By Steve Dale, CABC
Chronic kidney disease (CKD) or chronic kidney insufficiency is one of the most common illnesses affecting older cats. Studies suggest that as many as 30 to 40 percent of senior cats develop some degree of kidney disease.
While the EveryCat Health Foundation and others around the world – including a recent development in Japan – are working to proactively treat and even prevent CKD, there are steps you can encourage cat guardians to take.
This begins with hydration.
Indeed, cats evolved from desert-dwelling ancestors and naturally have less of a thirst drive than dogs. And they’re not necessarily running around to create thirst. Most cats, especially those indoors, consume less water than they require and live day to day at least partially dehydrated. Domestic cats may have evolved from a desert cat species, but that was thousands of years ago, and cats are not camels.
Dehydrated people may lack energy and not feel well. If they remain dehydrated for a period of time, this can impact their health, including kidney function. We don’t know, but assume the same may be true in cats.
Hydration becomes even more important once kidney disease develops, even in undetected early stage one CKD, according to the IRIS (International Renal Interest Society) Guidelines. Dehydration can damage kidneys, which lose their ability to conserve water efficiently, causing affected cats to produce larger volumes of dilute urine. This can lead to a cycle of increased urination and dehydration, even further challenging kidney function.
So, what can you encourage cat guardians to do to proactively supply hydration in a way that their cats will actually drink?
- Offer fresh water throughout the day: Fresh means fresh and well-oxygenated. Water sitting in the bowl for days isn’t appealing to many cats.
- Water fountains: Some cats are obsessed with running water. However, cats are sensitive to odors and tastes, and fountains can quickly develop biofilm, bacteria, and mineral buildup. Look for a fountain that comes apart easily, has smooth surfaces without hard-to-reach crevices, and can be thoroughly cleaned regularly. It can also be beneficial to select a model that doesn’t make much noise.
- Choice: There is no magic number, but the plus-one formula used for litter boxes will do for most homes. If there are three cats, having four water choices around the house is ideal. Cats can choose without having to compete with another cat or the family dog for the resource.
- Location: Water should never be located right next to a litter box. Since many cats feel safer using vertical space, having at least one watering hole up and away from toddlers and/or dogs is a good strategy. However, consider cats’ ages – geriatric cats aren’t as likely to climb a mountain for water or head down to a dark basement.
- Exercise: Cats rarely run around for long periods of time to work up a thirst like dogs, but interactive play (using a fishing pole-type toy) once or twice daily is important if not downright vital to support the cat’s well-being. Like people or dogs, activity can work up a thirst.
- Add Water to Meals: Without debating kibble vs moist food (or other choices, such as pate), providing some moist food daily will increase water intake, as most moist cat foods are about 70 to 80 percent moisture. Adding even just a small amount (maybe a teaspoon) of fresh water to all food – even kibble – is a good idea. No need to make the food soupy, or some cats will turn up their noses to it.
- Water Hesitancy: Consider Purina Hydra Care, a nutrient-enriched liquid supplement formulated to encourage cats who seem uninterested in H2O to drink more. The product contains osmolytes that help the body absorb and retain water, and studies have shown it can increase total fluid intake.
Exact cause of CKD
The exact cause of chronic kidney disease is often unknown. Aging itself appears to play a role, but other contributing factors may include high blood pressure, hyperthyroidism, kidney infections, chronic inflammation, dental disease, genetic predisposition, and previous episodes of acute kidney injury, as well as long-term dehydration. Exposure to toxins—including lilies, antifreeze, and certain medications—can also cause serious kidney damage.
Although CKD cannot always be prevented, regular veterinary visits offer the best opportunity for early detection, which enables the best treatments to slow disease progression. Most clients don’t do blood work in their kitchens. Because cats are remarkably adept at hiding illness, and kidney disease often develops gradually over years by the time obvious symptoms appear, a significant amount of kidney function may already have been lost.
Of course, newer diagnostic tools have improved the ability to detect kidney disease earlier. A traditional blood test measures creatinine and blood urea nitrogen (BUN). Symmetric dimethylarginine (SDMA) is a blood biomarker that can detect declining kidney function in cats earlier than traditional kidney tests such as creatinine, helping veterinarians to potentially identify CKD at an earlier stage.
Even with regular veterinary care, cat parents play a crucial role in recognizing early warning signs. One of the first symptoms is often increased thirst, accompanied by larger clumps in the litter box as cats begin producing more urine. Another reason to encourage clients to weigh cats regularly with a baby scale is to monitor gradual weight loss despite a normal appetite. As the disease progresses, cats may develop decreased appetite, muscle loss along the back, vomiting, nausea, poor coat quality, bad breath, lethargy, weakness, or behavioral changes such as hiding more often or becoming less interactive.
Because these signs can develop slowly, they are sometimes mistaken for normal aging.
The encouraging news is that cats diagnosed with CKD today often enjoy years of good quality of life. Prescription kidney diets, blood pressure management, hydration support, and regular monitoring can significantly improve outcomes, particularly when treatment begins early. Still, the hope is that one day soon we’ll do even better. Meanwhile, clients can play at least some role by ensuring proper hydration and paying close attention to changes in behavior.