Feline Chronic Kidney Disease (CKD) Treatment

In the early stages of CKD (stages I and II), there is already damage in the kidney called fibrosis, but few clinical signs of the disease are seen. The emphasis should be placed on slowing progression of the disease. Any supplements or drugs that are harmful to the kidney should also be eliminated.
From late stage III onwards to early stage IV, complications and outward symptoms of CKD become more common and more severe. In this period, treatment should be focused on minimizing the symptoms associated with CKD to ensure the best quality of life possible. Treatments given in stage I and II should also be continued.

1. Stage I and Stage II

   In stage I CKD, the kidneys are still working well, but there may be signs of kidney damage.
   In stage II, the kidneys are mostly able to work although the function may be reduced a little. There are some clinical signs that you may notice, or veterinarians may notice when testing for kidney damage or in medical check-ups.
   Recommended treatments are as follows:

   • Therapeutic diets that are restricted in protein
   • Phosphate binders that do not include calcium
   • Drugs that increase blood flow to the kidney and/or have other beneficial effects on the kidney
   • Treatment of any diseases that may damage the kidney (such as some diseases of the bladder and urethra, or dental disease)

   In case of constant high blood pressure or excessive protein in the urine, appropriate treatment drugs may also be administered. It is also important to provide a stress-free environment for your cats. In multi-cat households, you should have at least one litter box, one food dish and one water bowl per cat as well as one of each extra. They should also have fresh water available at all times for drinking.

2. Stage III

   In Stage III CKD, cats show a wide range of presentations, from few clinical signs to obvious signs becoming very unwell.
   Treatment in this stage is decided based on urine tests, ideally taken early in the morning.
   If tests show the disease is more advanced, careful fluid management is needed to keep your cat hydrated. Cats are particularly susceptible to becoming dehydrated because they do not have a strong urge to drink water like some animals do, even when their bodies need it. It is recommended to weigh your cat every day and if there has been any decrease, this means that the cat has lost that much water from its body. You should make sure that the cat is able to replace this amount of water, ideally via eating and drinking. If this is not possible, your veterinarian may suggest other ways to help maintain hydration. It is also recommended to feed your cat wet food rather than dry food, as the former contains more water.

3. Stage IV

   Cats in stage IV require even more careful monitoring than in stage III.
   In this stage, most cats excrete very dilute urine , which is a sign that the kidney has been greatly damaged and lost its ability to create concentrated urine. This means that the cat is unable to keep itself hydrated and body weight may decrease daily.

   In addition to treatments recommended in stage III, a feeding tube may be necessary to provide nutritional support, maintain hydration, and facilitate medication administration. If there is severe anemia, regular injections of hormones that produce blood (hematopoietic hormones) may be recommended. If there is lack of potassium (hypokalemia) or excess of acid in the body (acidosis), these symptoms should also be treated.

Drug therapy

While some drugs are only prescribed at certain stages of the disease, it should be noted that as CKD progresses, the overall number of medications that your cat receives may need to increase.
The following are drugs and supplements commonly used to treat CKD in cats:

Suppression of kidney function decline

Name	Effect
Prostacyclin (PGI2) derivative	Improves blood circulation in the kidney and suppresses hypoxia (lack of oxygen) and inflammation.

Suppression of proteinuria and hypertension

Name	Effect
Renin angiotensin system inhibitors	Suppresses proteinuria (high level of protein in urine). This drug should not be administered to dehydrated cats.
Calcium channel blockers	Lowers systolic blood pressure to below 160mmHg.

Management of hyperphosphatemia and anemia

Name	Effect
Phosphate binding agent (e.g. iron citrate)	Reduces absorption of dietary phosphorus in the intestine to improve hyperphosphatemia (high level of phosphate in blood).
Erythropoietin	When administered with iron supplements, erythropoietin improves anemia by producing red blood cells and increasing blood cell volume (PCV).

Management of hypokalemia and acidosis

Name	Effect
Potassium gluconate	Improves hypokalemia (lack of potassium).
Sodium bicarbonate	Improves acidosis (excess of acid in the body).