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.