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The kidneys are complex and hardworking organs. Most of us know that they filter toxins from the blood and remove them from the body via the urine, but they also regulate levels of electrolytes (potassium, calcium, phosphorus and sodium); produce a hormone called erythropoietin, which helps control the production of red blood cells; and produce renin, an enzyme that regulates circulation and blood pressure. When they go wrong, it can mean big trouble.
Chronic kidney failure, or "chronic renal failure" (CRF) means the kidneys are not functioning as they should be. It tends to affect more older cats than older dogs, and it’s one of the leading causes of death in geriatric cats. Fortunately, with good management, the disease can be treated for months and often years with good quality of life for the cat.
If your cat has been diagnosed with CRF, the goal of therapy will be to slow down or head off the problems associated with the disease: high blood pressure (hypertension) and related behavior changes, weight loss and lack of appetite, lack of energy, and nausea and vomiting. Your cat’s treatment and prognosis will depend on how far the disease has progressed at the time of diagnosis, as well as the cat’s age and whether he already has signs of complications such as hypertension.
When kidney disease is caught in the early stages — and, often, even when it has progressed — you can take steps to maintain your cat's quality of life. Fluids, diet and medications can all help.
Cats with CRF drink a lot of water and urinate frequently, but it’s not unusual for them to become dehydrated. To combat this, you’ll probably need to administer fluids subcutaneously (under the skin) daily or every few days. Fluids help flush waste products that the kidneys can no longer filter out of the body on their own. Giving fluids only takes two to five minutes and contributes greatly to your cat’s well-being.
Inserting a large needle beneath a cat’s skin sounds like something most of us would do our best to avoid, but giving fluids is a real lifesaver. Your veterinarian or a technician can teach you how to perform the procedure. You can administer fluids any place your cat is comfortable, whether that’s on a bed or on top of your washer or dryer.
The conventional wisdom about diet and CRF has been to reduce protein levels, but that’s not always appropriate. The amount of protein required depends on the stage of the disease. My colleague Dr. Susan Little, a board-certified feline specialist, says cats with mild to moderate CRF need adequate protein and calories to maintain their body weight and avoid muscle wasting and anemia.
A food with reduced levels of protein and phosphorus is appropriate for cats with moderate to severe CRF. Your veterinarian can recommend an appropriate commercial food or direct you to a recipe that you can make at home.
Always err on the side of giving your cat a food he will eat. It’s more important for him to maintain his weight than to eat a special diet. If possible, give him a canned food with high-quality meat protein. The high water content will help him stay hydrated.
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