Feline Chronic Renal Failure: an opportunity to make some changes
Updated: Oct 6
Loving pet owners are often shocked and sad when their cat is diagnosed with chronic kidney disease. However, there are ways to achieve perspective and support your cat’s kidney function.
The main thing I’ve experienced over the years in practice is that cats can live a quality life for many many years after initial diagnosis. I never like to put a number of years on a situation, I’m frequently proven wrong. Cats don’t follow expectations or statistics. Don’t panic. I remind myself often, treat the patient not the bloodwork.
Objective parameters
IRIS (International Renal Interest Society) sets forth clear guidelines for staging renal disease. Please use links to see guidelines for each stage. With a little study, the Pocket Guide can be understandable for most pet parents. Please book a consult or review with your veterinarian if you have any further questions on the following information.
Laboratory work and other diagnostics (frequency depending on stage and recommendation of your veterinarian).
Every 6-12 months (depending on age of diagnosis, stage and symptoms) a urinalysis can rule out infection, quantify specific gravity (urine concentration), screen for glucose, ketones, and excessive crystals. I do not use protein as measured by a dipstick to monitor renal function, a UPC (urine protein creatinine ratio) test will more accurately reflect protein loss through the kidneys. Urinary tract infection and bleeding can interfere with the accuracy of this test however.
Main blood values I monitor: Creatinine, BUN, SDMA, Phosphorus, Potassium, red blood cell count. In very thin cats, Creatinine is not an accurate value to monitor renal disease (focus more on SDMA in thin cats). A serum iron level would also help to determine if supplementation is advisable (as relates to anemia).
Abdominal Ultrasound and other imaging can help assess co-pathologies, cancers (lymphoma) in the kidneys or urinary system, kidney and urinary stones, kidney architectural and functional changes.
Weight and physical condition are monitored to make sure your cat is eating enough, getting enough nutrients or indicate changes in kidney and other dysfunctions.
Thirst, appetite, attitude. You are the frontline and advocate for your pet. If your pet is not doing well, request lab work, other diagnostics, or a referral. Push for sooner than later. Veterinarians get rushed, frustrated and tired. We miss things. It is not an easy profession. Reschedule with sedatives (for your cat LOL) if they are not doing well with any lab procedures. There is no reason to insist on a traumatic event. When the vet or tech tells you the cat is finished with everyone and needs sedatives – they are finished!
Hypertension
Most cats are comfortable with a very small blood pressure cuff and either an automated or doppler read blood pressure. Pressures over 170 mmHg should be treated. I typically use Amlodipine since I would have already been using supplements and other kidney supportive modalities by that point. The dose is typically ¼ of a 2.5 mg tablet. You can have it compounded into an oral liquid, tiny tabs, or flavored chewables from a compounding pharmacist. Sadly, transdermal formulations don’t work well or reliably. Some hypertension is not renal in origin (and sometimes takes a series of diagnostics and ruling out to figure out the best approach). Sometimes central nervous system (brain) signs may become apparent (and Amlodipine or other antihypertensives may not result in lower blood pressure). You may need an opinion from a veterinary internist or neurologist at this point to assist with balancing meds and diagnostics.
Anemia
The kidneys produce erythropoietin which is a hormone that tells the bone marrow to produce red blood cells. As the kidneys deteriorate, there is less of this hormone (the mechanism is complex and only recently more completely understood – see discussion on HIF). Cats can function with shockingly low hematocrits (in the upper teens, lower 20s) which is why regular lab work is necessary.
I have observed some renal support supplements, Chinese medicine herbs and homeopathic medicine support to improve red blood cell counts by way of supporting kidney health.
Synthetic erythropoietin (ex. Epogen, which is a human product) is administered (injected dose by a veterinarian) at a veterinary clinic and red blood cell responses must be closely monitored. This therapy has long been used for supporting improved red blood cell counts. I’ve found this to be helpful; however, I have had patients develop antibodies to this product and then they get more anemic than ever. So, it is advised to hold off starting this therapy as more of a later stage resort (21-22% HCT for example).
A newer, and now preferable, drug is Varenzin-CA1 (molidustat oral suspension /Elanco) for the treatment of non-regenerative anemia in cats with chronic kidney disease (CKD). This is easier as a once-a-day oral liquid that can be given by the owner at home. The mechanism of action: stabilizes hypoxia-inducible factors (HIF) (HIF is a complex of proteins that bind to switch on genes needed to make erythropoietin), making the body think it needs more oxygen and this stimulates the cat’s own erythropoietin to be released from the kidneys, which goes on to stimulate the bone marrow to produce more red blood cells. This medication also facilitates iron bioavailability by stabilizing HIF-α, allowing the cat to better mobilize and absorb iron which is integral to red blood cell formation.
Frequent monitoring and rechecks are paramount to safety and success. Please follow your veterinarian’s dosing/protocol/timing for rechecking complete blood counts and stopping the medication for the mandatory 7-day rest after the 28 day start up. Then you will want your cat’s hematocrit (at minimum) monitored every few weeks. If the cat becomes anemic again, the cycle can be restarted.
supportive care ideas
Diet
I will occasionally utilize prescription medical diets to dissolve bladder struvite crystals. Rarely do I put a cat with CKD on a prescription diet. My philosophy is, food and treats are a main joy for a cat. Clients often feel conflicted about shifting off of more natural balanced foods onto a kibble or highly processed canned diet. Some cats will not shift off of their preferred foods for anything. I don’t push them. An already compromised system is not supported by a cat being upset, picking at their food and not receiving enough calories.
Please do your best to wean your cat off kibble. Kibble is high in starch and carbohydrates, which cats do not utilize well leading to obesity, and predispose them to develop type 2 diabetes. Cats do not effectively drink water and get moisture from their food. Kibble diets can lead to excess particulates and crystals in the urine leading to kidney and urinary bladder sand and stones.
Especially if the cat is already used to raw food, slightly cooked, or freeze-dried diets, continue.
Darwin Intelligent Design Kidney Support: https://www.darwinspet.com/collections/intelligent-design-for-cats
http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf look at diets with Phosphorus 250mg/100 kcals or below, animal protein >50%, low carbohydrate <1-2%
Note: if a cat is not eating well, trial medicines (homeopathic, or allopathic ex. Maropitant) can help with nausea. Concurrent diseases such as inflammatory bowel disease, liver disease, pancreatic disease/ diabetes need to be ruled out and treated as appropriate.
RESOURCES
The following may contain affiliate links (taking you to Amazon or another website), which means I may receive a commission at no extra cost to you if you purchase through a link. See Pet Kidney Support in Resources for Pets for more.
*Standard Process Feline Renal Support 1 tablet twice daily
or Standard Process Renafood – give 1 tablet twice daily along with Renatrophin PMG (1 tablet twice daily)
*Fatty acid (salmon oil, sardine oil or sardines)
Nordic Naturals Omega-3 Cat, Unflavored - 2 oz - 304 mg Omega-3 Per One mL - Fish Oil for Cats with EPA & DHA - Promotes Heart, Skin, Coat, & Immune Health - Non-GMO https://geni.us/iJPv
or give sardines (1/2 large sardine or about 1 tsp every other day, tin is good for 4 days in fridge or can be frozen)
*B-complex
Rx Vitamins Amino B-Plex Liquid Nutritional Supplement for Cats & Dogs https://geni.us/d5QR06 OR
ThorneVet B-complexx VET – Vitamin B Complex Support for Dogs & Cats - 60 Soft Chews https://geni.us/p5hz
A pinch of baking soda in the food 2-3 times a week – kidneys need the bicarbonate ion to do their work
Flower Essences:
Kidney Strength Formula https://petessences.com/products/kidney-strength – add a few drops to water or food, or take a few drops on your hands and pet your cat – can be used daily.
This can complement your veterinarian's UTI treatments: https://petessences.com/products/cystitis
Probiotic
Vetoquinol Azodyl - Probiotic Supplement for Dogs & Cats - Offers Renal & Kidney Support for Pets - Easy-to-Swallow, Small Capsules - 90 Count https://geni.us/fKpA5b8
(I’ve seen this product to be useful in bringing down BUN and Creatinine)
Herbal Support
Vetriscience Veterinary Strength Kidney Health Chews - Balanced Kidney Support for Pets - Feline & Canine Renal Support - Holistic Formula - Chicken Liver Flavor - 60 Count (Active Ingredients per 1 chew: Astragalus membranaceus Root Powder, 120 mg, Rehmannia glutinosa Root Extract, 100 mg, Nettle Leaf Extract, 100 mg, Cordyceps Sinensis Extract, 100 mg) https://geni.us/UUJTr
VetriScience Kidney Health Powder, Renal Essentials Supplement for Cats, Kidney Care and Support with Mushroom, Astragalus Root, Nettle Seed and Herbs, Chicken & Cheese, 60 Scoops https://geni.us/GpYRI
VetriScience Kidney Health Chewable Tablets, Renal Essentials Supplement for Cats, Kidney Care and Support with Mushroom, Astragalus Root, Nettle Seed and Herbs, Chicken and Fish, 60 Count https://geni.us/9msScB
Other Therapeutics
Assisi loop (PEMF) https://assisianimalhealth.com/technology/, photo biomodulation (ex. Lite Cure Companion Laser) homeopathy, chiropractic, acupuncture and Traditional Chinese Medicine (TCM) – each has a mechanism to support kidney function.
Assisi loop - place over the mid back to treat kidneys. Also useful to ease pain related to arthritis.
LOOP Lounge tPEMF System for Dogs and Cats (Small) https://geni.us/LzDst
Assisi Loop 2.0 Manual tPEMF Device for Dogs, Cats, and Horses (10 cm) https://geni.us/Wz1H6FV
If indicated by lab work and appetite:
100-150 ml sub-cu fluids 2-3 times a week (useful if there are decreases in appetite and energy) – warm the drip line by running it through a pan of very hot water, cat can sit in a pet bed, carrier or box for ease of handling.
Aluminum Hydroxide Powder – helps bind up excess phosphorus in the food (that the kidney is not properly excreting). Please consult your veterinarian for prescriptions and dosing. Can also be made into a flavored liquid given at mealtimes.
Rx Vitamins For Pets Phos-Bind - Kidney Support Supplement Powder - Phosphate Binder for Cats & Dogs for Kidney Health - Supports Normal Kidney Cleanse and Essential Kidney Care - 35g https://geni.us/A4BWi (used to bind excess phosphorus in kidney failure conditions, please get dosing from your veterinarian – for cats, I use 1/16 tsp in food twice a day)
Potassium supplement (when lab work shows low potassium) – ex. Tumil- K, Rena-care
This is a detailed website with several educational and supportive resources. www.felinecrf.org
Picture and know that your cat is energetically and spiritually perfect. This can translate to healing on the physical plane. Of course, pay attention and make changes as needed, take deep breaths and enjoy this opportunity to learn and help your feline companion.
