CHRONIC KIDNEY DISEASE (CKD) MANAGEMENT PLAN:

Overall goal: Unfortunately, there is no cure for CKD, so our treatment measures focus on improving quality of life, controlling CKD symptoms (lethargy, increased thirst, increased urination, nausea), and slowing the progression of kidney disease.

  1. FLUID THERAPY: We generally start fluids at Stage 3-4 CKD. These patients can dramatically benefit from Sub-Q fluids given at home every 1-2 days. If you are interested in pursuing fluid administration at home, we are more than happy to help teach you and coach you through the process. It really isn’t very tricky!

  2. As needed for periods of anorexia: MIRTAZAPINE: Please let us know if/when your cat’s appetite starts to suffer. Because CKD leads to build up of waste products in the body, our Stage 3-4 CKD cats frequently get nauseous or even develop stomach ulcers that can make it difficult to maintain their appetite. This medication is great for stimulating the appetite in our geriatric and CKD patients, and it even helps control nausea.

  3. KIDNEY DIETS: Specially formulated kidney health diets are proven to help CKD cats feel better and slow the progression of their disease, and are recommend starting by Stage 2. These foods have limited, high quality protein, which reduces the workload on the kidneys. They also contain reduced phosphorus levels, as this mineral tends to accumulate in CKD cats as they kidneys fail to clear it from the body. CKD cats also tend to lose lots of potassium into their urine, so these special diets have extra potassium to help keep their levels up. There are a variety of great options available: Hill’s k/d, Royal Canin Renal, Purina NF, which all have different flavors and textures available. 

Nutrition tips: -With any diet change, SLOWLY transition onto a kidney diet over 1-2 weeks by adding more and more of the new diet while reducing the percentage of the old diet.  -Canned food is more ideal because it helps encourage more water consumption. Adding water to dry food is also helpful. However, if your kitty prefers dry kibble, that is OK too! Most CKD patients occasionally have episodes of nausea as a side effect of their disease, but this often leads to an aversion to the food they just ate. It is VERY COMMON for our CKD patients to eventually grow to dislike the special kidney diet they are on. When this occurs, let us know, and we’ll just switch to the next brand’s kidney formula.

  1. Mild nausea control: FAMOTIDINE (Pepcid) dosed at ¼ tablet by mouth once daily is a well tolerated OTC medication for times of nausea or poor appetite.

  2. “FLARE-UPS”: Most CKD patients that are well managed eventually have episodes of deterioration. Increasing Sub-Q fluids, or even hospitalization for a day or two of IV fluids, is often helpful for avoiding a crisis. Injections of potent anti-nausea drugs like Cerenia are also useful at these times. Common problems like an upset stomach, mild vomiting or diarrhea, can very quickly become a major crisis for CKD patients because they aren’t able to compensate as well for minor fluid losses—so ALWAYS seek help urgently your cat is ill for any reason. 

  3. Complication control: Medications and supplements may be added on as complications like high blood pressure, low potassium, or high phosphorus occur.