A simple explanation of the kidney's functions, and what happens to them in CKD. This page also briefly discusses how much function is required, and why cats are often not diagnosed until over two thirds of kidney function have already been lost.

Information about the causes of CKD, both proven and suspected. Once CKD is present, it is treated in the same way whatever the cause (except for glomerulonephritis, when additional treatments may be appropriate); so if you're tight for time, skip this page. Also skip this page if you're on a guilt trip: you did not cause your cat's CKD through e.g. your food choices.

How Bad Is It?

Information on how severe your cat's case might be, and a brief discussion about the concept of end stage renal failure.

Acute kidney injury (acute renal failure) is a kind of kidney problem that comes on suddenly, usually because of an "insult" to the kidneys. It is difficult to treat, but some cats do make a complete recovery, though others will be left with residual damage (CKD).

If you're feeling overwhelmed, this is probably the best page to start with. This page gives an overview of the main issues of concern for CKD cats. If you focus on any of these issues that are present, you greatly increase your cat's comfort level and chances of survival. The other pages in this chapter go into more detail about these issues.

Nausea, Vomiting, Appetite Loss and Excess Stomach Acid

Most CKD cats have problems with vomiting, nausea and appetite loss, and often the cause is excess stomach acid. This page describes the possible symptoms and various treatments available for these problems.

This is eventually a problem for most CKD cats. This section discusses the various types of fluid therapy available.

All About Phosphorus Control

High phosphorus levels in bloodtest results can make a CKD cat feel ill and may make the CKD progress faster. Even if the level is within normal range, this may not be enough. This page discusses the symptoms of high phosphorus levels and the possible treatments.

All About Hypertension (High Blood Pressure)

66% of CKD cats develop hypertension. It can make a cat feel rough, and in the worst case, the cat may go blind or have a stroke. Fortunately it's easily treated. This page covers possible symptoms and explains which is the best treatment.

Anaemia may develop for various reasons. Fortunately it is usually easy to control. This page discusses why CKD cats can become anaemic and describes commonly used treatments.

Constipation is quite common in CKD cats and can make a cat feel very uncomfortable. This page describes symptoms and treatments.

CKD cats often have an imbalance in their potassium levels. Most of them have levels which are too low, which can cause a number of problems, especially back leg weakness. This page discusses symptoms of a potassium imbalance and how to treat low or high potassium levels.

Metabolic acidosis means the cat's body is too acidic (which has nothing to do with stomach acid). It is quite common in CKD cats, usually in those with more advanced CKD, and this page explains more about the problem and how to deal with it.

Some cats develop kidney stones, which may cause or worsen CKD. This page discusses the various treatment options.

Coping with CKD

It can be emotionally draining dealing with CKD, so this page gives tips on how to cope with the ups and downs of the CKD rollercoaster, including worrying about the future, and how to deal with practical issues, including financial concerns.

I have set up an online support group which is free to join. This page explains how to join and how the group works.

Success Stories

The stories of some CKD cats, all of whom have led high quality and, in most cases, long lives despite having CKD. Includes cases of young cats, cats with kidney stones, cats with acute renal failure etc.

There are many possible symptoms of CKD. This page lists the symptoms which you may see in alphabetical order, and provides quick links to more information for each symptom and the relevant treatment. 

Fluid and urinary imbalances are common. This page describes symptoms of dehydration, symptoms of overhydration, and symptoms linked to the urinary tract, such as urinary tract infections.

This page describes the symptoms you might see relating to problems with waste product regulation, such as vomiting, gastro-intestinal problems, mouth ulcers etc.

These are frequent problems in CKD cats. This page discusses possible symptoms, such as twitching or seizures.

Discusses symptoms such as pain, hiding and changes in the coat or skin. 

Explains the meaning of these tests, such as  BUN, creatinine, azotaemia, potassium, magnesium etc.

Imbalances in phosphorus and calcium levels are extremely common in CKD cats. This page explains more, and includes a discussion of high calcium levels, ionised calcium and calcification.

Discusses the tests which indicate whether infection or inflammation are present and those which indicate anaemia and its severity.

This page explains more about obtaining urine samples and what these indicate, including urine specific gravity (USG), proteinuria (excess protein in the urine) and the diagnosis of urinary tract infections and kidney infections (pyelonephritis).

Discusses other tests which are sometimes used, such as ultrasound, x-rays, biopsy, intravenous pyelogram etc.

Explains more about factors such as fasting before tests, and how the handling of the blood may affect the results.

A rough guide to normal ranges for the various tests in the USA and the rest of the world.

The USA uses a different measuring system to the rest of the world. This page explains more about this and how to convert values from one system to the other.

There are so many treatment options that it can seem overwhelming. This page explains which are the most important treatments, which may be necessary in some circumstances, and which are optional or not recommended.

Explains more about how to manage these problems, including high calcium levels. Discusses the use of calcitriol.

Discusses commonly used antibiotics (Baytril, Convenia, Clindamycin and Clavamox/Synulox) and painkillers, including meloxicam (Metacam). It includes a treatment protocol should your cat have been given too much meloxicam and developed acute kidney injury.

Describes some treatments which are not mainstream but which have proven to be effective for many CKD cats, such as slippery elm bark and acupuncture. Also explains which treatments may not be appropriate, such as Tripsy and RenAvast.

Explains more about using ESAs to treat severe anaemia (PCV or HCT under 20%). Commonly used products are Epogen, Eprex, Aranesp (darbepoetin), Procrit or Neorecormon.

Tips on how to medicate your cat with minimal stress for both of you.

This page has suggestions on how to work with your vet as a team, and how to get a second opinion. It also explains the benefits of keeping your own records.

Where to obtain fluid supplies, medications and prescription food cheaply in the UK.

USA

Where to obtain fluid supplies, medications and prescription food cheaply in the USA.

Where to obtain fluid supplies, medications and prescription food cheaply in Canada.

Discusses the dietary and nutritional needs of CKD cats. Includes a discussion of the low protein debate, and explains why low protein is not necessarily a good idea for cats in the early stages of CKD.

CKD cats lose Vitamin B through increased urination. This page explains how supplementation, particularly of Vitamin B12 in the form of methylcobalamin, can help with problems such as anaemia and appetite loss.

Tips on how to introduce a prescription diet, and what your options are if your cat refuses to eat it. Also explains why certain foods, such as tuna or garlic, are not appropriate for cats.

This page tackles the common problem of persuading your CKD cat to eat, and how to get additional nourishment into him/her.

If your cat refuses to eat prescription foods, it can help to know the content, particularly the phosphorus content, of other cat foods. This page explains how and why I analyse the foods using Dry Matter Analysis (DMA), and gives a brief overview of what to consider when choosing a food.

Analysis of the phosphorus, protein, sodium and fat content of a number of canned cat foods in the USA, many of which are also available in Canada.

Analysis of the phosphorus, protein, sodium and fat content of a number of dry cat foods in the USA, many of which are also available in Canada.

Contact details for the main cat food manufacturers in the USA.

Analysis of the phosphorus, protein, sodium and fat content of a number of tinned cat foods in the UK, many of which are also available in the rest of Europe.

Analysis of the phosphorus, protein, sodium and fat content of a number of dry cat foods in the UK, many of which are also available in the rest of Europe.

Contact details for the main cat food manufacturers in the UK.

In 2007, a number of cats in the USA (and later in some other countries) suddenly began developing kidney failure. Some of them died. The problem was eventually traced to cat food ingredients imported from China. This page explains more about the scandal, which continues to be a problem for some cats who survived but who were left with CKD.

Maintaining hydration is very important for CKD cats. This page gives a brief overview of the different fluid therapies (oral fluids, intravenous fluids and subcutaneous fluids), and explains which is used when.

Intravenous fluids (IV fluids, or a drip) are given into a vein, and are therefore usually given in hospital. For this reason they are normally reserved for crisis situations, such as when a cat crashes. They are also commonly used before, during and after surgery.

Subcutaneous fluids (sub-Qs or sub-cuts) are given under the skin and can therefore be given at home. They are used to maintain hydration. Generally speaking, CKD cats benefit from subcutaneous fluids once their creatinine is over 3.5 (US) or 300 (international).

This page gives an overview of the various sorts of fluids (Lactated Ringers, saline etc.). It also provides tips on which needles to use, how to keep your cat calm, and generally how to make the process easier for you both.

A photographic demonstration of how to give sub-Qs using a giving set, the method commonly used in the USA.

A photographic demonstration of how to give sub-Qs using a syringe, the method usually recommended in the UK. It shows how you don't have to stick your cat multiple times!

In the UK in particular, it can be extremely hard to find a vet who permits you to use sub-Qs at home. This page discusses commonly used objections and how you can try to counter these.

Description of peritoneal dialysis, haemodialysis and continuous renal replacement therapy. These treatments cost thousands, so are rarely performed on cats, but the information is provided in case of need.

Heart problems are not unusual in older cats, so you may find yourself dealing with these as well as CKD. This page explains the different types of heart problem, describes the various heart medications that may be used, and discusses how to balance treatment for both CKD and heart problems.

Hyperthyroidism means that the thyroid is overactive, so the body's metabolic processes are in overdrive, causing a variety of different problems. Treating hyperthyroidism is therefore essential, but must be done cautiously because treating it may unmask existing but hidden CKD. This page explains more about hyperthyroidism and how to juggle both conditions.

Diabetes is relatively common in CKD cats. It is usually manageable. This page discusses the various treatments available and how to balance the dietary needs of a cat with both CKD and diabetes.

Pancreatitis is inflammation of the pancreas. It is fairly common in CKD cats, and shares some of the same symptoms. If your cat has relatively low creatinine levels but is acting sicker than you would expect, with vomiting and severe appetite loss, read this page.

PKD is a genetic disease in which cysts form in the kidneys. It is most commonly found in Persian cats. It can eventually lead to CKD. This page explains more about the condition.

Information on anaesthesia and the precautions that should be followed for CKD cats having surgery performed under general anaesthesia.

The Final Hours

Since CKD is ultimately terminal, eventually you will have to say goodbye to your cat. This page contains information on facing up to this painful parting, and explains the symptoms and behaviour which you may see in your cat's last few days or hours. This page also contains a discussion on whether to opt for euthanasia, and a description of what to expect during the procedure if so.

This page consists of descriptions from a few brave people of what they and their cat experienced towards the end, and why in most cases they opted for euthanasia. 

This page contains information on how to cope with your grief after you say goodbye, and where to find support. 

Prevention

In most cases you cannot prevent CKD. However, there are a few steps you can take to reduce the risks, which this page discusses.

Research

This page discusses ongoing research into CKD and AKI.

I have no personal experience of canine CKD but this page provides links to information.

Links to information about general feline health issues, cancer, liver disease and behavioural problems.

Wo Sie diese Webseite auch auf Deutsch finden können.

This site is also available in German.

My Three CKD Cats: Tanya, Thomas and Ollie

Tells the contrasting stories of my three CKD cats.

Harpsie was my second cat. He was an adorable blond Persian who had a host of ailments but who nevertheless lived to the age of 14. He had PKD, which was diagnosed at the age of 7, but it never developed into CKD.

This website is on facebook. I have terrible trouble logging into facebook for some reason, so I'm not on there very often. It's far quicker to find me via this site or Tanya's CRF Support Group.

The website is also on Twitter. I think I have done about three Twitter posts so far. As you're beginning to guess, I'm not really a social media person but hey, I'm trying.

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