Chronic kidney disease (CKD) is the leading cause of death in older cats. Dietary management is the most evidence-based intervention for slowing progression and improving quality of life.
Nutritional management of CKD cats is a long-term welfare commitment requiring balance between therapeutic efficacy and food enjoyment. Renal diets that are refused provide no benefit — forcing cats to eat unpalatable therapeutic food reduces quality of life without extending it. Gradual diet transition, warming food, and variety within renal diet options improve acceptance. The welfare paradox of CKD management is that treatment requires sustained dietary restriction of proteins and phosphates that cats naturally seek in their preferred foods. The welfare calculus — reduced disease progression and extended comfortable life versus dietary limitation — generally favours dietary management, but requires regular reassessment as disease progresses and appetite declines.