Aging and Feline Chronic Renal Failure (CRF) or Chronic Kidney Disease (CKD)

By Larry Jelinek

One of the chronic diseases showing up in the aging cat is Feline Chronic Renal Failure (CRF) or Chronic Kidney Disease (CKD). Unlike acute renal failure which abrupt shutdown of kidney function, the chronic disease is slower progressing. Cats are high protein consumers and as they age the kidneys are no longer able to process the waste products of this diet. As kidney nephrons which filter out waste products and electrolytes begin to die off blood levels begin to rise. Outward signs of the disease are not presented until the deterioration is advanced; so early detection is the best prevention. Key indicators of CRF are Creatinine and BUN (blood urea nitrogen), which can be diagnosed through blood work. Aging felines should be given a seniors blood test panel early on to diagnose any emerging problems.

Once the condition is detected early intervention can forestall the disease and add years to the cat’s life. Diet is the first intervention, switching to a low protein formulated food; and here I also stress the need to change to a wet diet as dry kibble competes with hydration. Access to plenty of fresh water is also key. There are veterinary CRF diets available and palatability is a key factor to encourage the cat to eat. I have found that Neo Hi-Tor is a retailed diet with high palatability.

Another early intervention can be the use of Rubenal an herbal aid to healthy kidney tissue which is marketed by Vétoquinol obtained in Canada and the U.K.

As the disease advances Azodyl marketed by Vétoquinol in the U.S., Canada, and U.K. contains just 3 varieties of "good bacteria", or what is referred to as probiotics, (also found in organic yogurt) specifically E. thermophilus (KB 19), L. acidophilus (KB 27), and B. longum (KB 31), along with some Psyllium husk. The use of Azodyl can lower blood levels of Creatinine and BUN up to 20% which is significant when these levels are elevated. The Azodyl works as an enteric dialysis drawing out and “consuming” the Creatinine and BUN. In conjunction with the addition of canned, plain pumpkin to their food one should expect optimum results as pumpkin has also through research been shown to enhance the effect of probiotics.

In advanced stages frequent hydration using subcutaneous fluid therapy is vital in providing hydration and electrolytes. The use of sub-q hydration can be learned as a home therapy. The use of Normosol R with a fast drip line, 20 drops / ml and Terumo 18 gauge one inch needles is recommended. The frequency of hydration can be determined by your veterinarian. Administering sub-q fluids is not so daunting and can be easily learned. The cats are also surprisingly co-operative. My cats will lie still while the hydration is being done which usually takes only a few minutes to get in 125 cc. Another adjunct therapy is the use of Benazepril hydrochloride (an ACE Angiotension-Converting Enzyme inhibitor) such as Fortekor which is flavoured. Fortekor helps regulate kidney fluid pressures to ensure elimination. Cyproheptadine can also be used to deal with loss of appetite in cats with CRF. Its vital to maintain an optimum weight. Depending on the diagnosed deficiencies other supplements and medications may be required and prescribed. Be creative with obtaining medications and supplements using the internet to locate veterinary pharmacies and good pricing as the cost of treatment can be problematic for some. I have used a local pet pharmacy as well as pharmacies in the U.S. and U.K. to obtain medications and supplements at the lowest cost. My cats need Rubenal for their kidney disease. It's made in Canada and to get it here you need a prescription and with the filling fee and tax it comes to $40 Cdn. However, I order it via the net from a pharmacy in England and with shipping pay $28 Cdn. So here is a product that is manufactured in Canada, shipped to England, and then shipped back again and still costs less than buying it in Canada! Also get on good terms with your veterinarian to learn to administer sub-q’s yourself; and get the necessary supplies at cost.

Another consideration is treating infections in CRF cats. Time is of the essence when one is confronted with an infection particularly a urinary tract infection (UTI) which could progress up into the kidney if untreated. I have found that many oral antibiotics can cause loss of appetite through gastro-intestinal upset. Also a broad spectrum antibiotic is desirable. Convenia (cefovecin sodium) is a great therapy as only a single sub-q injection is needed with a release time of over three weeks.

CRF is a challenging disease but with early identification, good veterinary support and therapies, one can add years to your cat’s life.

Table of normal ranges of Creatinine and BUN:

Measurement

Normal Range (International)

Normal Range (USA)

Urea (BUN)

3.5 - 8.0 mmol/L

9.8 - 35.0 mg/dl

Creatinine

40 - 180 µmol/L

0.5 - 1.80 mg/dl

Below are a couple of very informative websites devoted to CRF:

http://www.felinecrf.org/

http://www.felinecrf.com/index.htm

In Memory of Rachel, Kate, Jessica & Timothy