FAQ: Nutrients

Feline Chronic Kidney Disease

Feline Chronic Kidney Disease

Chronic kidney disease (CKD) is a common, progressive, and irreversible condition that affects a substantial proportion of aging cats. The disease is associated with a gradual loss of functional nephrons, resulting in decreased renal filtration capacity and the accumulation of nitrogen-containing metabolic waste products (uremic toxins). Although there is no cure for CKD, early diagnosis and appropriate, evidence-based management can help slow disease progression and support quality of life in affected cats.

This FAQ section addresses common questions related to chronic kidney disease in cats, with a primary focus on nutritional management as a cornerstone of care. It also explores common feeding challenges and highlights the importance of maintaining adequate hydration, key considerations when managing cats with CKD.

TABLE OF CONTENTS

Defining, Detecting, and Staging

How do you define chronic kidney disease in cats?

Chronic kidney disease in cats is defined as abnormal kidney structure or function, or both, that has persisted for at least 3 months.1,2 Regardless of the inciting cause, chronic kidney disease results in the progressive and irreversible loss of functional nephrons and, as a result, renal function. Over time, glomerular filtration rate declines, resulting in accumulation of phosphorus and nitrogen-containing waste products in the bloodstream which, in turn, leads to systemic complications.3,4

How common is chronic kidney disease in cats?

Chronic kidney disease (CKD) is one of the most common metabolic disorders in cats, particularly in mature adult and senior cats, although the prevalence varies considerably with the population and diagnostic criteria. Studies conducted in the United States and Europe have reported an overall prevalence of 1% to 3% in the general cat population, but CKD may exceed 30% in senior patients.2,5

What are the early signs of kidney disease in cats?

As cats age, the first potential indicator of chronic kidney disease (CKD) may be decreased urine specific gravity. Abnormalities in symmetric dimethylarginine (SDMA) may also be seen. However, clinical signs associated with chronic kidney disease typically develop late, when kidney function is already substantially compromised.3 The most common clinical signs of CKD include polyuria, polydipsia, weight loss, anorexia, and lethargy.6,7

What are common clinical signs of chronic kidney disease in cats?

Clinical signs of nausea, vomiting, and dysrexia are common in feline patients with chronic kidney disease (CKD), according to Dr. Jessica Quimby of The Ohio State University.8 Weight loss and loss of lean body mass, which can be seen in these patients, are likely attributable to changes in appetite as well as processes such as cachexia and sarcopenia. Therefore, serial evaluations of nutritional status are a key part of CKD patient management, and a proactive nutritional plan should be created for every patient.

Other common clinical signs of CKD in cats are polyuria, polydipsia, and lethargy.

How do you diagnose chronic kidney disease in cats?

To diagnose chronic kidney disease in cats, veterinarians primarily look for persistent elevations in serum creatinine and inappropriate decreases in urine specific gravity (< 1.035) over time.1 Abnormalities in symmetric dimethylarginine (SDMA) may also be seen. These findings should be supported by the presence of clinical signs; physical examination findings; routine urinalysis, serum biochemistry, and hematology; systolic blood pressure; and imaging.1,2

When and why do you stage CKD?

After diagnosing chronic kidney disease (CKD), Jessica Quimby, DVM, PhD, DACVIM (Small Animal Internal Medicine) stages the disease using guidelines from the International Renal Interest Society (IRIS). Staging occurs when the cat is stable and hydrated, and uses creatinine and symmetric dimethylarginine (SDMA) values measured at least twice. Staging is not done to diagnose chronic kidney disease but is performed after confirming CKD. Substaging is based on the presence or absence of hypertension and proteinuria.

Staging and substaging CKD help guide patient management. A cat with stage 1 CKD would appear healthy but needs additional considerations for anesthesia and medications. Veterinarians need to be aware that the kidneys might be less able to respond to insult and want to minimize further harm to the kidneys. Staging and substaging also provide an indication of prognosis.

What is the value of monitoring fibroblast growth factor 23 (FGF-23)?

In a patient with a serum phosphorus level within International Renal Interest Society (IRIS) target ranges, fibroblast growth factor 23 (FGF-23) can help determine whether additional phosphorus restriction is needed. If circulating FGF-23 is low, additional phosphorus restriction may not be necessary. However, high levels of FGF-23 are a reason to move a patient to a diet with less phosphorus relative to the current diet. IRIS treatment recommendations include guidance on using FGF-23.9

 

References

Role of Nutrition in CKD Management

What factors do you use when making dietary recommendations for a cat with CKD?

Getting a full dietary history from the pet owner is important. That history, along with the severity of disease and knowledge of any underlying or predisposing factors, affect dietary recommendations.1

For example, a cat with early chronic kidney disease (CKD) that is currently eating an all-life-stages diet with higher levels of calcium and phosphorus may do very well when switched to a diet that has lower mineral levels, specifically phosphorus. Many nontherapeutic diets can be a reasonable first step. However, if a cat has more severe disease and is already eating a diet containing a more conservative level of phosphorus, a therapeutic renal diet would be recommended.

While avoiding excess, feeding a diet with high-quality, highly bioavailable protein can help preserve lean muscle mass.

Whatever diet is chosen, one of the most important points is to reevaluate and reassess the patient. Make sure that the pet owners are in agreement. Whatever therapy, nutritional or medical (or both), monitor whether it is helping and is necessary. Monitor phosphorus levels.

What are the goals of dietary management of chronic kidney disease?

At any stage of renal disease, the objectives of dietary management are to meet the cat’s overall energy and nutrient needs, slow disease progression, reduce signs of uremia, address changes in homeostasis that result from inadequate kidney function, and improve quality of life as well as life span.2–4

Nutrition should be tailored to the individual cat’s needs and response to management.5 Individualizing the nutrition plan helps address weight loss and loss of lean body mass (LBM), or if the cat has not lost weight or muscle mass, helps maintain body condition and muscle condition.

Why are therapeutic renal diets recommended for cats with chronic kidney disease?

Several studies have documented the therapeutic value of feeding a renal diet in the management of feline chronic kidney disease (CKD). In addition to providing needed nutrients, therapeutic renal diets are formulated to improve CKD mineral bone disorder, decrease incidence of uremic crisis, and increase survival.6–8 Feeding a renal diet also decreases fibroblast growth factor 23 (FGF-23) concentrations, a biomarker that is positively correlated with disease stage.7 However, the failure of the patient to eat the diet negates the benefit of dietary management, and therefore a key therapeutic target for these patients is the maintenance of appetite and food intake.

How can nutrition be included in medical plans for CKD in cats?

Serial evaluations of nutritional status are a key part of CKD patient management, and a proactive nutritional plan should be created for every patient. A nutritional assessment should include body weight, body condition score, muscle condition score, adequacy of caloric intake (including open-ended questions about how the pet is eating), and a complete dietary history (including pet food, treats, supplements and items used to give medications). A nutritional plan is important in feline CKD because low body weight and decreased body condition are associated with a poorer prognosis.7 Additionally, appetite is perceived by caregivers as a significant aspect of quality of life.9

What key nutritional factors need to be considered when selecting food for a cat with CKD?

Key nutritional factors include phosphorus, protein, potassium, omega-3 fatty acids, and alkalinizing buffers. 

Therapeutic renal diets favor better clinical outcomes and can extend life span in cats with moderate to severe CKD when compared to feeding adult maintenance diets.6,10–12 The modifications to therapeutic renal diets typically include reduced phosphorus and protein, and added alkalinizing agents, potassium, omega-3 fatty acids, and antioxidants.2,10–15 

How can progression of chronic kidney disease in cats be slowed?

Dietary modification is a cornerstone of feline chronic kidney disease (CKD) management and central to slowing disease progression. Therapeutic diets are formulated with controlled protein and restricted phosphorus to reduce renal workload and phosphorus burden. Beyond these primary modifications, diets for cats with CKD may also be designed to provide increased caloric density, restricted sodium, balanced potassium, and an alkalinizing buffer to minimize acidosis. Some formulations additionally include supplementation with B vitamins, antioxidants, and omega-3 fatty acids to help support metabolic needs and overall kidney health.2,10–16

 

References

Feeding Challenges

What feeding challenges are associated with CKD in cats?

A poor appetite and weight loss are common in cats with chronic kidney disease (CKD), making nutritional intervention crucial to successful case management.1–3 Appetite and fluid intake may be depressed due to nausea from circulating uremic toxins, electrolyte imbalances, and metabolic acidosis.4 Although a poor appetite is more likely as CKD progresses,4–6 weight loss has been reported months to several years before diagnosis.2,7 Body condition and muscle losses significantly impact mortality, underscoring the need for nutritional intervention.1,2

How should a cat with CKD be transitioned to a therapeutic diet?

The transition to a therapeutic renal diet should be done gradually over 2 to 4 weeks.4,8 The exact protocol will depend on the individual cat. Some will rapidly accept the new diet, while others need a slower transition. 

Screening and early diagnosis of older pets for renal disease allow for transitioning to an appropriate diet prior to the onset of nausea and other clinical signs. A hospitalized or otherwise stressed pet should not be transitioned to a therapeutic diet as doing so may lead to development of a conditioned taste aversion.4,8 

To reduce stress, particularly in cats, renal diets should be provided in separate bowls and wet and dry foods should not be mixed together.8 To maintain intake, cats may need to be offered a variety of foods and forms on rotation.4,9 If the pet will not eat a commercial renal diet, a home-cooked renal diet formulated by a veterinary nutritionist is another option.5

What strategies may help increase food intake in cats with CKD?

Ensuring adequate energy intake is a crucial part of nutritional management of any disease, including chronic kidney disease (CKD).4,5,10  Nausea associated with feline CKD can often affect a cat’s appetite, and strategies for diet acceptance are often needed for these cats.11 Consider the following strategies to encourage cats to eat:

  • Address nausea and inappetence with appropriate medications.4,12
  • Utilize palatability enhancers.4 Added calories that are not complete and balanced should account for no more than 10% of daily calories.
  • Provide small meals frequently.4 Gently warming wet food to body temperature heightens aroma, which may stimulate appetite.
  • Clean food bowls frequently.
  • Feed in an easily accessible location separate from other pets.4
  • Hand feed, provided it does not stress the pet.

If cats cannot be enticed to eat an appropriate amount of renal diet with medical management, then a feeding tube should be placed.4,9 If that is not possible, feeding a senior food with controlled phosphorus and monitoring of blood phosphorus and FGF-23 to determine if a dietary phosphate binder is needed are recommended. This is not ideal as all over-the-counter diets must meet minimum requirements for phosphorus, a level higher than recommended for CKD.

Why are strategies needed to improve diet acceptance in cats with chronic kidney disease?

Medical problems associated with feline CKD such as nausea often affect appetite, and strategies for diet acceptance are often needed for these cats.11 To encourage cats’ food consumption and help owners adhere to veterinary diet recommendations, researchers with Nestlé Purina PetCare studied feeding strategies with the aim to enhance appetite and to provide cats with CKD a pleasurable eating experience.

Purina researchers observed that while dry food was available, cats with CKD continued to eat wet food throughout the day, even after the wet food became dry and cold. They also showed that feeding wet food more frequently (3 times a day vs. once a day) increased wet food intake while maintaining dry food intake. Therefore, it is recommended to feed cats with CKD a small amount of wet food multiple times per day to keep the food fresh and more attractive.13

In addition, feeding wet and dry food side by side, not mixed together, increased the amount of wet food consumed, compared to feeding wet and dry food separately at different times of the day. 

Finally, Purina researchers found that cats with CKD appreciate options. Presenting a variety of diets simultaneously, such as providing both wet and dry options appropriate for cats with CKD, stimulates more food intake compared to offering one type of food at a time.

What are specific examples of feeding approaches we can take with feline CKD patients?

There are several different approaches that can be easily adopted at home to help increase daily calorie intake and improve cats’ mealtime enjoyment:

  • Feeding wet food more frequently (e.g., 3 times a day vs. once a day) can increase wet food intake while maintaining dry food intake. Therefore, it is recommended to feed cats with CKD a small amount of wet food multiple times per day to keep the food fresh and more attractive.
  • Feeding wet and dry food side by side (but not mixed together) may increase the amount of wet food consumed, compared to feeding wet and dry food separately at different times of the day.
  • Presenting a variety of diets simultaneously, such as providing both wet and dry options, stimulates more food intake compared to offering one type of food at a time.
  • Warming up wet food to room temperature (around 70 °F/21 °C) or slightly higher (up to 100 °F/38 °C) before feeding can help stimulate appetite. This feeding strategy is especially effective for classic pâté diets.
  • Mixing pâté diets with warm water and stirring to ensure the texture is homogenous can elevate the temperature to increase food consumption and provide hydration.
  • When warming the food or mixing with warm water, it is important to ensure that the temperature is not too hot and is evenly distributed throughout the portion (i.e., no “hot spots”), especially if using a microwave.

 

References

Importance of Hydration 

When is increasing water intake indicated for cats?

Encouraging water intake can be useful for the health of all cats, but is particularly important for cats with specific medical conditions, including:

  • Feline lower urinary tract conditions such as urolithiasis
  • Constipation
  • Chronic kidney disease

What are the dangers of dehydration in cats with chronic kidney disease?

Dehydration is a common complication of chronic kidney disease (CKD) and can lead to inappetence, lethargy, weakness, constipation and increased susceptibility to uremic crisis.1 It may also precipitate pathophysiologic responses that have a negative effect on the kidneys.

Several physiologic mechanisms are triggered when the body senses dehydration, and chronic subclinical dehydration may result in compensatory effects that ultimately have a negative effect on the kidneys. These pathophysiologic effects include:

  • Release of vasopressin, which works to increase water reabsorption via increased expression of aquaporin channels in the collecting duct.2 This can result in intraglomerular hypertension and potentially the development of proteinuria and systemic hypertension.2
  • Activation of the renin-angiotensin-aldosterone system (RAAS), which is another critical component in the pathophysiology and progression of renal disease.3 Normally protective, the RAAS, which regulates blood pressure, fluid and electrolyte balance, and systemic vascular resistance, becomes maladaptive in patients with CKD.
  • Poor perfusion, which may exacerbate hypoxia at the tissue level in kidneys that are already susceptible due to fibrosis and damaged vasculature.

Therapeutically addressing dehydration may benefit the kidneys by reducing vasopressin secretion, decreasing the activation of RAAS and optimizing perfusion.

How can cats be encouraged to drink more water?

Several different techniques can be used to increase water intake in a cat with chronic kidney disease. Strategies may include:

  • Feed wet food—a wet therapeutic renal diet or a dry renal diet with added water.4,5 Although pets drink from their bowl to compensate for the lower moisture in dry diets, a number of studies suggest that wet food (>70% moisture) can help increase total water intake.6
  • Feeding diets with increased levels of salt may encourage drinking in healthy pets.7
  • Purina research has shown that specially formulated, nutrient-enriched, flavored water supplements can increase water consumption in cats and dogs.8–12
  • Provide fresh, clean water at all times, and clean water bowls daily.
  • Some cats prefer moving water (e.g., via water fountains), larger water bowls (whiskers don’t touch the sides) and water provided in a stainless steel or crockery container (plastic odors can deter cats from drinking).13,14
  • Offer multiple water bowls in multi-pet households, placing water bowls in different locations throughout the home.13

Are cats with CKD at greater risk for constipation and, if so, why?

The cause of constipation associated with chronic kidney disease (CKD) is likely multifactorial and the result of a dysfunction of water balance. Cats with chronic kidney disease, especially those in more advanced stages, are often polyuric secondary to hyposthenuria and may be losing additional fluid through vomiting and diarrhea. A cat with CKD may have trouble keeping up with fluid losses, which may result in dehydration. Dehydration affects acid–base and electrolyte balances and often manifests with clinical signs such as lethargy, anorexia, and/or constipation.4,5,15,16 Dehydration may also impair perfusion of renal tissues, which leads to kidney disease progression.15,17,18

In cats with CKD, low potassium (hypokalemia) may contribute to constipation through the effects of potassium on smooth and skeletal muscle function, including the muscles of the gastrointestinal tract. Potassium is essential for muscle contraction, so when potassium levels decline, intestinal smooth muscle becomes weak, gut motility slows, transit time through the colon increases, and water continues to be absorbed from feces. The result is stool that becomes dry, firm, and difficult to pass, resulting in constipation or obstipation in severe cases.

 

References

References

Defining, Detecting, and Staging

  1. Purina Institute. (2024). Comprehensive management of feline CKD: A panel discussion. Purina Institute. https://www.purinainstitute.com/sites/default/files/2025-01/Comprehensive_Management_of_Feline_CKD_Panel_Discussion_English.pdf
  2. Sparkes, A. H., Caney, S., Chalhoub, S., Elliott, J., Finch, N., Gajanayake, I., Langston, C., Lefebvre, H. P., White, J., & Quimby, J. (2016). ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease. Journal of Feline Medicine and Surgery, 18(3), 219–239. doi: 10.1177/1098612X16631234
  3. Grecu, M., Capotă, R., Horhogea, C., Rîmbu, C., Năstasă, V., & Tănase, O. (2025). Epidemiology of chronic kidney disease (CKD) in cats: An analysis of the factors involved. Life, 15, 1856. doi: 10.3390/life15121856
  4. Polzin, D. J. (2011). Chronic kidney disease in small animals. Veterinary Clinics of North America: Small Animal Practice, 41(1), 15–30. doi: 10.1016/j.cvsm.2010.09.004
  5. Marino, C. L., Lascelles, B. D. X., Vaden, S. L., Gruen, M. E., & Marks, S. L. (2014). Prevalence and classification of chronic kidney disease in cats randomly selected from four age groups and in cats recruited for degenerative joint disease studies. Journal of Feline Medicine and Surgery, 16(6), 465–472. doi: 10.1177/1098612X13511446
  6. Elliott, J., & Barber, P. J. (1998). Feline chronic renal failure: Clinical findings in 80 cases diagnosed between 1992 and 1995. Journal of Small Animal Practice, 39(2), 78–85. doi: 10.1111/j.1748-5827.1998.tb03598.x
  7. Bartges, J. W. (2012). Chronic kidney disease in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, 42(4), 669–692. doi: 10.1016/j.cvsm.2012.04.008
  8. Quimby, J. M. (2024, March). The importance of nutrition in feline chronic kidney disease. Purina Institute Digest, 4, 2–3.
  9. International Renal Interest Society (IRIS). (2023). Treatment recommendations for CKD in cats. https://static1.squarespace.com/static/666b9ecb4064a156963b4162/t/66a6dc1dbfaa20426da8e99b/1722211357641/IRIS_CAT_Treatment_Recommendations_2023.pdf

Role of Nutrition in CKD Management

  1. Purina Institute. (2024). Comprehensive management of feline CKD: A panel discussion. Purina Institute. https://www.purinainstitute.com/sites/default/files/2025-01/Comprehensive_Management_of_Feline_CKD_Panel_Discussion_English.pdf
  2. Sparkes, A. H., Caney, S., Chalhoub, S., Elliott, J., Finch, N., Gajanayake, I., Langston, C., Lefebvre, H. P., White, J., & Quimby, J. (2016). ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease. Journal of Feline Medicine and Surgery, 18(3), 219–239. doi: 10.1177/1098612X16631234
  3. Burkholder, W. J. (2000). Dietary considerations for dogs and cats with renal disease. Journal of the American Veterinary Medical Association, 216(11), 1730–1734. doi: 10.2460/javma.2000.216.1730
  4. Bartges, J. W. (2012). Chronic kidney disease in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, 42(4), 669–692. doi: 10.1016/j.cvsm.2012.04.008
  5. Quimby, J. (2023). Chronic kidney disease in cats. In C. Lenox, R. J. Corbee, & A. Sparkes (Eds.), Purina Institute handbook of canine and feline clinical nutrition (2nd ed., pp. 262–267). Embark Consulting Group, LLC.
  6. Geddes, R. F., Elliott, J., & Syme, H. M. (2013). The effect of feeding a renal diet on plasma fibroblast growth factor 23 concentrations in cats with stable azotemic chronic kidney disease. Journal of Veterinary Internal Medicine, 27(6), 1354–1361. doi: 10.1111/jvim.12187
  7. Parker, V. J. (2021). Nutritional management for dogs and cats with chronic kidney disease. Veterinary Clinics of North America: Small Animal Practice, 51(3), 685–710. doi: 10.1016/j.cvsm.2021.01.007
  8. Coyne, M., Szlosek, D., Webeck, J., Feliciano, R., Berger, N., Doukas, J., Denton, D., Zhang, L. Y., Holt, N., Michael, H., O’Kell, A. L., Riggott, J., Sweet, S. L., & McCrann, D. J. (2025). Use of a veterinary therapeutic renal diet in cats with early chronic kidney disease is associated with slower disease progression and improved survival. Journal of the American Veterinary Medical Association, 264(5), 590–598. doi: 10.2460/javma.25.10.0665
  9. Lorbach, S., Quimby, J., Nijveldt, E., Paschall, R., & Reid, J. (2022). Evaluation of health-related quality of life in cats with chronic kidney disease. Journal of Veterinary Internal Medicine, 36(6), 2369–2370. doi: 10.1111/jvim.165411
  10. Elliott, J., Rawlings, J. M., Markwell, P. J., & Barber, P. J. (2000). Survival of cats with naturally occurring chronic renal failure: Effect of dietary management. Journal of Small Animal Practice, 41(6), 235–242. doi: 10.1111/ j.1748-5827.2000.tb03932.x
  11. Plantinga, E. A., Everts, H., Kastelein, A. M., & Beynen, A. C. (2005). Retrospective study of the survival of cats with acquired chronic renal insufficiency offered different commercial diets. The Veterinary Record, 157(7), 185–187. doi: 10.1136/vr.157.7.185
  12. Ross, S. J., Osborne, C. A., Kirk, C. A., Lowry, S. R., Koehler, L. A., & Polzin, D. J. (2006). Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats. Journal of the American Veterinary Medical Association, 229(6), 949–957. doi: 10.2460/javma.229.6.949
  13. International Renal Interest Society (IRIS). (2023). Treatment recommendations for CKD in cats.https://static1.squarespace.com/static/666b9ecb4064a156963b4162/t/66a6dc1dbfaa20426da8e99b/1722211357641/IRIS_CAT_Treatment_Recommendations_2023.pdf
  14. Laflamme, D. P. (2020). Understanding the nutritional needs of healthy cats and those with diet-sensitive conditions. Veterinary Clinics of North America: Small Animal Practice, 50, 905–924. doi: 10.1016/j.cvsm.2020.05.001
  15. Ross, L. A., Finco, D. R., & Crowell, W. A. (1982). Effect of dietary phosphorus restriction on the kidneys of cats with reduced renal mass. American Journal of Veterinary Research, 43(6), 1023–1026.
  16. Grecu, M., Capotă, R., Horhogea, C., Rîmbu, C., Năstasă, V., & Tănase, O. (2025). Epidemiology of chronic kidney disease (CKD) in cats: An analysis of the factors involved. Life, 15, 1856. doi: 10.3390/life15121856

Feeding Challenges

  1. Boyd, L. M., Langston, C., Thompson, K., Zivin, K., & Imanishi, M. (2008). Survival in cats with naturally occurring chronic kidney disease (2000-2002). Journal of Veterinary Internal Medicine, 22(5), 1111–1117. doi: 10.1111/j.1939-1676.2008.0163.x
  2. Freeman, L. M., Lachaud, M. P., Matthews, S., Rhodes, L., & Zollers, B. (2016). Evaluation of weight loss over time in cats with chronic kidney disease. Journal of Veterinary Internal Medicine, 30(5), 1661–1666. doi: 10.1111/jvim.14561
  3. Markovich, J. E., Freeman, L. M., Labato, M. A., & Heinze, C. R. (2015). Survey of dietary and medication practices of owners of cats with chronic kidney disease. Journal of Feline Medicine and Surgery, 17(12), 979–983. doi: 10.1177/1098612X14563097
  4. Quimby, J. (2023). Chronic kidney disease in cats. In C. Lenox, R. J. Corbee, & A. Sparkes (Eds.), Purina Institute handbook of canine and feline clinical nutrition (2nd ed., pp. 262–267). Embark Consulting Group, LLC.
  5. Sparkes, A. H., Caney, S., Chalhoub, S., Elliott, J., Finch, N., Gajanayake, I., Langston, C., Lefebvre, H. P., White, J., & Quimby, J. (2016). ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease. Journal of Feline Medicine and Surgery, 18(3), 219–239. doi: 10.1177/1098612X16631234
  6. Bartges, J. W. (2012). Chronic kidney disease in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, 42(4), 669–692, vi. doi: 10.1016/j.cvsm.2012.04.008
  7. Bartlett, P. C., Van Buren, J. W., Bartlett, A. D., & Zhou, C. (2010). Case-control study of risk factors associated with feline and canine chronic kidney disease. Veterinary Medicine International, 2010(1), 957570. doi: 10.4061/2010/957570
  8. Scherk, M. A., & Laflamme, D. P. (2016). Controversies in veterinary nephrology: Renal diets are indicated for cats with International Renal Interest Society chronic kidney disease stages 2 to 4: The con view. Veterinary Clinics of North America: Small Animal Practice, 46(6), 1067–1094.
  9. Burkholder, W. J. (2000). Dietary considerations for dogs and cats with renal disease. Journal of the American Veterinary Medical Association, 216(11), 1730–1734.
  10. Laflamme, D. P. (2020). Understanding the nutritional needs of healthy cats and those with diet-sensitive conditions. Veterinary Clinics of North America: Small Animal Practice, 50(5), 905–924. doi: 10.1016/j.cvsm.2020.05.001
  11. Polzin, D. J., Osborne, C. A., Ross, S., & Jacob, F. (2000). Dietary management of feline chronic renal failure: Where are we now? In what direction are we headed? Journal of Feline Medicine and Surgery, 2(2), 75–82. doi: 10.1053/jfms.2000.0077
  12. Odunayo, A. (2023). Practical tool: Assisted feeding and using feeding tubes in canine and feline practice. In C. Lenox, R. J. Corbee, & A. Sparkes (Eds.), Purina Institute handbook of canine and feline clinical nutrition (2nd ed., pp. 61–64). Embark Consulting Group, LLC.
  13. Tu, H.-W. (2024, March). Strategies to improve renal diet acceptance in cats. Purina Institute Digest, 4, 6–7.

Importance of Hydration

  1. Feehally, J., & Khosravi, M. (2015). Effects of acute and chronic hypohydration on kidney health and function. Nutrition Reviews, 73(Suppl 2), 110–119. doi: 10.1093/nutrit/nuv046
  2. Torres, V. E. (2009). Vasopressin in chronic kidney disease: an elephant in the room? Kidney International, 76(9), 925–928. doi: 10.1038/ki.2009.325
  3. Siragy, H. M., & Carey, R. M. (2010). Role of the intrarenal renin-angiotensin-aldosterone system in chronic kidney disease. American Journal of Nephrology, 31(6), 541–550. doi: 10.1159/000313363
  4. Quimby, J. (2023). Chronic kidney disease in cats. In C. Lenox, R. J. Corbee, & A. Sparkes (Eds.), Purina Institute handbook of canine and feline clinical nutrition (2nd ed., pp. 262–267). Embark Consulting Group, LLC.
  5. Bartges, J. W. (2012). Chronic kidney disease in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, 42(4), 669–692. doi: 10.1016/j.cvsm.2012.04.008
  6. Queau, Y. (2019). Nutritional management of urolithiasis. Veterinary Clinics of North America: Small Animal Practice, 49(2), 175–186. doi: 10.1016/j.cvsm.2018.10.004
  7. Queau, Y., Bijsmans, E. S., Feugier, A., & Biourge, V. C. (2020). Increasing dietary sodium chloride promotes urine dilution and decreases struvite and calcium oxalate relative supersaturation in healthy dogs and cats. Journal of Animal Physiology and Animal Nutrition, 104(5), 1524–1530. doi: 10.1111/jpn.13329
  8. Zanghi, B. M., & Gardner, C. L. (2018). Total water intake and urine measures of hydration in adult dogs drinking tap water or a nutrient-enriched water. Frontiers in Veterinary Science, 5, 317. doi: 10:3389/fvets.2018.00317
  9. Zanghi, B. M., Gerheart, L., & Gardner, C. L. (2018). Effects of a nutrient-enriched water on water intake and indices of hydration in healthy cats fed a dry kibble diet. American Journal of Veterinary Research, 79(7), 733–744. doi: 10.2460/ajvr.79.7.733
  10. Zanghi, B. M., Wils-Plotz, E., DeGeer, S., & Gardner, C. L. (2018). Effects of a nutrient-enriched water with and without poultry flavoring on water intake, urine specific gravity, and urine output in healthy domestic cats fed a dry kibble diet. American Journal of Veterinary Research, 79(11), 1150–1159. doi: 10.2460/ajvr.79.11.1150
  11. Wils-Plotz, E., & Zanghi, B. (2019). Nutrient-enriched water supplements nutritionally support hydration in the domestic cat. Journal of Veterinary Internal Medicine, 33(5), 2516. doi: 10.1111/jvim.15597
  12. Zanghi, B., McGivney, C., Eirmann, L., & Barnes, M. (2019). Hydration measures in cats during brief anesthesia: Intravenous fluids versus pre-procedure water supplement ingestion. Journal of Veterinary Internal Medicine, 33(5), 2514. doi: 10.1111/jvim.15597
  13. Westropp, J. L., & Buffington, C. A. T. (2004). Feline idiopathic cystitis: Current understanding of pathophysiology and management. Veterinary Clinics of North America: Small Animal Practice, 34(4), 1043–1055. doi: 10.1016/j.cvsm.2004.03.002
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