Managing Chronic Kidney Disease in Cats: The Proactive Cat Owner’s Guide

Chronic kidney disease (CKD) is a common health issue, affecting 2-4% of all cats, and 30-40% of senior cats. As a proactive cat owner, it is essential to be aware of CKD and take steps to identify the condition and intervene as early as possible in to allow for the best opportunity to slow the progression and delay or minimize signs of illness that interfere with a good quality of life. In this blog post, we will delve into our management approach for different stages of CKD, which is based on recommendations of the International Renal Interest Society (IRIS).

Understanding How Chronic Kidney Disease Can Affect Your Cat:

CKD is a progressive condition that impairs the kidneys’ ability to function properly. In the early stages (stage 1-2), there are often no visible symptoms–this is when we focus on slowing down the disease’s progression. As CKD advances to later stages (stage 3-4), symptoms like nausea, poor appetite, vomiting, and weight loss become more common and severe, demanding greater emphasis on controlling these symptoms for an improved quality of life.

How We Detect Kidney Disease:

Ideally, CKD is detected in early stages on routine wellness lab profiles. We recommend annual screening blood work for young adults, with the addition of urinalysis for senior cats.

IRIS Guidelines

Stage 1 – Early Kidney Disease:

At this early stage, cats may have normal blood work results but show indications of kidney dysfunction, such as abnormalities on ultrasound or impaired ability to concentrate urine. The goals at this stage include discontinuing medications potentially harmful to the kidneys, ruling out treatable causes like kidney infection or obstruction, and screening for secondary high blood pressure or protein loss from the kidneys. To ensure proper hydration, constant access to fresh drinking water is crucial, and prompt correction of dehydration during other illnesses like diarrhea is necessary. In cases of high blood pressure or protein loss, appropriate medications (calcium channel blockers like amlodipine, or angiotensin receptor blockers like telmisartan) and dietary adjustments (sodium restriction, omega- fatty acid supplementation, therapeutic kidney support diet like Hill’s k/d or Pro Plan NF) are recommended.

Primary interventions:

-Ensuring adequate hydration at all times
-Minimizing use of medications that may be harmful to kidneys
-Telmisartan, omega-3 fatty acid supplement, and kidney support diet if needed for protein loss from kidneys
-Amlodipine (or telmisartan) and sodium-restriction if needed for high blood pressure control
-Monitor every 6-12 months

Stage 2 – Managing Mild Chronic Kidney Disease:

As CKD progresses to stage 2, it’s ideal to introduce a kidney support diet along with the strategies used in stage 1. Cats at this stage may have a reduced ability to concentrate urine, making sufficient water intake and aggressive hydration management during other illnesses even more important. Controlling blood phosphorus levels (goal 2.7 to 4.6) through dietary adjustments and supplements becomes beneficial for slowing the progression of kidney disease, though careful balancing of blood calcium level is required as well. Compromised kidneys may not be able to conserve potassium, so supplementation is sometimes needed. While symptoms are usually mild or not apparent in stage 2, it is essential to treat any suspected nausea episodes or reduced appetite with appropriate medications.

Primary interventions (in addition to those for Stage 1):

-Therapeutic kidney support diet, such as Hill’s k/d or Pro Plan NF
-Phosphorus-controlling supplement like Epakitin if needed
-Potassium supplement like Renal K+ if needed
-Nausea/vomiting medications like Cerenia as needed for vomiting
-Appetite stimulant like oral mirtazapine every other day for 3 weeks when episodes of reduced appetite, vomiting or weight loss occur
-Monitor every 3-6 months

Stage 3 – Managing Moderately Advanced CKD:

In stage 3, some cats may still be free from symptoms and managed similarly to stage 1-2 patients to slow down disease progression. However, most Stage 3 cats have mild to severe symptoms affecting their quality of life, such as nausea, vomiting, dehydration, anemia, and excessive body acidity. Treatment goals for patients free from signs of illness are similar to Stages 1-2, but for patients with symptoms, we shift our focus to helping the cat feel their best, which often includes routine subcutaneous fluid administration, nausea control, and appetite stimulation.

Primary interventions (in addition to those for Stages 1-2):

-Feed a kidney support diet like Pro Plan NF or Hill’s k/d
-SubQ fluid therapy
-Appetite stimulants like frequent or continuous courses mirtazapine if nausea, inappetance, or weight loss occurs
-Supplementation with oral sodium bicarbonate or potassium citrate if metabolic acidosis exists
-Monitor every 1-3 months

Stage 4 – Enhancing Comfort in Advanced CKD:

At this advanced stage, most cats have many symptoms at home. While it’s still important to work on slowing the progression of kidney disease, our primary goal is keeping this patient as comfortable as possible. Special foods, supplements, medications, and fluid therapies are employed to manage symptoms such as vomiting, nausea, poor appetite, weight loss, dehydration, and systemic acid build-up. These patients are unable to concentrate urine normally, so maintaining adequate hydration becomes increasingly important. Maintaining adequate protein and calorie intake becomes increasingly challenging. Referral for kidney transplant could be considered, though ethical implications remain.

Primary interventions (in additoin to those for Stages 1-3):

-Treatment of severe anemia with darbepoetin
-Hospitalization for in-patient management of “uremic crises” as needed
-Consider feeding tube or humane euthanasia if medications for nausea control and appetite stimulation are inadequate for maintaining adequate calorie intake
-Monitor at least monthly


Optimal management of chronic kidney disease in cats requires early detection and proactive measures to slow down disease progression and improve quality of life. As a dedicated cat owner, it’s important to be aware of common conditions like CKD and know that there are a variety of ways we can help, especially when caught early.

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Dr. Alison Barulich

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