TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 
   

 IS THERE ANY HOPE?

 

ON THIS PAGE:


Cat Who is Not in Crisis


Cat Who is in Crisis (Perhaps on Intravenous Fluids (IV or a Drip)


If Bloodwork Worsens After a Period of Stability


If Bloodwork Worsens Suddenly


If a Cat with Low Bloodwork Values Acts Sick


Treat the Cat, Not the Numbers


 

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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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Polycystic Kidney Disease (PKD)


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Home > What is CKD? > Is There Any Hope?

 


Overview


  • This is another of those questions which virtually everybody asks themselves as soon as they get the diagnosis.

  • In most cases, the answer to this question is yes.

  • This page tries to explain the various scenarios you may be facing and how to increase your cat's chances in each of these varying situations.


So Is There Any Hope?                                                                                          Back to Page Index


 

In most cases, I would say yes. Whilst I can't promise that your cat will pull through a crisis or survive for years, I can tell you firstly, the numbers do not tell the whole story; and secondly, that not being proactive is definitely going to reduce his or her chances.

 

Just as I cannot promise your cat will be a success story, nor can your vet know for sure that s/he won't be. None of us has a crystal ball (though if your vet does happen to have one, please find out where I can get one too because I could really use one). Vets have some idea of the prognosis based on your cat's test results and their previous experience, but there are so many other factors, such as the cat's attitude and tolerance levels (my Thomas ate like a horse with creatinine over 7 or 650 international), how proactive the vet is, which treatments are used and of course the caregiver's efforts. The only ones of these which we can control are the latter two (and possibly which vet you use, though that also depends upon where you live), so I recommend focusing on these and then, whatever happens, you know you've done your best.

 

In Prolonging the life of the renal failure patient (2000), Waltham Focus 10 (3), 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".

 

In The laboratory diagnosis of feline kidney disease (2008) Heine R Veterinary Focus 18(2) pp16-22, Dr Heine 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."

 

Survival in cats with naturally occurring chronic kidney disease (2000-2002) (2008) Boyd LM, Langston C, Thompson K, Zivin K & Imanishi M Journal of Veterinary Internal Medicine 22(5) pp1111-7 found that "median survival for cats in IRIS stage IIb at the time of diagnosis was 1151 days (range 2-3107), and was longer than survival in stage III (median 778, range 22-2100) or stage IV (median 103, range 1-1920)." But the median is a halfway point, i.e. 50% of cats lived less than the median, and 50% lived longer than the median. So sadly 50% of the cats in Stage 4 at diagnosis lived less than four months, but that means that 50% of Stage 4 cats lived for longer than four months. What I find interesting is that at least one cat in Stage 4 lived for 1920 days after diagnosis, or more than five years!

 

I would say that cats who are diagnosed early with low numbers have the best chance - many of them live for years. Although it is less common, some cats with high numbers also live for years. The longest surviving CKD cat I know of lived for sixteen years after diagnosis, having been diagnosed at six months of age. The next longest surviving lived for twelve years, having been diagnosed at three years old. So yes! In many cases there is hope. As the Success Stories page shows, even some cats with high numbers live for years.

 

Much depends upon your particular cat, how sick s/he is at diagnosis, how much s/he wants to fight, how well s/he copes with being handled, how good the veterinary care is that s/he receives, and, sadly, to some degree how deep your pockets are (though many treatments probably cost less than you think, see Obtaining Supplies Cheaply). This is not only my opinion: In Renal disease (2006) Dr D Polzin says "With appropriate therapy, cats with stages 2 and 3 CKD commonly survive 1 to 3 years...however, many survive much longer. A host of factors influence prognosis of CKD, both favorably and unfavorably. Included among these factors are the quality of medical care provided to the patient, the degree of interaction between the veterinarian and pet owner, and the level of owner commitment."

 

Some vets seem to recommend euthanasia almost immediately, but CKD is not generally considered to be a painful disease (dehydration feels a bit like a hangover, uncomfortable but not agonising), so there is no need to rush into an irrevocable decision.

 

I do not understand vets who take an arbitrary "if s/he's not better by tomorrow/within three days/whatever period the vet mentions, you have to put to sleep" approach. In the vast majority of cases, you need to treat your cat properly for at least two weeks before you can make an informed decision. Plus deciding on euthanasia is your decision, not the vet's, and you have to live with the feelings of guilt and loss which often follow. So do not be talked into euthanasia on the day of diagnosis or if your cat's numbers do not improve after a day or two on IV fluids,  because in many cases there is room for hope; the cat just needs some time to stabilise with proper treatments tailored to his or her particular needs

 


Cat Not in Crisis                                                                                                        Back to Page Index


 

If your cat has been diagnosed early and/or is stable, you are fortunate in many ways because with careful monitoring and a proactive approach, your cat may stay relatively well for months or years.

 

For cats who are stable but who have relatively high bloodwork values, perhaps at the top end of Stage 3, there is still hope: the values may fall with treatment, but even if they do not, there is a possibility your cat may remain at this level for some time (see below).

 

If your cat is stable despite having numbers at the top of Stage 3 or in Stage 4), your cat clearly copes well with CKD, which is usually a good sign, although treatments should still be begun as soon as possible, including possibly a session on intravenous fluids. 

 


Cat in Crisis: Probably Receiving Intravenous Fluids (IV)                              Back to Page Index


 

Since it is so hard to diagnose CKD early (see What Happens in CKD? to understand why), your cat may be in crisis at diagnosis. Please do not be too despondent if this is the case, particularly if your cat has crashed (see Symptoms) and is on a drip, as happened to Thomas. Many cats have horrendous bloodwork at diagnosis, or may experience a sudden crisis after having CKD for a while, which is often a reflection of severe dehydration. The true bloodwork values will not be apparent until your cat is rehydrated and stabilised, either via sub-Qs for less critical cases or via IV for more severe ones. If your cat has an infection, you need to get it under control before you can tell how severe things really are; hypertension may also make bloodwork look worse than it will once the hypertension is under control.

 

Cats with severe anaemia (PCV or HCT below 20%) often appear extremely ill, but usually feel and look dramatically better once the anaemia is under control.

 

Some cats with very high numbers will actually be suffering from acute kidney injury (AKI) rather than CKD, and whilst AKI is difficult to treat, if treatment is successful the cat may actually make a complete recovery.

There are a variety of possible outcomes for a cat who has crashed and is on IV with extremely high bloodwork values:

  • the cat's numbers improve on IV and the cat looks and acts better, and continues to do well at home;

  • the cat's numbers do not improve on IV, but the cat nevertheless acts better, and the numbers gradually reduce at home (usually with sub-Q therapy);

  • the cat's numbers do not improve on IV or with sub-Qs, but the cat acts better and continues to do well at home despite the high numbers;

  • the cat's numbers do not improve on IV, and the cat continues to act ill once s/he is home, and is put to sleep;

  • the cat's numbers do or do not improve on IV, but the cat crashes again once at home. 

Obviously I cannot predict to which category your cat might belong, but it is usually worth trying treatments, particularly if your cat has a kidney infection, where the numbers may improve once the infection is under control.

 

I am growing increasingly concerned recently about the number of vets who offer just one day on IV, tell the person their cat's numbers have not improved after that short stint, and recommend euthanasia. In most cases this is inappropriate in my opinion. Yes, not every CKD cat can be saved; but euthanasia is an irrevocable decision so you need to be very sure, and for most people that means giving their cat every chance. Dr S DiBartola says "Don't pass judgement on a lethargic dehydrated cat with markedly abnormal laboratory results. 2 to 3 days of conscientious intravenous fluid therapy can produce remarkable results."

 

For a severely ill cat, one or two days on IV are simply not going to be long enough. Thomas was on IV for four solid days and nights, and only began to eat a little on day 3. Also, Thomas's numbers did not improve at all on IV fluids. He had urea of 89 (BUN: 241) at diagnosis, and it was the same after four days and nights of IV. Some cats will actually have numbers which worsen while on IV fluids. Try not to panic! Your cat did not get this sick overnight, and s/he won't necessarily get better in only 2-3 days. In Thomas's case, my vet suspected he would fall into category 5 of my possible scenarios above, but in fact he was in the second category. He was acting a little better by the end of the four days on IV fluids, and with home treatments over a few weeks we eventually reduced his numbers to urea 27 (BUN: 76) and creatinine 316 (US: 3.57), where they stabilised for some months. 

 

So even if you are dealing with category 4, I would recommend that you make sure that your cat is given a reasonable stint on IV, and is given a reasonable chance of success at home, especially if anaemia is present. Being at the vet's is very stressful for most cats, and they often need a few days at home convalescing before they begin to act better.

 


If Bloodwork Worsens After a Period of Stability                                             Back to Page Index


 

If we take the analogy of a CKD cat falling over a precipice, what seems to happen to quite a few CKD cats is that the cat's bloodwork deteriorates in stages, like moving one step closer to the edge of the precipice; but the cat may remain stable at each step for some time. Thomas, for example, was in IRIS Stage 2 with a creatinine level of 318 (US: 3.57), nearly double what it should be, for six months; and he then moved a step closer, but still managed a couple of months with creatinine of 627 (USA: over 7) and had a very good quality of life during this period. Other cats may not show such extreme changes, with gradual falls that may be a year or more apart.

 

If your cat already has high numbers, and these worsen, try not to be too discouraged. Creatinine is not a linear measurement, so a worsening of creatinine that is already relatively high is not as sinister as it might first appear. The Diagnosis page explains more about this.

 

So if your cat's bloodwork has suddenly worsened, don't give up hope - if you review your treatment programme and add new treatments as appropriate (including a period on IV if the bloodwork values are high and your vet agrees) and work closely with your vet, you may well find your cat stabilises once again, albeit at the higher bloodwork values. If your cat's phosphorus levels worsen, it is particularly important to get these under control, because high phosphorus levels may make the CKD progress faster and also make many cats feel bad.

 


If Bloodwork Worsens Suddenly


Please do not panic if your cat's bloodwork worsens suddenly. Whilst this may indicate that the CKD is progressing, there are a number of other possible causes. Infections, particularly kidney infections, may cause a spike in bloodwork, as may kidney stones. An ultrasound can help determine if these issues are present.

 

Many cats with uncontrolled hypertension may have worsening bloodwork, which may improve once the hypertension is brought under control.

 

If your cat's phosphorus levels are high, it is particularly important to get these under control, because they may make the CKD progress faster and also make many cats feel bad.

 


If A Cat with Low Bloodwork Values Acts Sick


I would expect a cat with low bloodwork values (creatinine below 3.5, Stages 1, 2 and the lower part of Stage 3 of the IRIS classification system) not to appear too sick. These cats may have the occasional bout of vomiting or diarrhoea, and may sometimes not want to eat, but overall they should be doing quite well as long as they are not dehydrated and are eating enough.

 

Therefore if your low numbers cat is consistently off colour (lethargic and exhibiting general malaise) even after treatment for obvious problems, I would ask your vet about other possible causes. Many cats with hypertension feel off colour, but improve greatly once their blood pressure is back to normal. My Ollie had low kidney values (creatinine of 2.8) but had fairly regular diarrhoea. It turned out this was caused by hyperthyroidism and it disappeared once the hyperthyroidism was under control.

 

Some CKD cats who persistently exhibit general malaise despite treatment for obvious problems may have some kind of gastro-intestinal problem. Pancreatitis is a common cause in CKD cats; other possible causes include inflammatory bowel disease (IBD) or cancer (lymphoma). It would probably be worth considering an abdominal ultrasound in order to rule out such problems. 

 


Treat the Cat, Not the Numbers


 

Test results matter, but they are not the whole story. This is why we have a mantra on Tanya's CKD Support Group: "treat the cat, not the numbers". Of course, it is still important to do what you can to improve the bloodwork and to treat whatever issues arise, because this will both make your cat more comfortable and increase his/her chances of survival. This mantra is simply a way of pointing out that many cats do astonishingly well despite their bloodwork results being poor. There are no guarantees and it is a fine line to tread, but it is usually worth trying treatments, although you must also consider your cat's temperament when deciding how much to fight the CKD.

 

Some vets consider levels in Stage 3 to indicate high numbers and therefore to carry a very poor prognosis; but on Tanya's CKD Support Group, these are actually considered to be "medium numbers", and in fact many list cats have lived three or four years or longer with Stage 2 levels. Cats with numbers in this range should really be considered as having renal insufficiency rather than kidney failure.

 

Dr Katherine James has mentioned that most people seem to opt for euthanasia when creatinine remains consistently in the 660-900 (US: 7.5-10) range, and the cat is doing badly. However, this is just a rough guide; cats in Stage 3, with very high numbers despite IV therapy and rehydration, may sometimes respond very well to treatment and enjoy several months of quality life, particularly if their numbers have worsened gradually over time, giving their bodies time to adjust to the reduced levels of kidney function. Even if a cat is in crisis at diagnosis, there may still be hope: Vet Info mentions a cat they treated who lived for eight years with CKD despite initially presenting in crisis (click on Kidney Failure - Daily Fluid Treatment). The Success Stories page tells the stories of some CKD cats who have managed to lead happy and in many cases, lengthy, lives at various stages of the disease, including one cat, Paris, who survived for over sixteen years.

 

 

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This page last updated: 3 November 2011

Links on this page last checked: 27 March 2012