Treatment, Monitoring and Long Term Care

This article is for educational purposes only and does not promote or advertise prescription-only veterinary medicines. All treatment decisions should be made by a veterinary surgeon.

Chronic kidney disease (CKD) is one of the most common long term conditions affecting older cats in the UK. It is progressive and irreversible, but with appropriate management many cats maintain a good quality of life for months to years following diagnosis.

Management focuses on slowing disease progression, controlling complications, and maintaining appetite, hydration and comfort.

What is Chronic Kidney Disease in Cats?

CKD occurs when functional kidney tissue is gradually lost over time. The kidneys play a critical role in regulating hydration, electrolyte balance, blood pressure and waste excretion.

As nephrons are lost, remaining tissue compensates, but this adaptive process contributes to further damage, leading to a gradual decline in function.

How CKD is Staged: IRIS Classification

The IRIS staging system classifies CKD based on stable creatinine and SDMA levels in a well hydrated patient.

Staging should be confirmed on repeat testing and is used to guide treatment decisions, monitoring frequency and prognosis.

Common Clinical Signs

Clinical signs often develop gradually and may be subtle in early disease.

Core Principles of CKD Management

Management is usually multimodal and tailored to the individual cat. The main priorities are to support remaining kidney function, manage complications and maintain quality of life.

• Maintaining hydration
• Controlling phosphate levels
• Managing blood pressure
• Reducing proteinuria where present
• Supporting appetite and gastrointestinal comfort
• Correcting electrolyte abnormalities
• Managing anaemia where present
• Monitoring disease progression

Diet and Hydration

Dietary management is one of the most important parts of feline CKD care.

Renal diets are formulated to reduce phosphate intake, provide controlled protein levels and support metabolic balance. Your veterinary surgeon will advise whether a renal diet is appropriate based on your cat's stage of disease, appetite and overall health.

Maintaining hydration is equally important. Strategies may include feeding wet food, providing multiple water sources, using water fountains and, in some cases, subcutaneous fluid therapy under veterinary guidance.

Reducing Proteinuria and Slowing Progression

Persistent proteinuria is associated with faster CKD progression and reduced survival time.

Medications that act on the renin angiotensin aldosterone system may be used to reduce protein loss through the kidneys. Active substances that may be prescribed in proteinuric CKD include telmisartan and, in some cases, benazepril.

These treatments form part of a broader management plan and should be used only following veterinary assessment and monitoring.

Controlling Systemic Hypertension

Hypertension is a common complication of CKD and can lead to retinal detachment, neurological signs and further kidney damage.

Blood pressure should be monitored regularly in cats with CKD. Amlodipine is commonly prescribed to help manage systemic hypertension in cats where treatment is required.

Ongoing blood pressure monitoring is important to assess response and guide long term management.

Managing Hyperphosphataemia

As kidney function declines, phosphate excretion is reduced. Elevated phosphate can contribute to disease progression and clinical deterioration.

Management usually starts with dietary phosphate restriction. Where phosphate levels remain elevated despite dietary management, phosphate binders may be recommended by a veterinary surgeon.

Examples include products containing calcium carbonate, lanthanum carbonate or other phosphate binding compounds used under veterinary direction.

Correcting Hypokalaemia

Low potassium levels can occur in some cats with CKD and may contribute to weakness, cervical ventroflexion, reduced appetite and poor muscle function.

Potassium supplementation may be recommended where blood testing confirms hypokalaemia. Products containing potassium gluconate are commonly used to support normal potassium levels under veterinary guidance.

Managing Nausea and Appetite Loss

Uraemia commonly leads to nausea, gastric irritation and reduced appetite. Appetite loss can rapidly affect hydration, body condition and overall wellbeing in cats with CKD.

Supportive treatment may include:

• Appetite stimulants
• Nausea management
• Gastroprotectants where indicated
• Assisted feeding or feeding tube support in selected cases

The most appropriate approach depends on the individual cat, the severity of signs and any concurrent health conditions.

Managing Anaemia in Cats with CKD

As CKD progresses, some cats develop non regenerative anaemia due to reduced production of erythropoietin by the kidneys.

Anaemia may contribute to lethargy, weakness, reduced appetite, weight loss and reduced quality of life.

Treatment options vary depending on the severity of anaemia and the individual cat's overall condition. In selected patients, products containing the active substance molidustat may be prescribed to help manage CKD associated anaemia under veterinary supervision.

Regular monitoring of red blood cell parameters is important when managing anaemia in cats with chronic kidney disease.

Monitoring and Follow Up

CKD requires regular monitoring to assess progression, detect complications and adjust the management plan where needed.

• Blood tests, including creatinine, SDMA, urea and electrolytes
• Urine testing, including urine specific gravity and proteinuria assessment
• Blood pressure measurement
• Phosphate monitoring
• Red blood cell parameters
• Body weight and body condition scoring

Monitoring frequency depends on disease stage and stability, but many cats are reviewed every 3 to 6 months, or more frequently if unstable or recently started on treatment.

Prognosis and Long Term Management

Prognosis varies depending on stage at diagnosis, response to management and the development of complications such as hypertension, proteinuria, hyperphosphataemia or anaemia.

Many cats can maintain a good quality of life for extended periods with appropriate management, regular monitoring and prompt treatment of complications.

When to Contact Your Vet

• Reduced appetite or refusal to eat
• Vomiting or persistent nausea
• Sudden weight loss
• Lethargy or behavioural change
• Changes in drinking or urination
• Weakness or collapse
• Sudden vision changes

Early intervention helps stabilise patients and may prevent rapid deterioration.