Cat drinking water
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.

Managing CRF

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.

Medication can help extend survival time iin many cases and improve quality of life. Your veterinarian may prescribe drugs that will stimulate your cat’s appetite, reduce nausea, maintain normal concentrations of phosphorus in the blood and control levels of parathyroid hormone.

All drugs have potential side effects. Your cat may need regular blood work to monitor concentrations of certain hormones and minerals as well as kidney and liver function. Always ask your veterinarian to discuss the risks and benefits of any drug protocol so that you can make an informed decision.

Additional Tips

As kidney disease progresses, signs can change. Keep a close eye on your cat, and report any changes in habits, behavior, or attitude to your veterinarian.

Inserting the large needle of a fluid bag beneath a cat’s skin is scary at first. Practice on an orange or lemon a few times before you go live with your own cat. If you’re just not up to it — and no one will blame you if you aren’t — ask your veterinary team about other options for administering fluids. Some vet technicians can come to your home and administer fluids as needed.

Gently hold your cat and talk to him softly while administering fluids. If necessary, have an assistant help you, or wrap the cat in a towel to help him stay calm and still.

Before giving fluids, warm them to 95 to 98 degrees Fahrenheit — comfortably warm on your own skin — by placing the bag in warm water in the sink. Don’t submerge it, and don’t heat the fluids in the microwave.

End the session with a treat, so your cat associates something positive with getting his daily fluids.