Chronic kidney disease (CKD) is the most common fatal disease in older cats. Renal diets are central to management, but palatability and food acceptance are critical welfare considerations.
Renal diet management in CKD cats involves a genuine welfare tension: the diet that best protects kidney function is often less palatable, and forcing food refusal in a sick cat compromises quality of life and causes further weight loss and muscle wasting. The welfare-centred approach prioritises a renal diet the individual cat will actually eat consistently over the theoretically optimal formulation that goes uneaten. Transition to renal diets must be gradual and supported with palatability enhancers, gentle warming, and offering multiple renal diet brands to find the best accepted option. Anti-nausea treatment, particularly with maropitant or ondansetron, should be used whenever inappetence suggests uraemic nausea. Mirtazapine as an appetite stimulant is effective and well-tolerated in most cats. Subcutaneous fluid therapy administered at home significantly improves quality of life in cats with moderate-to-advanced CKD by reducing uraemia and restoring hydration. Quality-of-life monitoring must balance disease management objectives against the cat's daily experience of appetite, activity, and social engagement.