Chronic Renal disease, or chronic kidney insufficiency, is something that most cats will develop if they live long enough. It’s an unfortunate fact that cats have a shorter life span than we do. So as cat owners and lovers, we must shepherd them through this disease. And it ain’t as easy as it sounds. In the last 10 years, I have shepherded three such cats, and I offer my experiences with each, so that those of you out there who are also caring for one such kitty, be they newly diagnosed, or managing, may gain insight from my steps and missteps. A brief story of each, then a list of what lessons I’ve taken away at the end:
Kizzo
A cat that I inherited from my husband when we moved in together in 1998. In about 2000, his blood tests began to reveal kidney insufficiency (indicated at that time primarily by elevated Blood Uria Nitrogen, or BUN, numbers). At the vet’s recommendation, we switched his diet to dry Prescription Hill’s K/D, as putting him on a protein-restricted diet was the conventional wisdom of the time. Because we also had two younger cats, we also mixed in some cans of Fancy Feast to keep everyone happy. Kizzo ate well from both the K/D and Fancy Feast bowls, but he did start to drink an awful lot of water. We monitored his blood levels every 6mo-year. When they began to climb further, I began reading about further treatment, including subcutaneous fluid injections. Curious to see if it would help, I began taking him to the vet for an occasional fluid treatment. The vet administered about 150 cc of fluid from a conventional IV drip bag by sticking a small needle under his neck skin (but above the muscle). It took just a few minutes (but we had to kind of restrain him so that he’d stay still), and his mobility and mood always seemed to improve temporarily, so I was pleased. Despite this, his weight went down, an already skinny cat, he became emaciated, but his appetite was OK, and he continued to drink a lot of water. I just didn’t know what else to do, and the vet hadn’t given me a clear path of treatment to follow, beyond the diet change. Come 2004, I took him for fluid treatments every few weeks or so, but he was declining. His blood levels showed very high BUN, and he had begun to stumble a lot. It was clear that something had to be done, so I took him to the local emergency vet, which is part of the University here, so he was in very competent hands. It was too late, though – despite their best efforts, Kizzo’s condition had become acute, and his body didn’t have the energy left to respond to treatment that they offered (IV drip, phosphorus binder, among several others). He had begun seizing, and we elected to euthanize. Although sudden, it wasn’t a difficult decision, because he was in so much physical pain. We didn’t really know how old Kizzo was, as my husband had also inherited him from a friend, but some piecing together of shared memories with friends and a little math revealed that he was 18 when first diagnosed with CRD, and 22 when he passed away.
Bart
On the other hand, I knew exactly how old Bart was, as I adopted him as a 6mo old kitten in 1989. When Kizzo passed away, Bart became the resident “old Man” at 15, and equipped with the knowledge I’d gained from Kizzo’s experience, I aimed to combat CRD head on. Within a year or two, Bart’s kidneys also revealed an elevated BUN number, but I had also changed vets, and was coached instead to pay closer attention to the creatinine level, which was a more dependable reflection of kidney function. again, he went on the K/D diet, as Kizzo had done, as it was still the conventional wisdom. Because I felt guilty that I hadn’t done enough to treat Kizzo, I watched Bart like a hawk. I learned about the availability of home fluid treatments; that is, giving fluids subcutaneously at home, rather than dragging the cat in to the vet. Our vet gladly trained me in her office, and from then on I bought the supplies to give fluid treatments at home several times a week. Believe me, it took some getting used to. Bart was a sensitive cat, and never took to the routine well, but I continued with them every few days, then every other, then every day, as his kidney levels increased. If you are interested in this option, most vets will provide training and supplies. Though Bart hated the process, it was clear that he felt significantly better after each treatment.
As his health declined, and he showed anything like an acute problem (stumbling, vomiting) I would cart him off to the emergency vet. He would stay on with continuous IV treatment for a few days, and come home with better kidney values. Because the emergency vet was also a teaching institution, they provided him with a whole host of pharmaceuticals to combat the effects of CRD: famotedine for his gastritis, ACE Inhibitor, something else to prevent his spilling protein in his urine. He developed anemia as well, which responded to injections of Epogen. Poor Bart, almost as much as he hated the fluid treatments, he hated pills. And I hated giving them to him. But I continued, because I loved him and I wanted to do anything in my power to keep him comfortable. I also felt pressure from the emergency vet, as they insisted that this was the best course of action.
Because Kizzo’s decline had been so acute and sudden, we really didn’t know how long to carry out Bart’s treatment. This was certainly the hardest part of caring for the CRD cat; knowing when it’s time to let him/her make a graceful exit. Bart, normally a friendly, vocal, and happy cat grew quiet and withdrawn. Eventually, he declined to the point that he was nearly immobile, and could not bend down to the food bowls to eat properly. We knew then that it was time to say goodbye. He was 19.
Cap’n
Close on Bart’s heels was Cap’n (adopted in 1992 at just five weeks old), who even by the time of Bart’s passing had developed CRD and was getting fluid treatments at home. Luckily, Cap’n was much more amenable to the needle; barely acknowledging the initial prick, as if it were a bug bite. Because of Kizzo and Bart, Cap’n had been on a protein restricted diet by default for at least five years, so we kept it up. He had also developed hyperthyroidism a couple of years previously, and received twice daily medication to manage it.
As time went on I grew to regret some of the decisions that I’d made about Bart’s treatment, believing more and more that I prolonged his suffering and put him through a daily ritual that he dreaded. Truth is, he was my baby and I was really scared of losing him. But it shouldn’t have been about me. Knowing this about Cap’n, I vowed not to cart him to the emergency vet, and to keep his treatment to a minimum of fluid injections and his hyperthyroid medication. He seemed to thrive for a year or so, then declined fast. It was then that I stumbled upon the book mentioned in my previous post, “Your Cat: Simple New Secrets to a Longer, Stronger Life
A word about all of the treatments
I have gone into detail about my experience with each cat without once mentioning cost. This is a highly important consideration as well. Maintenance for a CRD cat involves at least a periodic blood test to check kidney values, and it’s no small price tag — about $100 a pop at my local vet. Giving fluids at home is relatively inexpensive; the bags are about $10-15 and contain 1000cc of fluid (150 is usually given in a single treatment). The costs for the emergency vet, though, were through the roof. I spent many thousands on Bart’s treatment; he was hospitalized three different times, each with a price tag of around $2k. Oof.
- pay closer attention to the creatinine level, rather than BUN, which is a more dependable reflection of kidney function
- if you have the capability, giving subcutaneous fluids at home provides some comfort and relief to the kidneys, and helps to prolong kidney function.
- cats are very stoic about their discomfort, so the pursuit of treatment is a very personal and difficult decision. There are no right answers.
- as it turns, out protein-restricted diets are not the way to go in managing CRD; rather, phosphorus-restricted is far better. Barring that, phosphorus binders can be given to help the phosphorus pass quickly through the system.
- In arriving at a treatment plan for your cat, consider the advice of your vet, the cost, the overall investment and think realistically about what you are willing to do. Do not beat yourself up for not trying to do everything. In my experience, I don’t think doing everything is a wise treatment plan (see Bart, above).