Well, no and yes. That’s a tough one.
A diagnosis of chronic kidney disease (CKD) means that your cat has lost 66% or more of their normal kidney function and is one of the most common illnesses in middle-aged and senior cats. In fact, in a recent study of 100 cats aged 6-13 years old, 44 cats had evidence of CKD despite no obvious changes at home (like peeing more or less than normal) or on physical exam.
Unfortunately, we can’t reverse changes in kidney function but there are many things that can be done to slow its progression and if there are no other abnormalities, chronic kidney disease generally progresses slowly. When diagnosed early, cats have lived as long as 8.5 years after the diagnosis. However, as this is can be a silent disease, some cats aren’t diagnosed until the later stages of the disease, usually when they have complications such as pyelonephritis (kidney infection) or hypertension (high blood pressure).
That all being said, it’s actually very fortunate that your cat has been diagnosed with CKD before they are acting ill as this allows us to act—that is, do everything we can to slow down the progression and ensure your cat has good quality of life for as long as possible.
So, where do we go from here?
The first thing we need to do is determine your cat’s stage of kidney disease. The International Renal Interest Society (IRIS) has developed guidelines for best treatment based on each stage.
- Imaging of the kidneys (x-ray or ultrasound) to look for signs of tumours, kidney stones, or other abnormalities that would worsen your cat’s prognosis.
- Assessing the level of protein loss from the kidneys into the urine (proteinuria) by testing the urine protein:creatinine ratio (UPC).
- Consistent significant proteinuria carries a poorer prognosis but an effective treatment to reduce or eliminate proteinuria is available (telmisartan or benazepril).
- Checking for hypertension (increased blood pressure) that can be caused by CKD as well as hasten the progression of CKD.
- Blood pressure assessment is a non-invasive procedure and very similar to human blood pressure assessment. Hypertension can be successfully treated with telmisartan or amlodipine.
- Depending on the results of your cat’s urine test (urinalysis), we may also recommend culturing the urine to check for kidney infection that can contribute to worsening of CKD.
How can I help my cat right now? The short answer: through their food.
The most effective and reliable treatment for cats with CKD is changing to a diet that’s restricted in protein, phosphorous, and sodium, and high in vitamins, fibre, and antioxidants. These diets have been formulated to be tasty but since they have a lower protein content, cats can take a few weeks to transition to them. (Remember, cats are carnivores and love their meat.) Our veterinarians will recommend what diet is best for your cat. And be sure to ask us for tips and tricks to help make this transition easier.
Take note: Cats with CKD can sometimes feel nauseous, and develop an aversion to the diet they are eating, linking their nausea to what they last ate. Because of this, the veterinary nutritionists working for the major prescription pet food manufacturers have formulated a range of renal diet recipes with different flavours, aromas, and textures that you can offer to your cat if their appetite declines (assuming other causes of inappetence have been eliminated.)
What other support might my cat need in the future?
In later stages of kidney disease, cats can face additional challenges such as:
- High phosphorous levels that can cause nausea.
- Phosphate binders (i.e., Amphojel®, Epakitin®) can be given orally to limit phosphorous absorption in the intestine and decrease blood phosphorous levels.
- Low potassium levels that can decrease appetite.
- Potassium supplements can be given orally or can be introduced in subcutaneous fluids (see below).
- Trouble staying hydrated, leading to lethargy, nausea, and decreased appetite.
- We can teach you how to give subcutaneous fluids at home to help maintain your cat’s hydration and help them feel better.
- Anemia (low red blood cell count) that decreases energy and appetite.
- Darbepoeitin or Epoetin injections can be given to increase red blood cell numbers.
- Vomiting and inappetence can occur more regularly as kidney disease worsens.
- Mirtazapine is an antihistamine that stimulates appetite and can be given orally or as a gel that’s absorbed through the skin on the inside of their ear.
- Maropitant (Cerenia) is a powerful anti-emetic (anti-vomiting) drug that is very effective for nausea and vomiting.
- Some cats benefit from feeding tubes to maintain nutrition and hydration if they aren’t responsive to the above medications.
To help your cat live their best life, we will recommend specific treatments and schedule regular blood and urine rechecks based on your cat’s condition. CKD can be a scary diagnosis, but most cases are manageable with cooperation between you and our veterinary team.