Keeping Kidney Cats Alive—Strategies that WORK!

Kidney Disease is very common in cats. It is an end of life problem for about 1/3 of the cats we see at Ann Arbor Animal Hospital. This means the disease is more common in the oldest patients, and it may be a reason for euthanasia due to poor life quality.

The typical patient shows weight loss, dehydration, thirst, a wet litter box, urine accidents outside the litter box, poor appetite, vomiting, bad odor from mouth, muscle weakness, or constipation.  In mild cases, only one symptom may be noted. Lab test abnormalities may include dilute urine; elevation to BUN (blood urea nitrogen), Creatinine, and Phosphate; anemia, and low potassium.

Our physical exam may show high blood pressure, extreme weight loss of  fat and muscle, tented, dehydrated skin, oral ulcers and depression.

Success in therapy means:

• Cat maintains body weight
• Cat acts normal, participates with family, uses litter box, and is not hiding all day in a closet.
• The work is not too exhausting for the family.
• See “The Sick Cat Bill of Rights”

It can be tricky to give oral medications to cats and they often will not eat anything if drugs are sprinkled on food.  Cats tend to hide under the bed if unpleasant events happen frequently. Below are several therapeutic options, as well as some feeding strategies that might mitigate some of the symptoms of kidney disease in cats.

Feeding Strategies:

• Kidney foods: Low salt, low phosphorus, high potassium and moderate but good quality protein foods are available by prescription from the veterinarian. At Ann Arbor Animal Hospital we routinely stock three types of dry and canned cat foods designed for feline kidney disease. Multiple studies have shown that kidney cats that willingly eat these foods live longer. It is okay to mix food the cat likes with the new food to try to transition into a new diet.

• Wet food adds moisture: Can food is 70% water. Cats do not drink efficiently. There is a lot of lapping for a cat to consume 3 ounces of water, but the cat may eat a small can of food easily. Water as part of can food or added to can food is one way to rehydrate the cat.

• Frequent presentations of fresh small food portions: Offer 2 tablespoons of fresh food on a clean plate several times per day. The fresh food will encourage the cat to eat more times and consume more food.

• The microwave trick: If a can of food is stored in the refrigerator, mix a small amount of cold food and water in a small bowl and microwave up to body temperature. Warming increases the food aroma, making refrigerated can food almost as palatable as just opened.

• The “cherry on the top” trick: Some cats may eat a new food if something they like is a morsel on top or just barely mixed into the top of the new diet.

Medications & Supplements

• Oral H2 Blockers: Famotidine, a popular for home treatment of heartburn for people (brand name PEPCID AC 10mg tab is dosed at 5mg once per day per cat). This appears to make the kidney cat feel better, eat better and vomit less.

• Subcutaneous Fluids: Rehydration at home by caregiver infusing Lactated Ringers Solution under skin is surprisingly well tolerated by most cats. The added fluid increases the volume passing into the kidneys, aiding in filtration, and allows correction of whole body dehydration and helps constipation. Many people find the SQ fluids easier to do than trying to pill the cat. When used for long term chronic medication, we dose at the amount that keeps the cat eating well. Typical is 100ml under skin once every day or every other day.

• Phosphate binders: We use Epikatin, a chitin product most cats will eat sprinkled on can food, and aluminum hydroxide as a liquid medication.

• Potassium Supplements: Sick kidneys tend to lose potassium. With Chronic kidney disease whole body potassium and serum potassium tends to be low. Sometimes the most dramatic symptom of kidney disease is ventroflexion, an odd head position related to muscle weakness caused by low potassium. Potassium supplements include- kidney diets, Tumil-K – potassium gluconate as a pill, powder or gel, and KCl added to sq fluid bag.

• Appetite Stimulants: A hungry cat eats more, and may eat more of the kidney diet. We have three choices: oxaxapam as a liquid, cyproheptadine or mirtazipine as pills.

• Hypertension medication: When blood pressure is measured at over 200 mm Hg systolic, we add Amlodopine to lower dangerously high blood pressure. We then monitor blood pressure.

Additional Treatment:

• Small and thoughtfully spaced blood tests: Due to poor blood cell production, we need to limit the volume and frequency of blood tests in these fragile older patients. Treatment adjustments for potassium and phosphate problems do require testing. We can get a lot of information from a single 1ml blood sample.

• Acupuncture: Some cats will eat better, move better, and act younger when treated with acupuncture at kidney points.

Our goal is to have a comfortable cat. We select one or more therapies. It would be very unusual to start six drugs at one time.

—Dr. Jess Franklin, DVM