Managing Stage 2 Kidney Disease In Cats: What You Need To Know

Kidney disease in cats is a serious condition that can lead to renal failure and even death. Cats are more susceptible to kidney disease than humans, with 10% of cats over ten years old and 30% of cats over fifteen years old developing the disease. Kidney disease is often hard to detect as cats may not display any symptoms until the later stages of the disease. However, early detection and treatment can improve a cat's longevity and quality of life.

Treatment options: tailored treatment, slowing progression, prolonging kidney function and improving quality of life

Treatment options for stage 2 kidney disease in cats are tailored to each individual cat and are aimed at slowing the progression of CKD, prolonging kidney function, and improving quality of life.

Firstly, it is important to discontinue all drugs that may be harmful to the kidneys, if possible. Screening for any treatable conditions such as kidney or bladder infections is also necessary, and these should be treated appropriately. Radiographs and/or ultrasounds should be performed to rule out stones, masses, or other lesions as causes of loss of kidney function.

Dehydration management is crucial, and this involves ensuring that fresh water is available at all times for drinking. If the cat is ill and losing fluids, dehydration should be corrected right away.

Systemic hypertension should be addressed, with a goal of maintaining a systolic blood pressure below 160mmHG. This can be achieved through medications such as a calcium channel blocker, such as amlodipine and/or telmisartan, and considering dietary sodium restriction.

Proteinuria (protein in urine) can be managed by feeding a clinical renal diet, prescribed by a veterinarian. A Renin-angiotensin-aldosterone system (RAAS) inhibitor, ACE inhibitor, or other prescription medication may also be prescribed.

Controlling phosphate intake is important, and this can be achieved by starting a clinical renal diet, prescribed by a veterinarian. Phosphate binders, such as aluminum hydroxide, may also be necessary.

Treating potassium deficiencies is crucial, and this can be done by starting a potassium supplement, such as potassium gluconate, and a clinical renal diet, prescribed by a veterinarian.

Regular monitoring of stage 2 chronic kidney disease is essential, including chronic condition exams, blood chemistry assessments, and blood pressure and urine protein measurements at specific intervals. Home observation for decreased appetite, increased thirst or urination, increased vomiting, and lethargy is also important.

Dehydration management: fresh water, correct dehydration

Dehydration management is crucial for cats with stage 2 kidney disease. Here are some detailed instructions for managing dehydration in your cat:

Provide Fresh Water

Ensure your cat always has access to fresh, clean water. Cats tend to prefer drinking from glass, ceramic, or stainless steel bowls rather than plastic ones. Use wide and shallow bowls that allow them to drink without submerging their whole head. Keep the water bowl away from high-traffic areas, food bowls, and litter boxes. Change the water daily and clean the bowl regularly to prevent the buildup of unpleasant odors and bacteria.

Encourage Water Intake

Encourage your cat to drink more water. You can try adding a small amount of tuna, salmon, or clam juice to their water, starting with a 1/4 teaspoon per bowl and gradually increasing. Alternatively, you can add low-sodium chicken broth to their water or switch from dry food to wet food, as wet food contains up to 80% water. You can also place ice cubes in their water bowl, as some cats are fascinated by the sound and appearance of bobbing ice cubes.

Monitor Water Intake

Monitor your cat's water intake by measuring the water level in their bowl at the end of each day. Keep a log to track their drinking trends, as significant changes may indicate a health issue. However, don't judge your cat's water intake solely on the amount of water you see them drink, especially if they are on a wet food diet.

Recognize Signs of Dehydration

Learn to recognize the signs of dehydration in your cat. These include poor skin elasticity, delayed capillary refill times, increased heart rate, and frequent urination. The "skin tent test" is a simple way to check for dehydration at home: gently pull up a small portion of your cat's skin over their shoulders and release; if hydrated, the skin will quickly snap back into place.

Correct Dehydration

If your cat is dehydrated, take immediate action. Contact your veterinarian for guidance and potential treatment. In mild cases, encouraging your cat to drink more water may be sufficient. However, in more severe cases, your veterinarian may recommend hospitalization and intravenous fluid administration.

Systemic hypertension: blood pressure monitoring and medication

Systemic hypertension is a common and potentially serious condition in cats, often associated with chronic kidney disease (CKD). It is characterised by a sustained elevation in systolic pressure of 140mmHg or greater, or a diastolic pressure of 90mmHg or greater. Cats with CKD are at a higher risk of developing systemic hypertension, with at least 60% of cats diagnosed with hypertension also showing signs of CKD.

Blood Pressure Monitoring

When measuring a cat's blood pressure, it is important to take several readings and create as quiet an environment as possible, as stress can cause temporary elevations in blood pressure. The cat will be taken to a quiet room and gently laid on its side, giving it time to calm down. To measure blood pressure, a small patch of fur on the underside of the cat's wrist or ankle will be shaved, and a small probe taped to the skin. A cuff will then be placed above this area, inflated, and slowly deflated as the veterinarian listens for the pulsing sound of blood to record the systolic blood pressure.

Medication

The goal of treatment for hypertension is to reduce the risk of target organ damage. Treatment generally involves medication and monitoring for the remainder of the cat's life, in conjunction with treatment for any underlying conditions such as CKD or hyperthyroidism. The first-line medication for treating feline hypertension is typically a calcium channel blocker called amlodipine, available as a small pill given once daily. If giving pills is not an option, transdermal preparations that are rubbed on the inside of the ear are available but may be less reliable. In some cases, other medications may be added or used in place of amlodipine, such as the angiotensin receptor blocker telmisartan or the ACE inhibitor benazepril. With any treatment, frequent check-ups and regular blood pressure monitoring are necessary to ensure blood pressure remains below 160mmHg and that there is no evidence of continuing target organ damage.

Proteinuria: clinical renal diet, medication

Cats with proteinuria (protein in urine) should be fed a clinical renal diet prescribed by a veterinarian. This diet is typically restricted in protein and phosphorus to help decrease azotemia and low in sodium to aid with hydration. It also contains amino acids to support muscle mass and omega-3 fatty acids to promote kidney health and reduce inflammation.

In addition to dietary changes, medications may be prescribed to manage proteinuria. A Renin-angiotensin-aldosterone system (RAAS) inhibitor, ACE inhibitor, or other prescription medication may be used.

One medication used to manage hypertension in cats with chronic kidney disease is a calcium channel blocker such as amlodipine and/or telmisartan. This medication aims to achieve a systolic blood pressure goal of below 160mmHG.

It is important to work closely with your veterinarian to determine the best course of treatment for your cat's individual needs.

Control phosphate intake: clinical renal diet, phosphate binders

Controlling phosphate intake is a crucial aspect of managing stage 2 kidney disease in cats. Here are some detailed instructions and guidelines on how to control phosphate intake through a clinical renal diet and the use of phosphate binders:

Clinical Renal Diet

A clinical renal diet is an essential part of managing kidney disease in cats. This diet should be prescribed by your veterinarian and tailored to the individual needs of your cat. The goal of a clinical renal diet is to reduce the amount of phosphorus and protein in your cat's food, as high levels of these can worsen kidney disease.

A clinical renal diet will typically involve feeding your cat a therapeutic kidney diet food that is low in phosphorus and protein. These therapeutic diets are designed to help decrease waste accumulation in the blood and improve hydration by reducing sodium levels. They also contain amino acids to support muscle mass and omega-3 fatty acids to promote kidney health and reduce inflammation.

It is important to note that not all cats will readily accept a new diet, so it is crucial to work closely with your veterinarian to find a therapeutic food that your cat will eat. Do not make any diet changes without consulting your veterinarian first.

Phosphate Binders

If your cat is unwilling to eat a therapeutic kidney diet or if their phosphorus levels remain high despite the dietary changes, phosphate binders can be used in conjunction with the clinical renal diet. Phosphate binders are products that work by binding to the phosphorus in your cat's food, preventing its absorption into the bloodstream, and allowing it to be passed out in the stool. This helps to reduce the overall phosphorus levels in your cat's body.

There are several types of phosphate binders available, including:

• Aluminium-based binders (e.g. aluminium hydroxide)
• Lanthanum-based binders (e.g. Fosrenol, Nefrokrill)
• Calcium-based binders (e.g. Tums, PhosLo, Naraquin, IrcVet)
• Sevelamer-based binders (e.g. Renagel, Renvela)
• Sucroferric oxyhydroxide-based binders (e.g. Lenziaren, Velphoro)
• Vitamin B3 (niacinamide) based binders (e.g. PhosFix)

It is important to consult your veterinarian before starting your cat on phosphate binders, as they can have side effects and interactions with other medications. Additionally, not all phosphate binders are created equal, and some may be more effective for your cat's specific situation.

When using phosphate binders, it is crucial to give them with or shortly before meals to maximise their effectiveness. The dosage of phosphate binders should be based on the amount of phosphorus in your cat's meal and their current serum phosphorus level. Work with your veterinarian to determine the appropriate dosage and schedule for administering phosphate binders.

In summary, controlling phosphate intake is a critical aspect of managing stage 2 kidney disease in cats. This involves implementing a clinical renal diet prescribed by your veterinarian and, if necessary, using phosphate binders to further reduce phosphorus levels. By following these instructions and working closely with your veterinarian, you can help improve your cat's quality of life and slow the progression of their kidney disease.

Frequently asked questions