Management of Kidney Disease in Senior Cats
The recommended treatment approach for managing kidney disease in senior cats should include a specialized renal diet, phosphate binders, hydration support, and management of secondary complications to improve quality of life and reduce mortality. 1, 2
Diagnosis and Assessment
- Monitor kidney function regularly in senior cats through:
- Blood tests (creatinine, BUN, phosphorus, potassium)
- Urine tests (specific gravity, protein-to-creatinine ratio)
- Blood pressure measurement
Core Treatment Strategies
1. Dietary Management
- Implement a specialized renal diet which has been proven to significantly reduce uremic episodes (0% vs 26% in cats on maintenance diets) and renal-related deaths 2
- Key components of effective renal diets:
- Reduced phosphorus content
- Moderate protein restriction (not severe restriction)
- Lower sodium content
- Higher potassium content
- B-vitamin supplementation
- Alkalinizing agents
- Omega-3 fatty acids
2. Hydration Support
- Maintain adequate hydration through:
- Multiple fresh water sources throughout the home
- Wet food incorporation
- Subcutaneous fluid therapy when indicated for moderate to severe cases
3. Phosphate Management
- Monitor serum phosphate levels regularly
- Use intestinal phosphate binders when dietary restriction alone is insufficient
- Target phosphate levels within normal range
4. Management of Secondary Complications
Hypertension
- Regular blood pressure monitoring
- Antihypertensive medication when systolic pressure exceeds 160 mmHg
Proteinuria
- ACE inhibitors for cats with significant proteinuria
- Monitor urine protein-to-creatinine ratio
Metabolic Acidosis
- Provide alkalinizing agents when indicated by blood bicarbonate levels
Anemia
- Monitor packed cell volume/hematocrit
- Consider erythropoietin therapy for severe anemia
Monitoring and Follow-up
- Frequency of monitoring based on International Renal Interest Society (IRIS) staging:
- Stage 2: Every 4-6 months
- Stage 3: Every 3-4 months
- Stage 4: Monthly or as needed
Important Considerations
- Energy intake must be maintained to prevent weight loss and muscle wasting 3
- Palatability of renal diets is crucial - gradual transition may improve acceptance
- The renal diet should be introduced early (IRIS Stage 2) rather than waiting for advanced disease 2
- Cats with remnant kidney function fed high protein diets show significant renal morphologic injury that can be prevented by dietary protein/calorie restriction 4
Pitfalls to Avoid
- Focusing solely on protein restriction without addressing phosphorus, sodium, potassium, and acid-base balance 5
- Delaying dietary intervention until advanced disease stages
- Neglecting regular monitoring of body weight and muscle condition
- Failing to address comorbidities that may exacerbate kidney disease
- Not providing adequate hydration support
By implementing this comprehensive approach to managing kidney disease in senior cats, veterinarians can significantly improve quality of life and potentially extend survival time for affected patients.