Medications for Cats with Kidney Disease

The feline CRF Information Center has an extensive list of medications available for treating cats with kidney disease, along with detailed descriptions of what each medication is designed to do. I urge you to consult their site before starting any drug treatment, for the latest research or news about drug recalls.

I'll give you a summary here, with one caveat: like medications for humans, most drugs come with a set of side-effects. So you'll have to weigh the advantages of using these medications against their detrimental effects (and the cost). We have been fortunate enough to manage Michou's CRF for over three years without the use of any prescription drugs -- just diet changes, fluid treatments, careful feeding, and probiotic supplements. So I'll let you decide for yourself.

For Anemia – medications used to stimulate the production of red blood cells include forms of the drug erythropoietin, such as Eprex.

For Appetite – Winstrol-V (stanozolof) is an anabolic steroid used to improve appetite and quality of life for cats with kidney disease. It is administered in tablet form or by injection.

Some vets prescribe Periactin, an antihistamine used for humans, to stimulate appetite in cats. It does not work for all cats but reportedly has fewer side effects than tranquilizers used for appetite stimulation.

And believe it or not, some vets even prescribe Valium for cats to boost their appetite!

For elevated Calcium levels – Calcitriol, an active form of vitamin D, is often prescribed. This is not a medication per se, but more of a nutritional supplement. Calcitriol helps prevent excess calcium from being absorbed into the body. However, there is a difference of opinion on the interrelationship between calcitriol, phosphorus, and calcium levels. For a more in-depth discussion, see the CRF Information Center website.

For excess Phosphorus – your vet may prescribe phosphorus "binders" to be given just before or after each meal, or with food. These substances bind with phosphorus to decrease the absorption of the mineral into your cat's bloodstream. Some common phosphorus binders include Alu-Cap, AlernaGEL, Amphojel, and Basaljiel. There are two main types of phosphorus binders on the market: calcium-based and aluminum-based. An aluminum-based binder will not elevate your cat's blood calcium levels, which can lead to other problems. Some phosphorus binders have been discontinued by their manufacturers or are difficult to obtain. Check with your vet.

For High Blood Pressure (hypertension) – Norvasc, a calcium channel blocker, is the most common medication prescribed for cats with both compromised kidneys and hypertension. There is also some research being done with ACE inhibitors (see below).

For Low Potassium – Tumil-K and RenaKare, forms of potassium gluconate, are available. This must be carefully considered and monitored, because the reverse problem – too much potassium in cats with compromised kidneys (and thus an inability to get rid of potassium) -- could potentially cause heart failure and other problems. So it's vital to consult and work with your veterinarian when addressing potassium levels.

For Stomach Irritation – You'll recognize Pepcid AC (famotidine) from the TV commercials for humans. This drug, available over-the-counter from your vet, can inhibit the production of stomach acid which can sometimes cause cats not to eat. Note that the tablet must be broken into smaller pieces for a dosage that is appropriate for cats. Other acid-reducing medications include Zantac (ranitidine) and Prilosec (omeprazole). Anti-nausea medications include Zofran (ondansetron) and Reglan (metoclopramide). They are all meant to reduce stomach acid and/or control nausea, which can suppress your cat's appetite.

For reducing toxins – Drugs such as Covalzin® and Kremezin may lower the amount of toxic dietary protein metabolites. Another drug called Azodyl is reportedly designed to lower blood Urea and creatinine levels by populating the cat's bowels with beneficial microorganisms.

It is interesting to note that the probiotic supplement I mentioned in the Appetite Boosters for Cats with Kidney Disease post would also increase the number of beneficial microbacteria in your cat's gut.

For fighting infections – No surprise here. You vet may prescribe various antibiotics, not to fight the kidney disease, but to ward off infections that may result from your cat's weakened immune system. As you may know, antibiotics, while they kill bad bacteria, also destroy the good bacteria in your gut. So you may want to follow-up any antibiotic treatment with a probiotic supplement (see above).

EXPERIMENTAL

The CRF Information Center mentions that there are research projects underway testing the use of ACE inhibitors and calcium channel blockers on cats. The theory is that these medications dilate blood vessels and increase blood flow in a way that doesn't over-tax the kidneys. You may want to Google ACE inhibitors and cats to find the latest research.

IMPORTANT NOTE ABOUT GIVING CATS MEDICATIONS

Many of these medications are made for humans with similar problems. Thus, the dosage in the human version would be much too high for a cat. You may need to locate something called a "compounding pharmacy" to have them prepare a dosage that is appropriate for your feline.

NEVER give a human pill to a cat! And always discuss a medication and its possible side-effects with your vet before trying it. There is an excellent article you may want to read, How to Give Your Cat a Pill.

If you notice any unusual behavior after starting a particular medication, tell your vet immediately. You may need to change the dosage or stop using the medication.

Nutritional Supplements for Cats with Kidney Disease

If you're like me, you may view medications as a last resort, due to the possibility of side effects. I would much prefer to take natural substances that support the body's own ability to heal, rather than introduce synthetic chemicals.

So, in addition to medications that your vet may have prescribed, you should know that there are nutritional supplements you may want to consider for your cat with kidney disease. These supplements can help keep important minerals such as calcium and potassium in balance, and may help improve your cat's appetite.

Your vet may tell you about Calcitriol, which is an activated form of vitamin D that helps your cat regulate the absorption and storage of calcium and phosphorus in the bloodstream. In our case, the vet noticed an increase in Michou's calcium levels during one of her blood tests. Calcitriol is a liquid which you can squirt into your cat's mouth using the eyedropper provided. Fortunately, it only requires a very small dose – 0.5 ml. But as you may know, prying open your cat's mouth and squirting something inside is never really a fun time for either party. Especially when kitty starts realizing what's coming. Nevertheless, Calcitriol is thought to be very helpful for cats with kidney failure, especially in the early stages.

Some cats may benefit from a vitamin B complex, particularly one with iron, which may be used to help treat anemia in cats with kidney disease. Some popular vitamin B supplements include Nutrived, Pet-Tinic, Procrit, Epogen, and Aranesp.

Cats that are urinating excessively may suffer from lower levels of potassium. Potassium is involved in many different bodily functions, including fluid balance, protein synthesis, energy, muscle contractions, even control of the heartbeat, to name a few. So your vet may recommend a potassium supplement to bring your cat's potassium levels back into balance. Some common potassium supplements are available in powder, gel, or tablet form. They include Renakare, Tumil-K, Renal K+ powder, Potassium Gluconate powder and an injectible Potassium Chloride supplement that can be mixed with the subcutaneous fluids you may be giving to your cat.

Omega-3 fatty acids may be helpful for cats with compromised kidney function. There is a nutritional supplement called Renafood from Standard Process that contains omega-3s and reportedly helps to maximize kidney function. One important note: Renafood is a supplement for humans with kidney problems.

As I mentioned in the Appetitie Boosters section, you cat may benefit from Probiotic Supplements to help digestion, improve appetite and prevent weight loss. There is a supplement called Renal Advanced from Candioli Pharma, an Italian company, that contains active lactobacillus acidophilus (helpful bacteria), bioflavinoids and other nutrients. One of our vets told us about it. It is a fine powder that can be sprinkled over wet cat food. It was recommended to improve digestion, cut down on nausea, and boost our cat's appetite. So far, it seems to have helped boost Michou's appetite and the amount she eats each day.

Appetite Boosters for Cats with Kidney Disease

I've talked about how important it is to switch your cat to a low phosphorus, low protein diet if your cat has kidney failure. But cats are finicky, and if they won't eat the new food so quickly, and continue to lose weight, you've got a problem. So the very first rule is:

Rule #1: Get them to eat.
You have to balance the benefits of a low-protein diet with Rule #1: making sure your cat is eating.

If your cat's not eating and gradually losing weight, then its health is in danger. You have to get calories into him. Here are some of the little tricks we've used that seem to work:

 Microwave the canned food. Just a few seconds in the microwave (5 seconds for room temperature food; 15 seconds if the food has been refrigerated). This tends to release the aroma of the food more, attracting the cat. It also (and this is gross but real), makes the food seem more like a freshly-killed animal meal. A warm kill. Like I said: gross, but that's a cat's life.

 Feed her smaller meals, more often. Rather than the regular morning meal and night feedings, break things up into breakfast, a mid-day snack, dinner, and a bedtime snack. Maybe even more often, if you're around the house and able to do it.

 Spoon-feed. Every so often, Michou will either stop eating, or not be willing to get out of her bed when we bring her food. When she appears particularly weak, we bring the food to her. We either spoon-feed at least half of her meal, or use our fingers to pick up clumps and hand-feed her. We're always surprised by how much she does eat – even when she refuses to eat by herself.

 Little treats. I know that I said feeding any protein or meat food cancels out the benefits of your cat's low-protein diet. And it does. But just to perk up her appetite when we notice she's not eating, we sometimes try:

o Tuna juice: this is the water from an open can of tuna. She seems to like the flavor and lapping up the juice helps with her hydration, too. We put a few, tiny slivers of tuna in with the juice as a treat.

o Table treats: a tiny piece of chicken or beef from a meal. I know, this is protein. But it perks up her appetite. And she obviously craves it, because she'll sit and meow for more. In fact, when we bring grilled chicken kabobs from our favorite restaurant home for dinner, Michou can smell them from upstairs. Our previously lazy cat who's too apathetic to get out of bed for her canned cat food suddenly shows up at our feet, giving us the eyeball treatment.

o Kitty malt. This is a gel-like substance for cats to help them avoid hairballs. But it's also a tasty treat that can perk up their appetite. It's made with glyercine and fat that can help coat their gut and may reduce constipation as well.

 Probiotic Supplements. There is a supplement called Renal Advanced from Candioli Pharma, an Italian company, that contains active Lactobacillus acidophilus cultures, bioflavonoids, and other nutrients. One of our veterinarians told us about it. It is a fine powder that can be sprinkled over wet cat food. It was recommended to improve digestion, cut down on nausea, and boost our cat's appetite. I can't refer to any clinical studies but anecdotally, we have noticed that Michou's appetite improved and she eats a greater volume of food per day, when we add this to her food. It is also very easy to incorporate into your daily routine. The vet had suggested another probiotic, but it was in pill form. The idea of having to fire a pill down Michou's throat each day wasn't something we wanted to pursue.

How about you? Have you developed a few little tricks or treats to get your cat to eat more or more often? Add your comments below.

Watching the Weight of Cats with Kidney Disease

Next to noticing that your cat is drinking and urinating more often, the other big tip-off that your cat may have kidney disease is a sudden loss of weight.

The weight loss is often because one of the symptoms of kidney failure is a loss of appetite and possibly nausea. Unfortunately, you may not notice that your cat is eating less until he or she has dropped several pounds. Weight loss is considered to be a serious problem when it exceeds 10 percent of your cat's normal body weight.

You may eventually notice the weight loss as well as an overall boniness to your cat that you didn't see before. Their spines and haunches may stick out. It could be due to the nausea and loss of appetite. Or the fact that your cat is drinking and urinating more, and therefore may be losing protein and electrolytes.

However, weight loss is associated with other feline diseases such as diabetes, thyroid disease, and inflammatory bowel disease, too. So it's important to get your cat tested by your vet to determine the cause of the sudden weight loss.

Presuming that your cat is diagnosed with kidney disease, you'll start a new special diet for her and start doing everything you can to maintain her weight, including low-protein foods, hydration, treats, and more.

See also:
 Appetite Boosters for Cats with Kidney Disease
 Nutritional Supplements for Cats with Kidney Disease

Fluid Treatment for Cats with Kidney Disease

When people have severe kidney problems, they often receive dialysis treatment. Dialysis is a medical process by which a person's blood is cleansed of toxins that would normally be flushed out by the kidneys. It generally requires sophisticated equipment, and is often done at the hospital.

While giving a cat kidney dialysis isn't unheard of, we can all appreciate that the expense and trauma of doing this on an ongoing basis make this difficult, if not impossible for most pet owners.

There is, however, a form of "mini dialysis" you can learn to do at home that is both easy and affordable. And that's to give your cat extra fluids (sterile, saline solution) "subcutaneously" – which means just under the skin and not into a vein).

Fluid therapy can be very beneficial to dehydrated pets with limited kidney function. Cats with kidney failure drink a lot of water. But they can't drink enough water to compensate for the reduced filtering function of their kidneys. But by adding even more fluid (water) to their system, you can help them flush out more toxins from their body and help them feel better.

Chances are your vet may have given your cat subcutaneous fluids shortly after your cat was diagnosed with kidney failure. The staff at your vet's office can show you how to do it, and provide all the equipment you need, which is:

 A 1000 cc bag of sterile fluid (a Lactated Ringer).
 A supply of disposable needles (probably 18 gauge with a pink plastic base)
 A sterile tube that connects the needle to the bag of saline fluid

You can use a wire coat hanger and a string or shoelace to attach the bag of fluid to the hanger. You then hang the whole thing from a door or any other secure, high object. It looks like the "mash" unit you see on TV medical shows.

Administering the Fluids

There are two important tricks to giving your cat fluids:

1) Inserting the needle well. Your vet's staff will show you how to make a little "tent" of the loose skin on the scruff of your cat's neck or upper back. You then poke the needle parallel to your cat's back, into this little pouch of skin you've created by "tenting" it. In other words, the needle goes sideways and flush with your cat's back. NOT straight into your cat!

It's interesting to note that you can tell how dehydrated you cat is by how easily you can make this tent of skin. If the skin pulls up easily, your cat is still fairly hydrated. If there is very little elasticity in the skin, it could be a sign that your cat is somewhat dehydrated.

2) Stay on schedule. Shortly after diagnosis, you may be on a very frequent hydration schedule, say, every two days (or even every day), to help flush toxins out of your cat and bring her blood levels back to normal.

As time goes on and she appears to respond to the treatment, you may dial back to every two or three days. By mistake, we have gone four days between treatments. Michou seemed to be a little out of sorts after waiting that long. Now, we stick to every two-and-a-half days. I use an "appointment alert" in my Outlook calendar, on my computer's desktop.

I also keep a paper diary of her treatments. I record the date, time of treatment, level of fluids left in the bag, and whether or not I used a new needle last time.

Our vet recommended changing the needle each time, and changing the "line" – the plastic tubing – every week. We felt that was an unnecessary expense. Instead, we use a sterile needle for two treatments, and then throw it a way. We use the sterile plastic tubing for weeks, if not months at a time, before getting a new one. We have not seen any detrimental results.

Since you're dripping 200 ml of fluid with each treatment, each 1,000 ml bag will last for 5 treatments or roughly 10 days to two weeks.

The Feline CRF Foundation website has a handy step-by-step illustrated guide for administering fluids to your cat, which you may find helpful.

You can also get more information about administering subcutaneous fluids in cats at Washington State University's College of Veterinary Medicine. Although you will probably learn everything you need to know from your vet's office.

Low Protein Diets for Cats with Kidney Disease

When your cat has kidney failure, one of the first things you need to do is get very involved with his or her diet.

Many vets recommend switching to a special canned low-protein diet. A low-protein, low salt, low phosphorus diet will help reduce the amount of waste products that your cat's kidneys will have to filter out. The lower salt and lower phosphorus may also help control the electrolyte balance in your cat's body, which is good for muscle and nerve function.

Since meat is especially high in phosphorus, low-protein diets will have less meat, and more fat. Reducing the level of highly digestible protein decreases the demand on your cat's kidneys and liver.

While there's no actual "cure" for chronic kidney failure, a low protein, low phosphorus diet may be able to slow the progression of the disease. It can ease the burden on your cat's kidneys, and may help you cat feel better, too.

Some popular low-protein, CRF cat foods include:

 Hills Prescription Diet Feline - K/D canned
 Royal Canin Veterinary Diet – Renal Medi-Cal® Feline Reduced Protein
 Eukanuba Veterinary Diet Multi-Stage Renal Formula (Canned)
 Iams® Veterinary Formulas Renal Multi-Stage Renal™/Feline Canned Formula
 Purina NF Kidney Function Brand™ FORMULA (canned and dry) - Purina Pet Food

Many of these brands have both canned and dry varieties. At this point, I believe that cats with kidney problems should only eat canned cat food. Dry cat food can dehydrate your cat at a time when they need more fluids, not less, to flush out toxins from their bodies. (I'd be interested in your opinion on this, especially if you are a vet or have been treating a cat with kidney disease. Add your comments below.)

After our cat, Michou, developed her kidney problems, I felt guilty at having fed her dry cat food for so many years. It was easy and convenient and she liked it. Plus, it naturally made it easier to leave her some food if we went away for a day or two. But today, the folly of that diet seems obvious. Just think of cats in the wild. Do lions and tigers eat grains? Vegetables? No, they hunt other animals. They eat meat. It just seems obvious today that we should have been feeding her wet or canned cat food all along.

Some studies have questioned whether restricting protein (and therefore reduced phosphorus) is good for a cat, in that it may not give the cat enough protein for other normal body functions. One expert is quoted as saying low-protein diets are not appropriate until your cat's Blood Urea Nitrogen (BUN) levels are double the normal reading (roughly 60-80 mg/dl).

All I can say is that we switched to this diet immediately after Michou's diagnosis and have been on it for over three years. There is one thing to watch out for, though...

And that's weight loss and loss of appetite. Michou was a heavy cat to begin with so the weight she initially lost brought her into the normal range. She is now a bit skinnier, even a bit bony, which is cause for concern.

But as you'll read in "Does My Cat Feel Pain," nausea and lack of appetite is a big problem in cats with kidney disease. You have to continually make sure they are eating, even if it means hand-feeding or spoon-feeding them at times.

And the biggest problem with switching a cat's diet, as you may know, is that the finicky little critters won't eat the stuff!

We experimented at first with 3-4 brands until Michou found one she seemed to like, which was the KD Chicken brand. But after about two-and-a-half years, as her appetite seemed to wane and she got thinner, we tried a few other brands. Lately, she's been on Royal Canin's Medi-Cal® for cats.

What NOT to Do With a Low-Protein Diet

Veterinarians warn not to supplement your cat's low protein, low phosphorus diet with any foods that are high in protein. This can cancel out the positive effects of the diet.

Foods to avoid include meat and milk, which is surprisingly high in phosphorus. Also avoid ever feeding your cat onions, which can lead to anemia, which is especially dangerous for cats with kidney failure.

There are more things you can do, as you'll see in "Appetite Boosters for Cats with Kidney Disease."