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Monday, February 1, 2016

Hurdle inappetence in cats with renal disease with a multifaceted approach

Navigating chronic kidney disease, or CKD is it's commonly referred to, is a journey sometimes fraught with challenges. In my experience, inappetence is the most common barrier in keeping things on track with managing a good quality of life for kitties with renal issues. 


Most felines with CKD experience a disinterest in food from time to time and it's nothing to be terribly worried about so long as it comes back within a day or so. Beyond that, you need to act fast so it's important to be vigilant about how your cat is behaving, and what other symptoms might be presenting. This helps to get to the root cause so that those things can be addressed and allow kitty to make friends with food again.



Common causes of a waning appetite in cats with renal insufficiency

Nausea, vomiting and excess stomach acid can all be culprits in suppressing a cats willingness to eat, on their own or in any combination. It's important to think outside the box though, as they can also be an indicator of other problems associated with renal insufficiency.

Nausea is hard to detect, as it may only manifest as a poor appetite. A cat may also appear uncomfortable, scrunched up, licking their lips or hunching oddly over their water bowl. 

Vomiting is not uncommon with CKD. Whether it's vomiting up a clear or white foam (a sign of excess stomach acid), or stomach contents, this can not only suppress appetite but contribute to dehydration. 

Excess stomach acid often accompanies CKD, and can make a cat less willing to eat.

Nausea can be mitigated by raising the feeding dishes slightly so that any acid reflux is minimized and feeding frequently so that the stomach doesn't stay empty for too long (that often increases the likelihood of excess stomach acid). Consider offering some food during the night as well. Anti-nausea meds prescribed by your veterinarian can be an option too, and work well to ease any discomfort. These drugs are usually given on a short-term basis. 

Your veterinarian can prescribe medications to reduce any excess stomach acid, and are usually given once per day. Compounded into a suspension, they are easy to administer.

An elevated phosphorus level is a familiar culprit when it comes to a poor appetite and is measured by doing bloodwork (just as other crucial markers like BUN and Creatinine are). Many commercially-available diets contain phosphorus levels that are not ideal for CKD cats, so a renal diet – low in phosphorus, for one thing – prescribed by the vet is par for the course. Unfortunately, a lot of cats are not fond of renal formulas, but will more readily accept their favorite standbys. To get around the problem, a phosphorus binder can be used. As the name suggests, these products – which are sprinkled on wet food just before serving – bind to the phosphorus in the food, keeping it from entering the blood. Instead, it's carried through the digestive tract and out with the stool. Helpful in bringing the phosphorus level back into a safe range, and a good appetite with it, these products are safe when used under the direction of a vet. 

Constipation can be an unfortunate fact of life with renal kitties. With the insufficient fluid level in the intestines, stools can become hard and difficult to pass, if it's possible at all. If your pet has not had a bowel movement or is straining, it's necessary to contact your clinician as there may be a blockage. Sometimes punctuated by inappetence or vomiting, this can be treated but it needs immediate attention. Constipation can be avoided with prescribed daily medication, which can help draw fluid into the bowel.

Dehydration comes with the territory in renal disease. If your cat isn't already getting sub-q fluids, your vet is most likely going to talk to you about administering those at a rate and volume that is appropriate for your pet. Fluids are a great way to help with hydration and getting the kidney values in check, and ultimately, the appetite.


Other considerations in encouraging an optimal appetite


Variety: There are plenty of choices with cat food, but what you might not know is that there commercially available foods that are on a 'low phosphorus' list (click here to get that). Even with prescription renal diets (brands like Purina, Hill's and Royal Canin), there are options: pate and stew-styles in canned food and in dry, Royal Canin offers kibble in different shapes to please picky cats. Don't be afraid to try different ones. Baby food is an old standby to spark interest in eating, as is Fancy Feast.

(Pro-tip: If your veterinary office doesn't carry several brands of renal food, ask them to write a prescription so that can be taken to a larger veterinary facility that does. You might even be able to get sample packs of dry prescription food from them for a small fee to try out on your cat which can save a lot of guesswork and money.)

Texture and temperature: Most cats have a preference for pate, but commercially-available canned food also comes in shreds, chunks and stews and what is appealing to one cat isn't necessarily to another. If your cat likes an even smoother texture, you can mush up a pate with a fork with little effort. You might consider blending in a little hot water to thin out the mushed food even further. Also, the temperature of canned food can affect how your furry friend feels about diving into a meal. Leftover food stored in the fridge can benefit from a few seconds in the microwave – just test it with your finger to check for any hotspots. 

Location: When a client notes that their pet has a diminished appetite, I often recommend that they try setting out multiple food dishes – yes, even a variety of food – throughout the house to make it convenient for their furry friend to eat. Some CKD cats have low energy, and this can make it easier for them to access the food, too. Remember to keep a safe distance from the litter box. Cats like a clean dining area.

Dishing it up: Cats often have sensitive whiskers, and flat or shallow feeding dishes can mitigate any unpleasant sensation they might otherwise experience. Glass, ceramic and aluminum dishes are an ideal choice. Plastic can harbor bacteria and odors that cats find unpleasant. (Ditto for water dishes – try a glass pie dish.) 

Heighten the senses: Offering catnip a few minutes before feeding can boost a cat's willingness to chow down. 

The buddy system: It's my experience that most cats appreciate a little company while they dine. I usually plop down on the floor and talk to my own cat, Silver, as well as my charges during mealtimes, which seems to encourage a heartier appetite. You might even try brushing them gently if they pause or seem disinterested if they like that sort of thing.

Drowsy dining: A strategy that I have tried with Silver is to offer up a little warmed food the minute he rouses from a deep sleep. With him feeling really comfortable and his mind not firing on all cylinders, he will sometimes go for a few mouthfuls of food.

Enhancements: A little extra help with boosting taste can be useful. An older kitty's taste buds might not be as keen as they once were, so try sprinkling a little Parmesan cheese atop or add a little fat free/low sodium stock, tuna or clam juice to canned food.

Prescription appetite stimulants: Though there can be side effects to these drugs, they are very helpful even in low doses. In my experience, they work within hours and the effects last for days. In some cases, only one dose is needed to jump start the desire for food. Your vet may decide that this approach is a good one.


A final word 

Managing chronic kidney disease in cats – especially when it comes to poor appetite – is most successful by having ongoing communication with your vet and following their recommendations. No two cats are the same and depending on their respective health issues, treatment regimens can vary.


Lorrie Shaw is a freelance writer and owner of Professional Pet Sitting. Shoot her an email, contact her at 734-904-7279 or follow her adventures on Twitter.


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