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Management of CRF

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Dietary Management

Food:

Your veterinarian may prescribe a low protein/low salt/low phosphorus diet for your CRF cat. This diet is designed to reduce the amount of waste materials in the system that must be filtered out by the kidneys. The low salt and low phosphorous help control the electrolyte imbalances that are common with CRF. While there is no cure for CRF, this diet may slow the progression of the disease.* CRF cats sometimes have a difficult time eating any foods because they tend to secrete excess stomach acids. Since these foods are often less palatable than the commercial foods, you must be patient and persistent in your efforts to get your cat to eat the prescribed diet.

Some cats may eat some or all of these foods, but many cats absolutely refuse to eat any. DO NOT starve the cat. If a cat doesn't want to eat, it WON'T. Remember that it's most important for them to keep food intake and body weight up. When introducing a new low protein diet, start by gradually increasing the new food and decreasing the old. This procedure could take anywhere from a week to a month depending on how finicky your cat is. If your cat doesn't like a dry version of the new diet, try the canned and vice versa.

*There are varying opinions in the veterinary community as to whether low protein food is effective in the management of feline CRF. Some experts believe that any benefit from eating low protein food may be from the lower content of phosphorous contained in the food rather than the low protein itself. Furthermore, some believe that a low protein diet contributes to weakness and muscle wasting, two very common symptoms in CRF cats.

Because protein metabolism residue (that the kidneys must filter) is what you are trying to eliminate, high quality protein that produces little waste may be preferable to simply reducing overall protein. For more information and both pros and cons regarding this subject, click on the links below:

You may eventually reach a point in the CRF progression when an appetite stimulant is necessary. Your cat doesn't feel good and doesn't eat. Not eating makes the cat feel even worse. When giving an appetite stimulant, it will probably be necessary to experiment with dosage. Too little may not work at all and too much may result in the cat being wobbly and/or confused. NEVER give a larger dose than your vet prescribes. Give the appetite stimulant prior to feeding. If appetite stimulants don't work, CRF cats may have to be temporarily force-fed, usually by implanting a tube into the stomach, or by liquefying food and hand-feeding with a syringe.

Special diet foods
The following foods are low protein/low salt/low phosphorus foods.
  • Hi-Tor Canned Neo-Diet Feline Canned Kidney Diet -
    Waggin Tails 1-888-763-2738
    • Restricted protein level to reduce the strain on the kidneys.
    • Calories are derived from high quality fats and carbohydrates.
    • Reduced levels of sodium and phosphorus.
    • Highly palatable in order to ensure adequate consumption and caloric intake.
  • Hill's Prescription Diet Feline k/d for the Nutritional Management of Cats with Kidney Disease (dry) 1-800-445-5777 from 8 a.m. - 5 p.m. CST, Monday-Friday, available through a veterinarian's office.
  • Hill's Prescription Diet Feline k/d with Chicken for the Nutritional Management of Cats with Kidney Disease (canned) 1-800-445-5777 from 8 a.m. - 5 p.m. CST, Monday-Friday, available through a veterinarian's office.
    Note: We apologize if our Hill's links fail. Hill's frequently changes the urls for their prescription diets. If these links do not work, go to the Hill's homepage and look in their prescription diet area. 
  • Medi-Cal® Feline Reduced Protein is specially formulated for cats with advanced kidney disease, chronic liver disease and heart failure. It helps prevent the formation of calcium oxalate and metabolic urinary crystals and stones.  Dry and canned, available through a veterinarian's office. - Royal Canin Veterinary Diet.
  • Royal Canin Veterinary Diet - Renal LP 21 (Dry) and Renal LP (Pouch) For the Management of Chronic Renal Failure in Adult Cats  1-800-592-6687, Monday - Friday 7:30 am - 5:00 pm CST, available through a veterinarian's office.
 

More special diet foods:

The foods in this list, while not formulated specifically for CRF cats, may be prescribed by your vet as a useful adjunct to your cat's diet regimen.

  • Hill's Prescription Diet Feline g/d for the Nutritional Management of Older Cats, (canned and dry) 1-800-445-5777 from 8 a.m. - 5 p.m. CST, Monday-Friday, available through a veterinarian's office.
  • Prescription Diet® a/d® Canine/Feline Critical Care - This food is sometimes prescribed by vets on a temporary basis for weight gain in CRF cats. It is not for long term use. 1-800-445-5777 from 8 a.m. - 5 p.m. CST, Monday-Friday, available through a veterinarian's office.

Commercial foods

If your cat refuses to eat the above foods, do some research, read ingredient contents and compare protein contents on commercial foods. Canned foods appear to be lower in protein because the protein is expressed as a percentage of the total weight which includes water. Most commercial cat food companies have 800 numbers on their cans and can be contacted for complete nutritional listings of their foods rather than the general label listings on the food cans, which may not include phosphorus content. They are all helpful and willing to provide information. Some commercial foods are lower in protein, salt and phosphorus, so it's worth researching if your cat won't eat the special diets.

Baby Food

Some of our visitors have written that they have used baby food to encourage their CRF cats to eat. We have been very reluctant to add baby food to our Dietary Management page because the formulation of baby foods is not nutritionally correct for cats and may actually be dangerous to cats if the foods contain onion. See the warnings, below.

In light of the inadequacies of baby food as a substitute for cat food, we can only suggest its use in those cases where the cat has ceased to eat anything else at all. Please read the warnings and discuss them with your vet before feeding any baby food to your cat.

Warning: Regular cat food has been formulated to include essential ingredients that cats need. Baby food does NOT contain these essential ingredients. One of these VERY ESSENTIAL ingredients is taurine.

Warning: Make absolutely certain that the baby food you feed your cat DOES NOT contain any onion powder or onion salt. The smallest amount of either of these two ingredients may induce anemia in a cat (or a dog). Check the labels on the baby food and call the 800 numbers for confirmation of ingredients.

For additional information about onions and cats, please click on these links:

Treats

While treats shouldn't really be given in the early stages of CRF, you may reach a point when you think the cat deserves some enjoyment regardless of the consequences. CRF cats are generally having a tough time with sub-Q fluids, medications and foods they don't like and need some joy in their lives. An occasional treat is not going to make that much difference during later stages of CRF.

  • Royal Canin Veterinary Diet - ROYAL CANIN Veterinary Diet™ feline Treats are designed as a palatable reward for good behavior and to enhance the bond between the cat and the owner.

Tips for Getting Your Cat to Eat:

  • Warming the food in the microwave for a few seconds to room temperature or slightly warmer may make it more palatable (i.e. strengthen the aroma) to the cat.
  • Mix different low protein foods together. You just might hit on the right combination.
  • Mix dry foods together (one the cat likes with a low protein food). Place them in a closed container for a period of time. The scents mix together and your cat may be enticed into eating the low protein food.
  • Mix combinations of canned low protein food and canned commercial food together.
  • To improve flavor, mix:
    • water
    • tuna juice (salt-free and packed in water only, not vegetable broth which may contain onions)
    • clam juice
    • low-salt chicken broth (without onions)
    • beef broth (without onions)
    • with any of the foods.
  • It's a good idea to mix a little warm water with the food at any time because every little bit of fluid helps. Do not use bouillon as it's too salty
  • Cats won't eat what they can't smell. Try putting a couple drops of oil from a can of anchovies on the food to increase aroma.
  • Sometimes cats can be coaxed to eat. Talk to the cat, stroke the cat, sit with the cat, then offer a plate of food and wait or try to hand-feed.
  • Try placing food on the cat's paws or mouth to 'jump-start' the cat.
  • Ask your veterinarian or check pet supply catalogs for flavor enhancers which can be sprinkled on food to entice the cat to eat.
  • To keep food fresh and palatable, feed small amounts at frequent intervals, particularly if your cat is a 'nibbler'.
  • If your cat likes 'people tuna', you can try mixing tuna and water in the blender to make 'tuna water' to mix with other foods.
  • Try mixing a tiny bit of catnip with the food.
  • Experiment and be creative.

Feeding Tubes

Some Feline CRF caregivers have reported success with the use of feeding tubes. There are several different options which can be discussed with your vet and a description of each can be found at this Web site: http://www.lbah.com/Feline/ftube.htm Although feeding tubes do make it possible to provide nutrition when a cat won't eat, these devices will not prevent vomiting and nausea. In addition, the insertion of some feeding tubes requires anesthesia, an added risk for a cat with advanced kidney failure.

These web pages provide helpful information on the use of feeding tubes and PEG tubes:

Water

While it's important that all cats have fresh water daily, it is crucial that CRF cats have access to fresh water continually. It's advisable to have at least two bowls of fresh water located in different areas of the house for your CRF cat.

Standing water tends to get warm and stale and can gather bacteria, dust and small flying insects even when the water is changed and the bowl is washed every day. You might consider investing in a filter for your water faucet or an automated waterer for your cat which will deliver continuous, fresh, filtered water. This may encourage your cat to drink more water than it would from a regular water bowl. While we are not affiliated with any companies that manufacture waterers, we have been told (both by vets and CRF caregivers) that cats seem to prefer fresh flowing water and that water consumption increases when using an automated waterer device.

Some cats drink from spigots and toilet bowls. If your cat drinks from the toilet, PLEASE make absolutely certain that you are not using any toxic cleaners or toilet bowl deodorizers, etc.

Because CRF cats tend to have upset stomachs, water at room temperature is usually preferable to cold water although some cats prefer ice water. Cats drink more water when they eat dry food and they drink more when the weather is warm. There is no set amount of water for a normal cat to drink each day. More than six to eight ounces per day is usually considered excessive for a normal cat. CRF cats may drink more than this daily.

Vitamins

As long as your cat is eating the proper food, it shouldn't be necessary to supplement, at least in the early stages of CRF. But, since CRF cats urinate frequently, they may be losing water-soluble vitamins, including Vitamins B and C, especially if they are also having trouble eating or keeping their food down. There are a wide variety of multivitamins available, in tablets and liquids. Tablets can be ground into a powder and sprinkled on food. If you do decide to give your cat vitamins, always consult with your veterinarian first for recommendations as to type and brand that are suitable. Cats can overdose and even die on vitamin supplementation.

Food Recall Bulletin

Click here for links to information about pet food recalls

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