Last updated January 19, 2018

Chronic Kidney Disease, also known as Chronic Renal Failure (CRF) is a common condition in aging cats. It is the result of a gradual decrease in kidney function.

The Function of Healthy Kidneys

Healthy kidneys act like a filter to remove waste products from the body. They regulate electrolytes such as potassium and phosphorous, and they produce erythropoietin which stimulates red blood cell production. Kidneys also produce rennin, which contributes toward regulating blood pressure. Kidneys also play a major role in turning vitamin D into its active form, which controls calcium balance in the body.

Signs of Chronic Kidney Disease

Signs of CRF can be subtle at first, and include increased thirst and urination, vomiting or other signs of nausea, lethargy or depression, poor hair coat, loss of appetite, lingering over the water bowl, eating cat litter, constipation, a strong ammonia-like odor to the breath, and changes in vision and hearing.

Chronic Kidney Disease is Irreversible

There is no cure for kidney disease, but it can be managed with supportive care. Early diagnosis improves the prognosis for longterm survival with good quality of life.

The goals of therapy for chronic renal failure are to increase hydration, decrease the buildup of toxins in the blood, treat any possible underlying reversible disease (infection, hyperthyroidism), maintain good blood flow to the kidneys, and minimize any further damage.

Dietary Modification

Cats with kidney disease need moisture in their diet, so dry food is contraindicated. There is some controversy around protein restriction for cats with kidney disease. While many veterinarians still recommend so-called prescription kidney diets, there is no solid evidence that protein restriction prevents further damage to the kidneys, especially not in early stages of the disease. In fact, protein restriction may do more harm than good. Additionally, these “kidney diets” are generally not very palatable, and many cat won’t eat them.

There is, however, strong evidence that restriction of phosphorus benefits cats with kidney disease. Phosphate binders such as Calcitriol are generally well tolerated by most cats.

All veterinarians will agree that it is more important that a cat will eat than what he eats.

For more information, read The Right Diet for Cats With Kidney Disease

Fluid Therapy

Cats with chronic kidney disease pass large amounts of urine and become easily dehydrated. Dehydration can be prevented by feeding canned or raw food, and by encouraging cats to drink. However, frequently, these cats don’t feel well enough to eat or drink enough to combat dehydration, and your veterinarian may prescribe fluid therapy. Fluid therapy also aids in flushing waste products through the kidneys.

Cats will need to be hospitalized for intravenous fluid therapy, but fluid therapy can be also performed by the cat’s guardian at home by giving the fluids subcutaneously. Depending on the stage of kidney failure, cats may benefit from fluid therapy ranging from once a week to every day.


Holistic supplements to strengthen renal function may be beneficial and are available in the form of herbal, homeopathic or nutraceutical form. Always discuss supplements with your cat’s veterinarian prior to administering.

Getting Cats to Cooperate with Treatment

One of the most frustrating aspects of treating cats with chronic kidney disease is getting cats to cooperate with the various treatments. Frequently, multiple pills and supplements a day, combined with fluid therapy, can interfere with the bond between cat and human. The goal of therapy needs to be to choose the most effective treatment with the least amount of stress for the cat, and the human.

This article was previously published on and is republished with permission.


33 Comments on How to Care for a Cat With Chronic Kidney Disease

  1. Maggie is on her second relapse, just got home from 48 hours in ER Vet hospital. She is doing worse, not eating (even after appetite stimulants), and her breathing has become labored.

    I am taking her to my vet today to have her look at her. The vet said we might try steroids…, and I think I’m going to try those. It’s either that or have to have her put to sleep.

    This sounds crazy, but I looked at her and asked her to let me know if she wanted to just go, if she was tired… she got up off the bed and started drinking water…

    The one thing that disturbs me (and maybe incorrectly) about some of these comments are the comments that claim a certain supplement saved their cats life and virtually cured their kidney disease…. that lays guilt on folks and maybe, just maybe, their cat is not as far gone, or they’re just fortunate….

    But, it doesn’t help people that are constantly second guessing themselves…., very painful, actually.

    • I’m sorry Maggie had a relapse, Carol. The comments about what has worked for others are offered in the spirit of helping others. It sounds to me like you’re doing everything you can to help Maggie.

  2. Back in 2006, we lost our first cat to CKD…she lived 3 months after the initial diagnosis. We gave her fluid treatments every other day. She finally had a seizure (luckily we were there when it happened and the vet was still open)…it was time to say good-bye.

    She taught us the importance of regular check-ups with the vet and keeping an eye on the small nuances in behavior…cats can hide their ailments very well.

    Some tips for giving fluid treatments…warm up the bag of fluids in a bowl of warm water…the fluids at room temperature will still be a shock to your cat. And, use Terumo needles…these were the best and sharpest (less pain) needles I could find.

    Sadly, it looks like our 2 present cats both might be entering into CKD, at the same time!!…they both tested high for the new SDMA test for kidney function…BUN and Creatinine are still very good and no clinical signs…going back for urinalysis and re-check of SDMA.

    If SDMA is still elevated maybe this will give us a head-start in managing and treating for a longer survival after diagnosis. I still dread the eventuality of giving fluid treatments…I don’t know who it’s more stressful for, the cat or human.

    • We were informed yesterday my boy has advanced ckd. He is still eating like he’s at the Golden Coral buffet lol and drinking lotsa water started drinking from the toilet bowl, that’s new. Yesterday Dr Dave showed us how to administer fluid IV, tonight we will attempt to do so. The wofe and I agreed if it’s to stressful we will not put BAMF thru it, also we will not be greedy to keep him to apiece ourselves.
      We love our 12 yr old kitty I thought ke would live to be old and grumpy lol that’s not gina happen.
      I , we are still wrapping our heads around the news, I will not let him see me cry.

      • Danny, giving fluids is easy. It is scary the first couple of times. Pls use Terumo ultra thin walled needles – 20 gauge. They insert like butter. I put my kitty in a box on the dining table so she wont walk away. I also went to the vet and had the tech show me how to set it up, start to finish, and watch while you do it. I did this without my cat. I warm the fluid line in a heating pad to warm the fluids. It literally takes less than 2 minutes, so your kitty should be fine.

  3. Hi my cat has her 2nd relapse and has just discharge from hospital from fluid treatment. This time round she sleeps throughout the clock, did not eat and drink. I have to syringe her with water to ensure she is drinking some water. Is this normal? This is about 21 year old this year.

    • I’m surprised your vet didn’t recommend giving subcutaneous fluids, Kelly. Giving water via syringe is unlikely to provide enough additional hydration.

    • My cat who is almost 20 crashed twice before we started her on subcutaneous fluids. I would talk to your vet. I was really scared starting my cat on fluids – but after a few times it got a lot easier to do. That was over two years ago now and she is still here with us. Don’t lose hope!

  4. I read that cats with chronic kidney disease should limit phosphate intake. But I don’t know how much is acceptable. Do you know Ingrid? My cat eats Natures Variety can and it states .20% on their website. Is that okay? I am thinking about switching to Merrick but they do not provide those details.

    • A rule of thumb is that phosphate levels in food should be below 0.5% on a dry matter basis, but I believe the only diets that are that low in phosphate are the so-called prescription diets, and they are too low in protein. I would look for a diet as low in phosphate as possible, and discuss adding a phosphorus binder with your vet. You may need to call pet food manufacturers to get phosphate levels.

    • You could check out There is a tab called “Nutrition” at the top of the page. Click on that and browse through their foods for cats. They provide phosphorus levels on a “As fed” amount based upon their overall percentage in a formula. You can also find the same chart and more information for certain products if you click on the tab for “Cat Cuisine”. We have been feeding our cat with kidney failure the “Paw Lickin’ Chicken” which has .13% phosphorus – but they have some that are even lower. Also under their FAQ’s they talk about their food specifically for dogs and cats with kidney issues. I found that helpful and comforting. You can find the FAQ’s under the “About Us” tab. Hope this helps.

  5. Thank you for the post Ingrid. I have been fortunate to never have a kitty with kidney disease. We have many other things. It is good to know.

  6. My 18 year old cat has been in renal failure for almost 2 years. When I found out I immediately started researching what to give her. She receives VetriScience Renal Supplement, Azodyl (probiotic for kidney failure), CoQ10 (especially formulated for cats and dogs), Apawthecary Detox Blend, Grizzley Brand fish oil, Organic By Nature wet food and we give her subcutaneous fluids. She is also on Miralax for constipation. All of it gets crushed and mixed with her food. She doesn’t seem to mind it. I would like to think she knows it helps her. I have read that by the time you find out your cat has renal failure they have already lost 75% of kidney function. I would like to attribute the fact that she is still with us to our daily regiment of supplements. Unfortunately, most vets do not understand or use holistic and natural methods and I had to do all my own research. It’s a travesty how many animals lives could be extended if only veterinarians would use more holistic methods.

    • Thanks for sharing what works for you cat, Nic. I, too, wish that more vets would educate themselves on the benefits of holistic modalities.

    • Nic, I am so glad to find this info. Wish I had seen this last year. I lost my most special cat last Nov. He was suffering from this. I now have my oldest cat suffering for a month or so. One of my other 2 cats is just showings of this. I will try this regiment on her before it is too late. Thanks so much for sharing.

      • Update: My cat with kidney failure turned 19 a couple of months ago. We are still using the above mentioned products but have also added Apawthecary slippery elm for nausea, vomiting and it is also used as an appetite stimulant – she loves the stuff. It seems to be working. She vomits less frequently and we recently found out that she weighs over 9 pounds – which is really great for a cat in stage 3 of kidney failure. We are having to discontinue our use of the Organic By Nature food because they did away with the line. We are now feeding her Weruva. They have several cans of food with low phosphorus and we add a little water to her dish.

  7. Fortunately, I caught my cat Mimi’s kidney failure very early, on routine bloodwork/urinalysis. She was 9 years old. She’s now 16 years old. She eats high quality canned food, and she gets subcutaneous fluids twice a week. I know that at some point, the fluids will become a daily event. I’m grateful for every day with her. I realize that having a cat live this long is not the norm.

    I do highly recommend the Renavast supplement. I saw Mimi’s BUN and creatinine go down after being on it for a few months. I made sure to keep everything else the same. It’s definitely worth a try.

  8. Hi
    In July 2010 I adopted a snow bengal girl named Roxy. She was a rehome due to “accidents”. The former owner had been told by her vet that the cat was afraid of the dark (seriously?) and/or afraid of her children. I brought Roxy into my home when she was 10 months old. Almost immediately, I noticed the constant drinking and peeing. I brought her to my vet for a complete workup and got the devastating news – my baby had congenital kidney disease. I was told that she wouldn’t live a lot of years – likely not past 10. I tried all the “prescribed” cat foods and she just wouldn’t eat them. Fast forward to 5/2014. One evening she started howling (an ungodly sound) and panting. At 11pm on a Friday night of a long holiday weekend, I raced her to the emergency vet. I was told she was in end stage kidney failure. What a minute – she’s only 3, what happened to those 10 years? She stayed at the vets and I cried all the way home. They gave her fluids, meds and supplements and sent me home after the long weekend – and told me to see my vet in a couple of weeks to see if her bloodwork was better or the same. The followup bloodwork showed that all the improvement from the time in the hospital was temporary. I’ve been told she has anywhere from a few weeks to a few months and I’m not coping with it very well. I’ve had cats since I moved out on my own some 30 years ago. I’ve loved them all, including the 3 other that I currently have, but the bond that is between me and this little girl is extrodinary. I’m trying to find some way to learn how to accept this – not to give up, but to be able to let her go when she needs me to.

    • I’m so sorry about Roxy, Ellen. What a devastating diagnosis. All my best to you as you try to cope. Try to focus on treasuring every moment you have with her rather than on what may come down the line. I know it’s hard.

  9. I cared for my Siamese, Indi, for a year and a half with CRF, and it wasn’t always easy, but it actually brought us closer. We became inseparable. She seemed to make the connection between the fluids and feeling better. I would pump her up and she would get such a satisfied look on her face. She failed quickly, in the end, and died at home in my arms at the age of 19-1/2. My vet still talks about her as one cat he will never forget.

    • I, too, have found that caring for a terminally ill cat can actually increase the bond between cat and human, Judi. It certainly was the case for me with Buckley.

  10. My first cat, Squeakers died at a very young age…5 1/2…of kidney disease. I noticed that she was drinking and peeing copiously, the litter in the litter box was “gooey”, very hard to scoop. Before, when it took her to the vet, she said Squeakers’ kidney levels were a bit high. That was a few months before the excessive drinking/peeing. I thought she had diabetes, I didn’t know much about kidney disease, but I had read that it could happen in senior cats. When I took her to the vet, she said Squeakers had kidney disease. Since she’d stopped eating, I was very worried. The vet directed me to Hill’s k.d and N.F food, and she started eating again. Every week or two, I brought her in for a checkup and fluid shots. It sure was expensive too. I was working, and on SSI and found the payments hard to handle. Finally, the vet said it would be better to stop the fluids. In November 2008, I lost my job, so I was home more, in a way, that was good. Squeakers knew that her time was almost up, she stuck to me like glue. Then, a week before she died, she chose a cardboard box and just stayed there. My other cat, Sandy, was very intuitive, and knew Squeakers’ time was coming soon. In the past, they barely tolerated each other, but Sandy hung around Squeakers more in the weeks before she died, and Sandy tried to get my attention, the night before Squeakers died. Squeakers collapsed on Saturday, December 8, while I was trying to get her to eat. My vet was already closed, and I can’t drive, so I called a friend who called a friend who could drive us to the emergency vet clinic. By the time we got there, Squeakers was already gone. In a way, I was relieved…for her, she didn’t have to go through this anymore, and for me…even though she was my first kitty and very sweet, and I still miss her, but I didn’t have the day-to-day worries of is she going to eat/drink today? and how long will she hold out? Now my mom has a friend with a 14-year-old cat who has kidney disease, but he’s been having 3-4 seizures almost every day! They just got him to the vet recently and found out about the kidney disease, but when my mom told me about the seizures, a lightbulb went on in my head “uh oh, kidney disease!! Though it could be something else, but I knew because of his age it most definitely would be kidney disease. My heart goes out to her, but I’m sorry, I never want to be in that place again. Squeakers never had seizures…Thank God!

    • I’m sorry about Sneakers, Niki. Caring for a cat with kidney disease can be very challenging. All my best to your mom’s friend’s cat.

  11. I wish I had this information earlier. I just lost my beloved Quentin 4 days ago at the age of 5. It was a quick unravelling of his life, I didn’t see the signs and will always wonder what if…..He went to sleep surrounded by love.

    • I’m so sorry about Quentin, Barbara. He was so young! I know it’s hard not to second guess yourself. I’m glad you were with him at the end.

  12. My Ms. Gabby went into renewal failure after trip we took. Not sure if the person we entrusted our baby to even showed up for 5 days. That and her companion if 14 years had past just months earlier and the pesky dig was boarded. So all alone she went into shutdown. We immediately took Gabby to the vet as she was lethargic and not eating. That was the beginning if a year if TLC and treatment. We injected fluids once a day and it broke my heart every time, but, it made a difference in the way Gabby felt so I was happy to do it.

    The one thing that made it easier? The fact that I talked my vet (finally) into give me an Rx for the lactated ringers fluid. Instead if paying $35-40 per bag, we filled it at Target for $5. That eased our financial woes somewhat and made the situation a lot les stressful.

    I hung an “s” hook on a drape rod and left the “watering station” out and ready for administration. Left her favorite cozy cushion on a table close by so it wasn’t only for the water treatment. A long long tube was also extremely helpful for those times Gabby just didn’t want to be in the offending area. I mean, who could blame her, she knew she was fixin’ to get stuck, sometimes that just isn’t fun at all!!

    Gabby was a trouper! We kept the fluid regime up for nearly a year and she thrived. One day, she looked at me, and the look let me know that she was ready to relinquish her 9th life. One of the most heartbreaking looks I’ve ever experienced.

    Actually, the best advice is…if your pet gives you that look, that look of “I love you but please let me go” let her go. You have done what you could and now you have to stop being selfish and let your baby stop suffering. Hardest thing you’ll ever have to do. God Bles our furry friends. =^..^=

    • I’m sorry about Ms. Gabby, Laurie. It is heartbreaking when we have to let go. It’s such a cliche, but I believe that it truly is the greatest gift we can give our cats in the end.

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