Chronic renal failure (CRF) can exist but be asymptomatic in cats for a very long time – even for years. Normally, by the time an owner notices signs of renal failure and a diagnosis is made, the condition is irreversible. Nevertheless, there are a number of management techniques that can help maintain a cat’s quality of life. The goals of treating feline renal failure are to alleviate the signs of uremia (which is the build-up of nitrogenous wastes in the bloodstream), delay progression of the disease and make the cat as comfortable as possible, for as long as possible.
Treatment Options for Cats with Chronic Renal Failure
The most effective initial treatment for cats with CRF is aggressive fluid therapy. Because the cat’s kidneys can’t perform their normal tasks, circulating waste products must be artificially flushed out. Over-hydrating the cat by pushing fluids helps accomplish this. Fluid therapy is typically first administered intravenously through a sterile needle inserted into one of the cat’s veins. This is an inpatient procedure. Once the cat is rehydrated, fluids can be given under the skin (subcutaneously; normally in the scruff of the neck between the shoulder blades). How frequently fluids are given depends on the extent of kidney damage. Most owners quickly learn how to administer subcutaneous fluids at home.
Supportive care is essential to managing cats with CRF. Renal diets are available from several commercial cat food manufacturers. These diets are designed to reduce the amount of circulating waste products and reduce stress on the cat’s kidneys; they typically are low in protein, sodium and phosphorus, have a high-quality protein source and are high in calories. Canned food may be a better option than dry food for cats with CRF, because of the greater water content and increased palatability.
Oral and injectable medications are available to help control high blood pressure, address anemia, decrease stomach acidity, sooth the stomach lining and limit protein loss in the urine. Vitamin and mineral supplements, including vitamin B, sodium bicarbonate, potassium gluconate, potassium citrate, vitamin D and calcitriol, may be recommended. Blood transfusions can help severely anemic cats. Human recombinant erythropoietin is also available to counteract anemia.
Kidney transplants have become a legitimate option for owners of cats with chronic renal failure. Post-surgical survival is reportedly between 70% and 85%, with some cats living for years. Medication must be given for life after a kidney transplant to prevent rejection of the donor organ. These drugs have many potential side effects. Kidney transplants are only offered at a few veterinary teaching hospitals and specialty referral centers. The costs associated with this surgery typically exceed $5,000. Transplantation is something for owners to discuss with their veterinarian, particularly if their cat is only mildly to moderately ill and does not have underlying systemic illness. The kidney donors are often shelter cats that are adopted by the owner of the cat receiving the kidney.
Chronic renal failure is progressive and incurable. How long a cat can live comfortably with CRF is difficult to predict. Many cats have months or years of quality life ahead of them, if they are managed appropriately.