18 year old cat

I have an eighteen year old cat.  She has the beginnings of kidney disease.  I have tried to get her to eat the special kidney food but she just plain refuses.  She went for almost 4 days without eating at all rather than eat the special hard or soft food (perscription).  So she eats friskies special diet, fancy feast cans and royal cain dry food.  Other than the special diet she has eaten the other food basically her whole life.  She has steadily lost weight and is now down to 4.5 lbs.  She is a small cat but she is very very skinny.  She still runs over when I sit on the couch in the evening and jumps in my lap wanting to be petted and purrs when I do.  She jumps up on the kitchen counter.  She likes me to give her water out of the faucet.  She wants to be with the family in the evening but sleeps most of the day.  I know if she keeps loosing weight she can't live forever.  My vet has examined her and wants to continue to do tests every three months but it is alot of money and all she says is to feed her the food she just stubornly won't eat.  I can bring myself to starve her to death so i break down and give her what she wants.   I do give her pepcid.  Overall she doesn;t seem to be suffering but what should I look for and what should I expect. My childhood cat had a stoke at about 11 years old when I was away at college so she is the first can to grow old with me and I worry I my inadvertantly let her suffer.

Thanks

DTM, you came to the right place. CRF is very common in cats. I lost a cat that way 7 months ago.

The reason your cat refuses to eat prescription food (called k/d) is it has less meat, the stuff cats need to survive, than regular cat food. That's because cats with CRFneed lower amounts of phosphorus and protein than healthy cats. Most cats don't like it, so don't be alarmed. You can give your cat the other wet food just to avoid starvation, which would kill her faster than the CRF. Not eating for days causes hepatic lipidosis, aka fatty liver disease, so eating anything is more important than eating the right thing.

If it is possible to not feed dry food at all, stop feeding it. CRF causes dehydration, so your cat needs a lot of water during every meal. Also, to encourage her to drink more, you should buy a stainless steel water fountain (Pioneer and Drinkwell sell them on Amazon) that trickles down. They do require having an electrical outlet, but claim to be dishwasher safe.

Beyond food, water, and Pepcid, keep track of litterbox changes. Is she urinating more than usual? That would indicate excessive thirst. Less than usual is unlikely because she is willing to eat regular foods.

Also keep in mind she may become anemic, which causes her to feel cold. If this happens, she will sit on your lap more often than usual. Use a heating pad if you have one or buy a heated cat bed (K&H sells them in a variety of styles) if you don't.

Unfortunately, I know all this because I went through it last year with my favorite cat. I never got the chance to buy a water fountain because it progressed so quickly by the time I got that suggestion, it was too late to do anything. Usually CRF progresses much slower.

I, too, recently lost my elderly cat to CRF. He was 16.  He, too, went from 12 lbs, to skin and bones.  He, too, hated the kidney foods he was supposed to eat . 

Here is a great website that might be of some help to you.  http://www.felinecrf.org/which_foods.htm

Are you administering sub-q fluids?  This is something that we found very helpful in keeping our Sven hydrated, even though he drank bucket fulls on his own.  It's quite easy to do at home, particularly if you have more than one person around. 

Also, we chose NOT to have his blood tested very often, because, frankly, we weren't going to do anything different based on what his blood said, like start him on a bunch of medicine, because we believe in quality of life vs quantity (that is just our views, not everyones, naturally), and he was so very difficult to pill, etc. that it would have been too stressful on him.

I will also tell you that the new way of thinking is that good protein is not bad for kidney cats, they need it!  We actually started feeding our Svennie raw shortly before he died (with our Vet's blessing).  I just wish we had started him on it years before...before the damage was already done!

which prescription food do you have? since your cat already eats royal canin, maybe you could try the royal canin prescription food.

I'll share some of my experiences with my adorable, beloved Tuffy who was diagnosed at around 2 years old. (Aug 28 1996-July 17, 2004.)

Another member posted Helen's site that was started years ago because of her CRF/CKD kitty, Tanya. There is loads of information there, so I suggest you start there and read all you can about this disease and how to manage it. The link is: http://www.felinecrf.org/. This was one of the first sites I found when my Tuffy was diagnosed years ago. Helen has added a lot of information since then, so it is one of the first places I send folks to. Another site with helpful information and some supplements that have helped CKD kitties is: http://www.holisticat.com/crf.html.

With kitties with CKD, you do NOT want to limit their protein amount, as is still suggested by some vets, therefore they prescribe the nasty kidney food low in protein. Current advice in the last few years is to not limit protein, but limit phosphorus (see below). Do not feed a low protein diet, please. The reason you are seeing weight loss is because if kitties do not get enough protein from real meat in their diet, their bodies use their own muscle mass instead (simplified version of what happens). I mean, kitties are obligate (true) carnivores, and by restricting protein you are basically starving them. They need meat to survive, unlike humans and to some extent dogs.

What you do want to try to limit is the phosphorus amount in kitty food, but you can use a phosphorus binder mixed in every meal to help with that. (Helen's site has info on this.) I used Egg Shell Powder (ESP) as a phos binder for Tuffy per Holisticat's website. High phos levels in labs is one of the main causes for tummy upset and kitties generally feeling crappy and not eating. Keeping this under control can go a long way towards helping them feel better.

Kitties with CKD need to eat, so try to find foods with quality, real meat in the food, or whatever they will eat at other times. Canned is best, or even raw that maybe you lightly cook and then puree and add phos binder to it and a tiny amount of Egg Shell Powder (ESP) for a calcium source that won't raise her blood calcium levels. Chicken and turkey are lower phos meats. Egg whites that have been cooked (do NOT feed raw whites) are a good source of protein with lower phos, although some kitties aren't too fond of it--could maybe try cooking with some unsalted butter or other animal fat to make it more appetizing (this worked for my Tuffy). I would never feed a CKD kitty kibble unless that is all that they would eat.

Warming food slightly can bring out the aroma of foods when our little CKD kitties aren't too keen on eating. They also enjoy eating off your fingers. I found this such a bonding experience to do this with my Tuffy--it was one of the few positives we had in our life at that time. He also enjoyed drinking from a glass of water (I had one that had mL on the side so I could monitor how much he was drinking (see below).

Water, water, water! Next to a quality diet w/real meat (or as close as you can get), water is vitally important. It flushes toxins from the body that your now kidney impaired kitty needs to be done "manually" -- so to speak. I tried to give Tuffy sub-Q fluids, but he was quite the little fighter when it came to that, so I started adding extra water to his food, syringing by mouth 5-10mL, 4-5 or so times a day on the days he absolutely would not let me do sub-Q fluids. I aimed for 5-10mL per pound of his body weight. I kept a log of how much water I had added to his food and syringed throughout the day. I tested his hydration so that I knew if I needed to give more or not: lightly pinch some skin on the body, if it snaps right back down, they are hydrated. You can also feel their gums to see if they feel smooth or sticky--if sticky they need more water.

If you can do sub-Q fluids, get Terumo needles--they slide in like butter. Most vets give you crappy needles that are like pitch forks and hurt--at least my vet did back when Tuffy was to have sub-Q's. Maybe if I had known that beforehand, Tuffy might not have ended up hating it so much. <sigh> You want Lactated Ringers Solution (LRS) unless there is a darn good medical reason to go with a different type of sub-Q fluid. Some vets prescribe Normosol, but that can burn. Some others can raise their lab values, including urine pH.

Big ole hugs to you and your sweet little one. CKD can be managed, so just hang in there and learn all you can, but remember to take care of yourself too!

you might want to consider a feline-only vet. 

http://www.catvets.com/

EmilyMayWilcha said:

The reason your cat refuses to eat prescription food (called k/d) is it has less meat, the stuff cats need to survive, than regular cat food. That's because cats with CRF need lower amounts of phosphorus and protein than healthy cats.

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Emily, I have to disagree about restricting protein. Phosphorus, yes, but not meat protein. The reason being is that kitties are unable to down-regulate hepatic enzyme activity associated with protein metabolism even when dietary intake is low; as a result, this puts them at risk of protein malnutrition. They will basically starve to death because their nutritional needs are not being met by feeding good quality meat protein. Feeding an obligate (strict) carnivore a protein restricted diet will cause more muscle and organ wasting in an already weakened body.

mrsgreenjeens said:

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Here is a great website that might be of some help to you.  http://www.felinecrf.org/which_foods.htm

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That is a great site, and one thing she says it that it's more important the cat eats than it eats the "right diet".