Nutritional management is the cornerstone of chronic kidney disease care in cats. Evidence-based dietary approaches slow progression and improve quality of life significantly.
CKD nutritional management exemplifies the intersection of welfare and evidence-based veterinary medicine. The disease causes progressive loss of kidney function, leading to accumulation of uremic toxins, dehydration, nausea, hypertension, and anemia — all of which impair welfare. Phosphorus restriction in renal diets has the strongest evidence for slowing progression and extending comfortable life. However, the welfare of refusing to eat a renal diet must be weighed against the benefit: a malnourished cat refusing prescription food has worse welfare than a well-nourished cat eating a non-prescription lower-phosphorus diet. Nutritional management must be individualized and flexible, prioritizing caloric adequacy alongside phosphorus reduction. Home fluid therapy is transformative for many CKD cats, dramatically reducing uremic episodes and improving daily comfort.