Caring for a cat with kidney disease
My cat, Cleo, just died, and I feel utterly wretched, but one thing that brings me comfort is the fact she had a much longer life than anyone expected and I did everything I could for her. She had kidney disease (often referred to as CKD, Chronic Kidney Disease). You can’t cure CKD, you can only delay its progression. The kidney function decreases over time and the cat will typically start showing signs.
I’ve read stories online from other people whose cats had kidney disease over the years because I was dreading what it might be like when she got to end stage. Some of what we did directly went against advice you’ll typically get given by vets or random strangers online. All cats are different in some way. If you read up on the lifestyle of Creme Puff, the oldest recorded cat that ever lived (38 years!), Creme Puff’s owner did things you’d never dream of trying with your own cat. But I just thought it might be nice to write about what we did differently because whatever we did, it must have worked.
Cleo had stage 3 kidney disease when we got her. There are 4 stages of kidney disease.
Cats diagnosed at stage 2 have a life expectancy of 2–3 years.
Cats on stage 3 have a life expectancy of 18 months.
Stage 4 is 1 month max.
We had Cleo for 6 years and 11 months. We were told by every vet that ever did blood tests that she was at stage 3 the entire time. The amount of water she drank also suggested it was definitely stage 3. Cats with CKD drink a lot more water than usual. We had cups and dishes all throughout the house to encourage her to drink more water. We don’t know how old she was when she first got diagnosed. She could have been a record-holder for the longest a cat has lived with stage 3 kidney disease for all we know.
They told us when we first got Cleo that she couldn’t have treats. She needed a special diet of renal food only, which many brands do as a variety of flavours of wet food pouches and dry food, so its not as if they don’t have any choice at all. Cats with kidney disease need a low protein diet and must be fed renal food and are only allowed anything else very occasionally because their kidneys can’t filter toxins as well as a healthy cat. When we got her, they said it was okay to give her tuna every once in a while and to save it for when she needs medicine that she won’t take by other means.
The marker that vets use for the four stages of kidney disease is the creatinine volume in their blood.
Anything below 1.6 is stage 1.
1.6 to 2.8 is stage 2.
2.9 to 5 is stage 3.
Anything above that is stage 4, which is end stage.
These stages indicate how well the kidneys are able to filter out creatinine. Although the creatinine isn’t as clear cut as “we had a blood test, our cat’s creatinine was 5.1, therefore it is stage 4”. Sometimes Cleo would have blood tests with creatinine that high and we just had to alter a few things and it would go back down again at the next blood test. The creatinine level is a vague indicator of how things are going. A better indicator is your cat’s mood, how much they’re eating, what they weigh and whether they’ve changed their behaviour.
Cleo had a bad blood test in January 2022 that suggested stage 4 was on its way.
Here she is on a shed roof that same month.
The vet said cats on stage 3 are meant to be sluggish and lethergic, which Cleo wasn’t showing any signs of. The vets didn’t get it, but who cares? We have an active healthy cat, right? So there wasn’t really as much to worry about during that blood test. She was still acting normally, but it was a sign we had to change a few things. So lets walk you through the whole story of how we cared for Cleo.
We did exactly as advised for the first few months in 2018, just renal food, no treats, she was an indoor cat only. They said to keep her indoors because they were worried about her immune system. Cats with kidney disease that get sick are a cause for concern if they ever need to be given medicines that might put a strain on the kidneys and cause further damage. Just this summer when we she was in the hospital because of a particularly big blade of grass stuck in her throat, they had to keep her on a drip for a few days to bring her creatinine back down so they could sedate her for the operation to remove it.
She also had a weak heart. I remember trying to take her outside early on, just holding her, and her heart started beating faster and she wriggled out of my arms, ran to the front door and started scratching it to go back inside.
So that sounds like an indoor cat only, right? Well she did start investigating the back garden. Its hard not to. There’s a glass sliding door across the back of the living room, so its pretty hard for a cat not to get used to watching the pigeons and squirrels.
I opened the back door a few months after we got her and I went and sat on the lawn and watched her as she came up to the door to investigate. She looked over her shoulder, as if expecting to be told by someone to stay away, and then back at me. As if to say “really? I’m allowed?” I just sat there, and she cautiously came out and joined me.
I had these supervised garden sessions over the next few months, and she gained a lot more confidence and I trusted her to stay safe. She started vanishing behind the fence at the back. There’s a little patch of trees and bushes behind the garden that leads out onto a path next to a road, but she never went that far. She had her territory and I let her explore out the back. I only ever let her out the back because I was concerned about the cars on the road out the front. There was only one occasion where I saw her out the front. I was washing the dishes one day and saw a cat wandering outside the front and I thought “wait, that’s my cat!” I went out and got her. She looked confused and meowed at me, as if to say “how did I get out here?” Outside of that time, I only ever saw her out the back. Cats are territorial. They have their designated prowling areas.
The garden became hers. I think maybe part of the reason she lived so long was she got a lot of exercise. She was always jumping on the shed roof and running along fences chasing squirrels and frogs and birds. She loved it a lot. Every morning I’d wake up and she wouldn’t be meowing at me to give her food, she’d lead me to the door and insist I open it. I never let her out overnight. I always locked the door after giving her her dinner at the end of the day.
She slowed down towards the end of that first year we had her. We could tell she was sick because whenever you picked her up, she’d always wriggle really violently and leap out of your arms, but now she was floppy and let you hold her. This was around the end of November 2018.
They thought it was stage 4 because her levels were really high and she’d stopped eating. The rules with kidney disease are malleable: ideally you should give them the renal food, but its more important for them to eat something, so we gave her tuna for every meal because it was her favourite, and she did eat it. They gave her fluids, sent her home, but then something weird happened. She had diarrhoea for a few days, but she slowly got her strength back and made a full recovery. The vets called and said they found ecoli in her urine. Ecoli can be fatal to humans. This was a cat with stage 3 kidney disease. How she survived this I will never understand.
We still didn’t know if her kidney values were going to go down and she was really bony and thin, so to get her weight up we kept giving her tuna, and we also started giving her dreamies, basically cat junkfood, and she loved them so much. She looked like this by the end of January 2019.
We knew we probably should have, but we sort of just…never stopped giving her dreamies. She’d always do a little velociraptor-style sqwark around lunchtime when she’d usually get given them, the same noise when she wanted the door open for the garden. I think the fact she was so freakishly strong and really really wanted to live so she could go in the garden and eat dreamies and tuna was probably a factor in her long life. We knew they went against the guidelines but we always did these things because we thought it was better for her to have a good but short life instead of a long crappy one. Turned out she was allowed a long good one. Life is fair sometimes.
I’m not suggesting you actually do this with your cat for the record. What I’m saying is the ‘rules’ aren’t quite as clear cut as you might think.
And we basically just carried on like that until January 2022 when we had a periodic blood test, just randomly, you have to have them occasionally, and we were told the values were at stage 4. We noticed no difference in her behaviour at all, and they said that was a better marker of her health but that we probably had to stop the dreamies and exclusively feed her the renal food. So that was 3 full years of eating cat junkfood that she would never have been allowed under other circumstances.
We still gave her tuna once a week as a treat, and this post-dreamies phase lasted up until about the middle of the next year when the creatinine was high again. The vets also said her mercury was high and this was probably a result of the tuna, which was a real shame, but it had to be done. They also gave us this liquid thing called a ‘phosphate binder’ which apparently binds the phosphates in the food or something. She hated it so I didn’t give it to her very often because she wouldn’t eat and as they always said, its better for them to eat something than nothing.
She still loved the garden. She was still incredibly energetic for a cat with her condition.
It took all the way up until October 2023 for her next health scare. She stopped shitting. We weren’t sure what was causing it. The neighbours got a new dog. Could have been stress. Apparently she also developed hypocalcaemia. She was on a drip at the Royal Veterinary College for a few days and seemed to recover again. I was hoping for just another few months, but she just kept going. I think she wanted another summer with us, and she got it.
She stopped eating that much over the summer of 2024. She still liked her biscuits. I kept buying different types of renal food and trying her with new brands, putting water on the food so she’d end up drinking more water, putting her plates in different places. Emily said I was like a scientist trying to figure out the best way of keeping a cat with kidney disease going.
It was about June/July when we had another blood test and it showed the creatinine was at 5. Stage 4. She still wasn’t really acting differently, and she had another blood test a few weeks later that was 4.37, so we were still unclear what was going on and the value seemed to be going in the right direction. She still vanished into the garden occasionally. She was still enjoying life.
Then I noticed one day that she had stuck her head in the litter tray and was licking the cat litter. Apparently this happens sometimes for various reasons. Kittens get curious. Sometimes its because they’re deficient in certain nutrients. It can also be a sign of anaemia (which we now know is what this was). We replaced the clay litter she’d had for years with a wood based one and that stopped her doing it. Apparently the cat litter had high levels of calcium so maybe that was the cause of the hypocalcaemia? They did say at her last blood test the calcium level had come back down.
Then about August, she came back to the house one day making a choking noise. Lots of snot kept coming out of her nose. None of the sites said this was a kidney disease side-effect and it was pretty obvious she’d eaten a big piece of grass and got it stuck. We had to get her to the Royal Veterinary College again because our local vet didn’t have the kit to remove it. They were about to do it, but then they measured her creatinine levels and found it was 5.37. She was on a drip for a few days and her creatinine went back down to 3.75, which they were happy with, and they proceeded with the operation.
After a few days of recovery, she was back to her old self and more energetic than ever. During a remote personal training session, Emily had her tablet perched on the ironing board, and Cleo leapt for it for some reason and knocked it off. The last thing her trainer saw before it disconnected was a massive angry cat face.
That was around the time she started having problems jumping. I thought maybe she’d hurt herself during that incident. She’d get skittish at jumps she’d made easily before and had to be picked up. I once saw her haul herself up the scratching post next to the ironing board with just her front legs because she couldn’t make the jump. At the time, the vets theorised that since she was getting older it might be arthritis. Now, I’m pretty sure I know what it was (answer later).
She still kept going. She spent most days on the radiator. We thought maybe it was because it was warm and she was usually fairly inactive in winter. The last week in November, I noticed that more and more biscuits would be left uneaten in her bowl. She wasn’t really eating any of the wet foods I tried. I also noticed her breath stank, and that’s one of the key things they say to watch for with kidney disease.
I kept swapping the foods, seeing if she was just bored by them. The last Sunday, she didn’t eat anything or drink anything. I kept trying, but she just stayed there. I gave her a bit of tuna and she did eat that so that eased the anxiety a bit. We found some crusty stuff on her teeth so we tried to kid ourselves it was tooth infection.
We arranged a vet trip for the next morning.
Then on the Monday morning, I was woken up by the sound of her in the sink. I rushed downstairs and found her trying to move some plates that had been left in the sink. She kept doing her sad meow at me. I turned the tap on and she lapped it, but she struggled to get her head in place to get a constant stream of water. When I left for work, Emily said she jumped in the shower with her to get water, which was very unlike her.
At the vets, the bloods said the creatinine was 8. Off the charts high. They said they’d put her on a drip all day and see what happened, but they had to send her home because we don’t have a 24 hour hospital at our local vet. We got her back at the end of the day with the suggestion we get a referral to Royal Veterinary College the following day. She was so tired and floppy she could barely sit down properly. I had to hold her dish of water next to her face while she lapped it, and she could barely do that, she kept letting her face fall into the water. She was really uncoordinated. Maybe it was the sedatives they gave her? We didn’t know, but all I knew was that none of this felt right.
Royal Veterinary College managed to get the creatinine back down to around 5 but it was pretty clear she’d hit stage 4 in her kidney disease. They also found she had a kidney stone blocking the path of the urea which might have explained why it went so high. Apparently kidney stones that cause blockages like this cause high levels of pain in the abdomen which probably explained the jumping issue because her front legs were fine, her back half wasn’t. At the same time, she really wasn’t showing any other signs of pain and she got the jumping back for a while so we weren’t any the wiser. They said they could potentially do an operation to install a tube to bypass the blockage, and they would have done it immediately because it can be quite dangerous, but because she was almost certainly on stage 4, they also weren’t sure how long the stone had been there and whether it was the cause of this sudden downturn, and they wanted to see how she did on fluids. They were also unsure a cat on that stage of kidney disease would survive invasive surgery.
The next day, the vet that was taking care of her said she was withdrawn and she lost the ability to control her own body temperature. She brightened up when they put her in an incubator and her levels were coming down, but it was clear she wouldn’t keep going without the drip, incubator and all the strong pain relief medications they were giving her.
The thing that scared me so much about the constant threat of stage 4 kidney disease was what her life would be like with it. I kept googling ‘cat stage 4 kidney disease’ and specifically looking for how long people’s cats lived with it, and some people reported their cat living on stage 4 for surprisingly long amounts of time, but these stories never seemed to mention what their cat’s life was actually like with stage 4 with strong meds and fluid drips occasionally, some of which could be done at home. Could a cat on stage 4 still go outside? Could they still run, jump, play? How much food did they eat? I didn’t want to keep her going like that just for our sake if she was going to be hating every minute of it.
I was dreading it, kidding myself that maybe the operation would be viable, but it was clear it wasn’t. We couldn’t even wait another day because she was deteriorating so rapidly and we owed it to her to be with her when she went. I knew it would happen eventually, cats aren’t exactly immortal, and my biggest fear was she would go on an operating table and we’d get the call saying “sorry she didn’t make it”.
Me and my partner both agreed at pretty much the same time to make the euthanasia call. She was only going to get worse and it wouldn’t be right to have her suffer on for our sake. She died surrounded by people that loved her, and she purred as she left us.
And that’s our story with Cleo. I’m not saying if you do what we did then your cat with kidney disease will live as long as she did or if you don’t then they won’t. This is just our story. Like with Creme Puff, sometimes something you’d never dream of doing ends up working and so you keep doing it. I think the reason Cleo lived so long was we always did whatever was in her best interests and she loved us and knew that we loved her. That’s all that matters.
