Chronic kidney disease (CKD) is the most common kidney disorder in cats and one of the leading causes of death in older cats. It requires proactive monitoring, careful nutritional management, and a welfare-focused approach throughout its progressive course.
CKD affects approximately 30-40% of cats over 10 years and 80% of cats over 15 years, making it an almost universal geriatric condition. It is characterised by irreversible loss of nephron mass and progressive decline in glomerular filtration rate (GFR). The International Renal Interest Society (IRIS) staging system (Stages 1-4) guides management and prognosis based on creatinine, SDMA, and urine protein:creatinine ratio.
Early CKD is often subclinical, detected only through bloodwork. As disease progresses, signs include increased thirst and urination, reduced appetite, weight loss, muscle wasting, vomiting, and lethargy. Advanced CKD causes uraemia—toxin accumulation causing nausea, neurological signs, oral ulcers, and profound weakness. Hypertension is a common concurrent condition causing additional organ damage including retinal detachment and blindness.
CKD causes chronic nausea, reduced appetite, weakness, and potentially hypertension-related vision loss and headaches. Quality of life assessment should consider hydration status, appetite and interest in food, social engagement, activity level, and owner-perceived wellbeing. Regular structured assessment using quality of life tools enables objective monitoring and guides treatment intensity decisions.
Prescription renal diets—reduced phosphorus, modified protein, increased potassium—are evidenced to slow CKD progression and reduce uraemia symptoms. Dietary compliance is challenging in anorexic cats; palatability and texture preferences must be accommodated. Adequate caloric intake takes precedence over dietary perfection—a cat that refuses renal food but eats normal food may be better served by the latter than anorexia. Phosphate binders, potassium supplements, and anabolic agents support nutritional management.
Antihypertensive treatment (amlodipine) is essential in hypertensive cats to prevent further renal and retinal damage. Anti-emetics improve appetite and reduce nausea. Subcutaneous fluid therapy at home can maintain hydration in dehydrated cats, improving wellbeing and potentially slowing progression. Erythropoiesis-stimulating agents treat renal anaemia. Phosphate management reduces renal inflammation. Each decision weighs benefit against treatment burden on the cat.
Three-monthly monitoring (bloodwork, blood pressure, urine assessment) in stable cats tracks progression and enables early intervention. Frequency increases with disease severity. Home assessment of water intake, bodyweight, and behaviour provides valuable welfare data between visits. Telemedicine veterinary consultations can support frequent monitoring with reduced transport stress for fragile cats.
CKD is progressive and ultimately fatal. Uraemic crisis—severe nausea, neurological deterioration, and profound weakness—marks decompensation and warrants serious welfare assessment. Quality euthanasia, preferably at home to minimise final distress, is a compassionate endpoint. Advanced care planning while the cat is stable, rather than crisis management, enables informed and timely decisions.