Treatment, Medications and Long-Term Care in the UK

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 (International Renal Interest Society) 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

• Increased thirst and urination
• Weight loss and muscle loss
• Reduced or variable appetite
• Vomiting or nausea
• Lethargy
• Hypertension

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

Core Principles of CKD Management

Treatment is multimodal and tailored to the individual patient. Key priorities include:

• Maintaining hydration
• Controlling phosphate levels
• Managing blood pressure
• Reducing proteinuria
• Supporting appetite and gastrointestinal comfort
• Monitoring disease progression

Diet and Hydration (Foundation of Treatment)

Dietary management is one of the most important interventions in feline CKD.

Renal diets are formulated to:

• Reduce phosphate intake
• Provide controlled protein levels
• Support metabolic balance

Maintaining hydration is equally important. Strategies may include:

• Feeding wet food
• Providing multiple water sources
• Using water fountains
• In some cases, subcutaneous fluid therapy

1. 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 (RAAS) may be used to reduce protein loss through the kidneys.

Telmisartan is licensed in cats for reduction of proteinuria. ACE inhibitors such as benazepril may also be used in selected cases.

Formulation choice depends on the individual patient and ability to administer medication.

2. Controlling Systemic Hypertension

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

Amlodipine is widely used as first-line therapy in cats.

Blood pressure should be monitored regularly to ensure adequate control.

3. Managing Hyperphosphataemia

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

Management includes:

• Renal diets (first-line)
• Phosphate binders if dietary control is insufficient

4. Correcting Hypokalaemia

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

Supplementation may be required depending on blood test results.

5. Managing Nausea and Appetite Loss

Uraemia commonly leads to nausea, gastric irritation and reduced appetite.

Supportive treatment may include:

• Appetite stimulants (e.g. mirtazapine)
• Antiemetics (e.g. maropitant, ondansetron)
• Gastroprotectants where indicated

Monitoring and Follow-Up

CKD requires regular monitoring to assess progression and adjust treatment.

• Blood tests (creatinine, SDMA, electrolytes)
• Urine testing (proteinuria, USG)
• Blood pressure measurement
• Body weight and condition scoring

Monitoring frequency depends on disease stage but is typically every 3–6 months, or more frequently in unstable patients.

Prognosis and Long-Term Management

Prognosis varies depending on stage at diagnosis, response to treatment, and development of complications such as hypertension or severe phosphate elevation.

Many cats can maintain a good quality of life for extended periods with appropriate management.

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

Early intervention helps stabilise patients and prevents rapid deterioration.