TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

 

HOW BAD IS IT?

ON THIS PAGE:


Percentage of Function Lost 


Chronic Renal Failure Versus Chronic Kidney Disease


Usual Tests for Assessing Kidney Function


How Bad Are My Cat's Results


International Renal Interest Society (IRIS) Staging System


Treat the Cat, Not the Numbers


What To Do At Each Stage


End Stage Renal Disease (ESRD)


 

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Site Overview


What You Need to Know First


Alphabetical Index


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WHAT IS CKD?


What Happens in CKD?


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The Importance of Phosphorus Control


All About Hypertension


All About Anaemia


All About Constipation


Potassium Imbalances


Metabolic Acidosis


Kidney Stones


 

SUPPORT


Coping with CKD


Tanya's Support Group


Success Stories


 

SYMPTOMS


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


UK Dry Food Data


UK Cat Food Manufacturers


2007 Food Recall USA


 

FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


Dialysis


 

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Home > What is CKD? > How Bad Is It?

 


Overview


  • This is usually one of the first questions people ask themselves after diagnosis. 

  • This page attempts to help you understand a bit more about what the test results mean, and why they do not tell the whole story.

  • It also explains why it is not as bad as it sounds when your vet says your cat has lost a certain percentage of his/her kidney function.


Percentage of Function Lost


 

Let's get this one out of the way first, because chances are things may not be as awful as you fear.

 

Most people panic if their vet says their cat has lost two thirds or more of his/her kidney function. I regularly hear from people who say things like "my vet told me my cat has lost 75% of kidney function so things look really hopeless".

 

Take a deep breath. I know it sounds like a massive loss of function, but it is actually completely normal for CKD not to be diagnosed until a cat has lost at least 66% of kidney function. In many cases the cat has lost even more kidney function. The What Happens in CKD? page explains why this is the case.

 

This may gradually change following the introduction in 2015 of the SDMA test), but even with this test, CKD cannot be detected until 40% of kidney function has been lost. So whichever way you look at it, your cat is unlikely to be diagnosed with CKD until a lot of kidney function is gone.

 

Some cats are diagnosed before they show any symptoms, perhaps because they have had annual blood tests run. If your cat has not been acting sick despite having lost 66% or more of his/her kidney function, this demonstrates that cats can often manage very well on limited kidney function.

 

On the homepage I give my vet's analogy of a CKD cat being near the edge of a precipice. Another way to look at it is that your cat was edging through a door and has now crossed the threshold; but the kidneys have probably only lost a tiny bit more of the function they had a few months ago when your cat was a step further away from the doorway.

 

It is also quite possible that your cat was fine one day and sick the next. In these cases, something may have happened to push the cat through the doorway, such as an infection. Treating the cause may allow you to pull the cat fully or partly back outside the door.

 

In either case, the cat might linger in the doorway, not moving fully into the other room for some considerable time. Many cats can continue to manage quite well even after diagnosis - for a small number of cats, things only become critical when they have lost as much as 90% of function, and there are some cats who cope astonishingly well with even less function.

 

So the goal is, not to worry about the function that has already been lost, but to try to help your cat manage with whatever function remains for as long as possible.

 


Chronic Kidney Disease versus Chronic Kidney Failure


 

You may also be frightened because your vet says your cat's kidneys have failed. Fortunately, this may also not be as bad as it sounds.

 

There are a number of different expressions used to describe chronic kidney disease. It used to be widely known as chronic renal failure (CRF), and for many years this website was known as Tanya's Comprehensive Guide to Feline Chronic Renal Failure.

 

I decided to changed the name in 2011 and use the expression Chronic Kidney Disease (CKD) instead. This was for two reasons. Firstly, it is the term most commonly used in the academic literature. Secondly, I think it more accurately reflects the nature of the disease, and focuses on the important word, "chronic" rather than on that awful word, "failure", which tends to scare people, making them feel the end is nigh.

 

Chronic means that CKD is an ongoing disease. This is good news, because it means that in many cases it can be managed. For this reason, some vets prefer to use the word "insufficiency" for early stage cases instead.

 

Whatever expression your vet uses, try to focus on the chronic aspect of CKD.

 


Usual Tests For Assessing Kidney Function


 

The usual way for a vet to determine how advanced your cat's case is via blood tests. Many vets will also analyse your cat's urine (urinalysis).

 

In some cases, an ultrasound will also be offered.

 

Many vets now take the test results and categorise them according to the system proposed by the International Renal Interest Society (IRIS). This divides CKD into four stages; so if your vet tells you, for example, that your cat is in Stage 2, s/he is probably referring to the IRIS staging system. There is more information on this below.

 

Remember, your cat's test results are only part of the story. There are other factors at play, including how your cat is acting, how proactive your vet is, whether there is an infection etc. For this reason, we have a mantra on Tanya's CKD Support Group: treat the cat, not the numbers.

Blood Tests


Your vet will test a number of measurements in your cat's blood, but the main measures of kidney function in bloodwork are:

SDMA is a newer test which was introduced by Idexx in 2015/2016. This test appears to be able to detect CKD earlier than the traditional bloodtests (see Early Detection). Creatinine and SDMA are both used by IRIS to help stage CKD (see below).

 

Blood tests can tell vets quite a lot about how a cat's kidneys are functioning, but in some cases the results can be misleading. Blood drawn from a severely dehydrated cat, for example, will make the results look a lot worse than they actually are. In such a situation, the results may improve greatly once the dehydration is corrected (you are really just seeing the true situation). Similarly, bloodwork may look really poor in a cat with an infection but improve once the infection is under control.

 

Urine Tests


The urine tests will usually look at:

Proteinuria is used by IRIS to help stage CKD (see below).

 

If your cat has an infection, this may make the kidney values in bloodwork look worse than they are. Unfortunately, in CKD cats infections do not always show in urine tests.

 


How Bad Are My Cat's Results?


 

Many vets now use the International Renal Interest Society's staging system:

 


IRIS Staging System


 

Many vets now take the test results and categorise them according to the system proposed by the International Renal Interest Society. This divides CKD into four stages; so if your vet tells you, for example, that your cat is in Stage 2, s/he is probably referring to the IRIS staging system.

 

The stages give some idea of how advanced your cat's case is, but also are there to help your vet come up with a tailored treatment plan.

 

Staging of CKD (2015) International Renal Interest Society looks at three things in this order:

Algorithm for staging of chronic kidney disease in cats (2015) International Renal Interest Society is a helpful algorithm for what to check when, depending upon the various findings.

 

IRIS Staging System: Blood Tests: Creatinine and SDMA


 

IRIS Staging: Creatinine


The IRIS staging system begins by looking at the cat's creatinine levels. Here are the four stages, together with my estimate of the likely percentage of function lost at each stage:

 

Stage of Disease

Blood Values:

US Measurements (mg/dl)

Blood Values:

International Measurements (µmol/L)

Approx. Level of Kidney Function Lost

Stage 1

Creatinine below 1.6

Creatinine below 140

 0 - 65%

Stage 2

Creatinine between

1.6 and 2.8

Creatinine between

140 and 249

 

66 - 75%

Stage 3

Creatinine between

2.9 and 5.0

Creatinine between

250 and 440

 

76 - 90%

Stage 4

Creatinine over 5.0

Creatinine over 440

Over 90%

 

Feline chronic kidney disease (2015) Grauer GF Today's Veterinary Practice 5(2) pp36-41 believes slightly different percentages of function are lost at the various levels of creatinine. He states "80% nephron loss may result in a serum creatinine concentration of 2 mg/dL. With progression, serum creatinine concentration should be approximately 4 mg/dL when 90% nephron loss has occurred." He adds "At the onset of International Renal Interest Society (IRIS) Stage 4 CKD (serum creatinine concentration > 5 mg/dL), it is likely cats have < 10% of their original nephron population."

 

So essentially Dr Grauer believes cats with a creatinine level between 2 and 4 mg/dl have lost 80-90% of kidney function. On the other hand, I attended a webinar with Dr D Chew in which he stated that a change in creatinine from 2 mg/dl to 4 mg/dl indicates only a 5% worsening.

 

Thus there is no consensus over how much kidney function has been lost at each stage. It is not that important though, what is important is how your cat manages with whatever function is remaining. Some cats manage really well with very little funtion: Renal dysfunction in small animals (2016) Brown SA Merck Veterinary Manual says "With appropriate therapy, animals can survive for long periods with only a small fraction of functional renal tissue, perhaps 5%-8% in dogs and cats."

 

Cats in Stage 1


Let's take a closer look at cats who are apparently in Stage 1, even though these values (creatinine below 1.6 mg/dl or 140 µmol/L) are normal in many laboratory ranges. Obviously, not every cat who is ostensibly in Stage 1 has CKD! The problem is that when measuring creatinine, you cannot detect CKD until at least 66% of function has been lost, because before that there are usually no symptoms (see above). Therefore for cats in Stage 1 who do indeed have CKD, bloodwork values are usually within the normal range, and kidney problems would only be suspected if an anatomical or functional abnormality had been detected, or if the SDMA test result indicates a problem (see immediately below).

 

Feline chronic kidney disease (2015) Grauer GF Today's Veterinary Practice 5(2) pp36-41 says "The staging system outlined in Table 2 is not used until the presence of CKD has been confirmed." He goes on to say "Note that this staging system suggests that azotemia in cats begins with serum creatinine concentrations of 1.6 mg/dL or greater. However, serum creatinine concentrations must always be interpreted in light of the patient’s muscle mass, urine specific gravity (USG), and physical examination findings in order to rule out pre- and postrenal causes of azotemia."

 

IRIS does allow for this in its guidelines, stating that if there is no evidence of CKD, the cat should be re-assessed in 2-3 months, and every three months thereafter if creatinine is increasing or every six months if creatinine is stable.

 

IRIS Staging: SDMA


Following the introduction of the SDMA test, which is thought to be able to detect CKD when only 40% of kidney function has been lost, the IRIS guidelines were revised in 2015 as follows:

 

SDMA Test Measurement Current IRIS Staging* New IRIS Staging

Over 14 ug/dl

Stage 1 Stage 1

Over 25 ug/dl

Stage 2 but with a low body condition score Treat as if in Stage 3
Over 45 ug/dl Stage 3 but with a low body condition score Treat as if in Stage 4

*The stage your cat would currently be considered to be in if the SDMA reading did not exist.

 

In all cases, two readings in a stable cat (who is not dehydrated - this can make the numbers look a lot higher than they really are), ideally after fasting (though that is not always the best choice for a CKD cat), are required before making a firm diagnosis of CKD. In practice, most vets will make the diagnosis based on bloodwork taken once during your initial visit, but remember, this is not optimum.

 

IRIS Staging System: Proteinuria


Algorithm for substaging by proteinuria (2015) International Renal Interest Society then recommends sub-staging based on whether proteinuria is present.

 

Healthy cats only have tiny amounts of protein in their urine because their kidneys do not allow the protein to leak through. In CKD cats, this mechanism can be faulty and excess levels of protein in the urine, known as proteinuria but sometimes referred to as microalbuminuria, may occur.

 

The usual way to determine if a cat has proteinuria is via the urine protein:creatinine ratio (UPC). Three urine samples should be collected over a minimum period of two weeks before a conclusion is drawn.

 

Urine Protein: Creatinine Ratio

Proteinuria Status

Below 0.2

Non Proteinuric (NP)

Between 0.2 and 0.4

Borderline Proteinuric (BP)

Over 0.4

Proteinuric (P)

 

There is a correlation between the severity of proteinuria and the prognosis. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria (2006) Syme HM, Markwell PJ, Pfeiffer D & Elliott J Journal of Veterinary Internal Medicine 20 pp528–535 found that cats with a urine protein:creatinine ratio below 0.5 survived almost three times as long as cats with a urine protein:creatinine ratio of over 0.5.

 

However, don't panic if your cat's level is over 0.4 because the UPC ratio is not always accurate - for example, blood in the urine, infection or inflammation may give a false positive result. Hypertension may worsen proteinuria, so getting blood pressure under control may lead to an improvement in the UPC ratio. Even if your cat's UPC ratio is indeed high, it may gradually reduce with treatment. Please see the separate Proteinuria page for more information.

 

IRIS Staging System: Hypertension


Algorithm for substaging by blood pressure (risk of target organ damage from hypertension) (2015) International Renal Interest Society then recommends substaging based on whether hypertension is present. It considers a cat's blood pressure in terms of how likely it is that damage to organs such as the eyes will be caused:

 

Average Systolic Blood Pressure Measurement (mmHg)

Risk  of Damage

to Organs

Blood Pressure Substage

Treatment Plan

Under 150

Minimal

Normotension

No treatment necessary

150 - 159

Mild

Borderline hypertension

Treatment is not normally necessary. However, it may be appropriate to begin or increase blood pressure medications if ocular or neurological signs are present

160 - 179

Moderate

 Hypertension

Begin or increase blood pressure medications

Over 180

Severe

Severe hypertension

Begin or increase blood pressure medications

 

Hypertension is a very serious concern for CKD cats, so there is a separate Hypertension page.

 


Treat the Cat, Not the Numbers


 

When vets tell people there is no hope for their cat, it is usually based on test results as outlined above, particularly blood tests which show high kidney values. However, I have heard of vets who tell people their cat should be put to sleep without doing any tests at all, based purely on the cat acting sick. I don't think this is appropriate. Your vet may be right, there may be no hope for your cat, but if you're thinking of making the irrevocable decision to put your cat to sleep, you need proper, accurate information on which to base your decision.

 

Even if you do have some blood test results, the numbers only tell part of the story. In Prolonging the life of the renal failure patient (2000), Waltham Focus 10(3) pp10-14, Dr Jonathan Elliott states that "in a retrospective study, the correlation between plasma creatinine and survival in cats who presented with signs of stable CKD was very poor, with only 5% of the variation in survival time being predicted by the initial plasma creatinine concentration".

 

Renal Disease (2006) Polzin DJ Delaware Valley Academy of Veterinary Medicine states "Severity of renal dysfunction as determined by serum creatinine concentration or measurement of GFR provides a less accurate means of assessing short-term prognosis than does the clinical condition of the patient. The relationship between magnitude of renal dysfunction and clinical signs of uremia is often unpredictable. Therefore, short-term prognosis should not be established on the basis of a single measurement of the severity of renal function. In addition, a single determination of renal function is unreliable as an index of the potential for improvement in renal function."

 

Finding the right balance: medical management of renal patients (2014) Vaden SL Eukanuba Veterinary Diets Clinical Symposium, Norway says "Attention should be given to the well-being of the patient rather than achieving a "magic" number for serum urea nitrogen or creatinine."

 

In The laboratory diagnosis of feline kidney disease (2008) Heiene R Veterinary Focus 18(2) pp16-22, Dr Heiene states "cats can sometimes, especially in cases of acute kidney injury secondary to obstructive FLUTD, develop creatinine values of 1600-1800 μmol/L (20.98-23.6 mg/dL) and yet recover."

 

I don't know why some vets don't try to fight CKD. Perhaps they think it's not worth trying because CKD is incurable. Yes, CKD is incurable, but it can often be managed so your cat feels better. As one member of Tanya's CKD Support Group said, "vets are about the cure, we are about the care."

 

So try not to worry too much about which stage your cat is in, especially since numbers can be artificially inflated at diagnosis. The stages are supposed to help the vet work out which treatments are likely to be needed, not encourage them to write off cats in the higher categories. Yes, your cat's chances may be worse if your cat is - and remains - a high numbers cat; but some cats do well despite high numbers, so try treating the cat, not the numbers and see what happens.

 

Therefore, if your vet has told you there is no hope for your cat, and has recommended euthanasia, I urge you to:

  1. read this page, and also the Is There Any Hope? page to explore the various scenarios you may be facing;

  2. check out the Index of Symptoms and Treatments page to see which symptoms your cat has; and

  3. ask your vet about trying some of the Treatments that are appropriate for any of the symptoms you are seeing and any imbalances indicated by your cat's test results;

before making the irrevocable decision to put your cat to sleep.

 


What to Do At Each Stage


 

You may now know into which stage your cat falls, but that doesn't really tell you much about what you are facing on a practical level. And you still may not know how severe your cat's case is if your cat is in crisis. Let me repeat that:

 

Your vet cannot say how severe your cat's case is if your cat is in crisis.

 

So if your cat appears to be in Stage 4, don't despair. You may not be seeing the true situation. IRIS  staging of CKD (2015) International Renal Interest Society says that "Staging is initially based on fasting blood creatinine assessed on at least two occasions in the stable patient", but your vet may have forgotten this. Bloodwork can look high for the following reasons:

  • the cat is severely dehydrated

  • the cat has an untreated urinary tract infection or a kidney infection

  • the cat has untreated hypertension (high blood pressure)

  • the cat has kidney stones

If any of these problems are present, they need to be treated and your cat stabilised before you can make an accurate assessment of your cat's situation.

 

Staging is not only about how severe the CKD is. It is intended to help with treatment plans. You should monitor for:

so you can nip these problems in the bud if they are present.

 

The most important thing for cats in all stages is to get food into them! See the Diet and Nutrition chapter for tips and hints.

 

You should also consider that nobody knows how fast your cat will progress through the stages. Even if your cat is in Stage 4, you do not know if this will stay the same or worsen quickly. Feline chronic kidney disease (2015) Grauer GF Today's Veterinary Practice 5(2) pp36-41 states that although CKD is irreversible, "some cats with CKD have stable serum creatinine concentrations for months to years."

 

In virtually all cases it is worth trying treatments for at least two weeks. Treatment recommendations for CKD in cats (2015) International Renal Interest Society has some suggestions on what to watch for and be prepared to treat at each stage, including what to do if proteinuria or hypertension are present.

 

Whatever stage your cat is at, most people find the treatments only take about 20 minutes out of their day, including the time needed to give subcutaneous fluids.

 

Here are some tips on what you may be facing:

 

Cat in IRIS Stage 1, Stage 2 or the Lower End of Stage 3


If your cat seems to fall into IRIS Stage 1, 2 or the lower end of Stage 3, it is early stage and with proper care and a little luck on your side, your cat could live for years.

 

Most cats in these stages (creatinine below 3.5-4.0 mg/dl US or 300-350 µmol/L international) will not need subcutaneous fluids and can easily be managed with just a few treatments tailored to the individual cat's needs, e.g. treatment for excess stomach acid, constipation remedies and/or control of elevated phosphorus levels.

 

If your cat has proteinuria or hypertension, these should be properly controlled.

 

In all cases, it is essential that your cat eats!

 

Cat in Stage 4 or the Upper End of Stage 3


If your cat seems to fall into Stage 4 or the top end of Stage 3, don't despair. You may not be seeing the true situation. Bloodwork can appear high for the following reasons:

In such cases, the numbers you are seeing won't be an accurate representation of true kidney function.  Feline chronic kidney disease (2015) Grauer GF Today's Veterinary Practice 5(2) pp36-41 says "This staging system cannot be applied to patients with pre- or postrenal azotemia or those with acute or acute-on-chronic kidney disease." You need to treat your cat, particularly any dehydration, before you can know the true status of the kidneys.

 

If your cat has moved to Stage 3 or 4 from an earlier stage, especially if this has happened abruptly, the same principle applies: make sure any possible causes of the worsening bloodwork have been treated.

 

Even if your cat proves to be at the top of Stage 3 or in Stage 4 following stabilisation, don't give up hope: some cats do seem to manage very well on very little kidney function, and it is possible that your cat could be one such cat. You will probably need to be more proactive and your cat will usually need more treatments than cats with lower bloodwork values, but it is certainly worth trying to help.

 

These cats will usually need the same treatments as cats in lower stages for whatever problems may be present, e.g. for excess stomach acid, high phosphorus levels, constipation etc. In addition, they will usually need regular fluid therapy in the form of subcutaneous fluids in order to avoid dehydration.

 

Cats in IRIS Stage 4 will often have anaemia, and will need treatment for that - untreated severe anaemia can be very dangerous and can kill a CKD cat before the CKD does. Fortunately, many effective treatments for anaemia are available, meaning no CKD cat need die of anaemia. See the Anaemia page for more information.

 

Cats in IRIS Stage 4 may have metabolic acidosis, so ensure your vet checks for that and treats it if it is present.

 

Please see the Is There Any Hope? page for more information.

 

If your cat's creatinine levels improve, this usually indicates that your cat is doing better. However, occasionally creatinine falls because of muscle loss (because creatinine is a by-product of muscle).  The Merck Veterinary Manual states "Serum creatinine levels can be falsely lowered in patients with severe muscle wasting." So if your cat's creatinine level falls but your cat has lost a lot of weight and muscle, this might be the cause rather than improved kidney function.

 


End Stage Renal Disease (ESRD)


 

This expression literally means that the cat's kidneys are at the point of failure and there is no longer anything that can be done. Some vets use it in this sense, referring to a cat who is rapidly becoming unable to deal with the CKD, ceasing to respond to treatments and likely to die very soon. However, other vets use it to mean any cat with numbers in Stage 2 or above (see above), when in fact many cats in these stages can live for a long time.

 

Try to clarify what your vet means by ESRD, and if he/she merely means that your cat has high numbers, consider treating the cat; the numbers may come down with treatment, and even if they don't, your cat might be able to handle high numbers as Thomas did. Even if your vet thinks death is imminent, it may be worth treating your cat regardless to see how he or she responds; cats are real fighters and can often pull through.

 

Obviously though, you don't want your cat to be in pain when it is a hopeless situation. It is not always easy to tell when a CKD cat has come to the end of the road - The Final Hours contains details of the symptoms you are likely to see towards the end, and discusses making the painful decision to let go.

 

 

 

 

 

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This page last updated:17 May 2017

Links on this page last checked: 17 May 2017

 

   

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

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