finco DR, Brown SA, Brown CA, Crowell WA, Sunvold G, Cooper TL; Am J Vet Res. 1998 May;59(5):575-82
Effects of dietary protein and calorie restriction in clinically normal cats and in cats with surgically induced chronic renal failure Adams LG, Polzin DJ, Osborne CA, O'Brien TD; Am J Vet Res. 1993 Oct;54(10):1653-62
Feline Hyperthyroidism and its Relation with Renal Function WSAVA 2006 by Sylvie Daminet, DVM, PhD, DACVIM, DECVIM-CA
Feline Hypertension: Risks, Diagnosis and Management Clarke E.
Atkins, DVM, DACVIM (Internal Medicine & Cardiology)
last updated: 10/12/2008
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