There are 4 stages of Chronic Kidney Disease (CKD) that are defined by the IRIS scale, these are defined by blood and urine test results in relation to the function of the kidneys. The main areas of focus when caring for a cat with CKD are food, drinking and toileting. Your veterinary surgeon will advise you on what stage your cat is.
Food and feeding
What your cat eats when they have been diagnosed as having Chronic Kidney Disease (CKD) can make a huge difference to them. A change to a Renal diet has been proven to help slow progression of the disease, it won’t cure but will slow the progression and can make a difference to your cat’s quality of life. It is vital you discuss with your vets before moving your cat onto a Renal diet as there are different foods suitable for different stages.
There are a few specific renal diets on the market, and as cats tend to have particular likes and dislikes when it comes to food, the selection available means with some time and searching you will find the renal diet that suits your cat.
Things to consider when choosing a Renal diet:
What does your cat currently eat eg. wet, dry, mix?
Do they prefer a certain shape of dry food or flavour?
Are they a jelly, gravy or mousse/pate kind of cat?
Does their usual brand make renal veterinary diets for cats?
Changing your cat’s food should be done gradually over one to two weeks and not whilst they are particularly unwell; the reason for this is a food introduced whilst a cat is feeling sick for example can cause food aversion, due to the cat linking the food to that feeling; this is the reason why prescription diets are not introduced during hospitalisation at the vets.
Feeding a veterinary prescription diet within a multi cat household can be tricky. Ideally you need to be able to feed them separately and allow enough time for them to eat their renal food and not have access to steal the other cat’s food. Microchip feeders can be really helpful, you may only need the one, but this will depend on your individual cats eating habits. Due to CKD generally being age related there may be other conditions, like Osteoarthritis, that may benefit from raising a food bowl when you introduce changes to feeding places.
For example, Gizzmo is a large breed cat with Osteoarthritis, the microchip feeder on the floor was less accessible, so raising it up created a more suitable and comfortable position for Gizzmo to eat.
Scent is very important for cats when eating so when your cat is reluctant to eat then try warming the food up for a few seconds in the microwave, ensure you check it is not too hot and only warm to the touch, warming the food can help increase the smell and encourage them to eat it. Food bowls needs to be away from the wall so the cat eating can survey their surroundings.
Cat’s nature and instincts are all related to being solitary hunters; because of this, encouraging cats to eat can also be done by using puzzle feeders, there are a lot on the market, or you can get creative, empty toilet rolls with a hole cut into the side with dry biscuits in is an effective puzzle feeder.
Water and drinking
CKD causes cats to have a increased thirst and need for water to help prevent dehydration. Increasing the amount of water available and providing different locations and even new novel ways for them to access water is very valuable. Again, raising water bowls up, like food bowls, can increase intake by making it more comfortable for your cat.
The general rule one water bowl per cat plus one, e.g., 2 cats = 3 water bowls would benefit with an increase of one or two more. Fill bowls right to the top, cats are reluctant to place their face fully into a bowl. Ideally, they need to be away from the wall so they can choose where to drink from and watch what’s going on around them. Provide water on every floor in the home.
Indoor cat water fountains are great for those cats that enjoy drinking from running water, you are not always on hand to turn the tap on for them. Cats with access to outside need to have access to safe and clean water to help prevent them drinking unsafe water due to their increased thirst. A water fountain is great but needs to be kept clean and free from harmful chemicals.
Get creative, for example a watering can that never has chemicals or additives in it filled to the top and left outside can be a safer outside drinking source than a puddle.
Something new on the market to help – Purina have a nutrient rich water supplement that can be given alongside a renal diet and water called Hydracare and helps cats maintain hydration which is very important for cats with CKD. Please note before feeding Hydracare always check with your vets that it is suitable for your cats individual needs.
Due to CKD causing increased urination it is extremely helpful that even a cat who always goes outside has access inside to a litter tray, to help reduce stress and in house soiling.
The general rule of one litter tray per cat plus one e.g. 2 cats = 3 litter trays. Depending on age and other health conditions adapting a litter tray to have a very low side can help those cats with Osteoarthritis. Using small sized litter granules can also help as treading on larger sized litter like wood pellets can be uncomfortable.
Place a litter tray on every floor of your home. Ensure they are away from busy and noisy areas. Avoid placing them next to entry and exits too.
Choose a litter tray that suits them, some prefer uncovered litter trays where others choose a covered litter tray. Cats are very smell sensitive and the use of scented cat litters or liners can put them off using the litter tray. Make sure the depth of the litter is about 3cms as this has been shown in studies to be preferred as the cat has enough to dig and then bury its business. Clean out any soiled litter asap and completely change the cat litter every week and clean the tray. Ideally use soap and hot water or an unscented specific litter tray cleaner to ensure that the product you are using is not toxic to cats.
Note: Amonia based products will put the cat off using the litter tray If they are not using a litter tray, try moving its location. If they don’t use any litter trays you may need to consider trying different cat litters and/or litter trays but don’t do this all at the same time otherwise you will not know what change means they now want to use it.
If they go outside to the toilet help them by finding an area where they will be hidden, loosen the soil and add fine/play sand (not builders sand) to aid drainage.
What to look out for:
It is important to contact your vets if you are concerned in any way and even the slightest change in behaviour, can indicate a potential deterioration. Some changes to look out for are:
Not eating and being unable to tempt to eat, (don’t leave it longer than 24 hours, especially if offering of food is accompanied by visible salivating).
Appearance of disorientation, reluctance to jump, go out and moving slower and cautiously.
Weight loss. A weekly weight check at home could help identify any weight changes and be very useful. (Neonatal or baby scales are ideal)
Changes in toileting increased or decrease use of the litter tray or house soiling.
To monitor changes regular check ups are advisable to check blood pressure and undertake urine or blood tests depending on what the vet feels is necessary.
Susie Phillips is a Registered Veterinary Nurse and has completed the ISFM Advanced Certificate in Feline Behaviour. Susie has volunteered for Shropshire Cat Rescue with her mum for over 5 years and loves it.