Dr. Hofve on what to feed a cat with kidney disease
One question I get a lot is “What should I feed my CKD cat?” (CKD stands for chronic kidney disease. It’s also called CRF, chronic renal disease.)
Not having a definitive answer, I requested an interview with one of my favorite cat experts, the holistic vet, Dr. Jean Hofve.
She provided some surprising and helpful answers!
Dr. Jean, if you had a cat diagnosed with kidney disease (or were treating one), what kind of diet would you want the cat to be on?
“Well, I have that cat, my own 15-year old boy Flynn. And he’s on the same diet he’s always eaten. The cats get a mixture of homemade raw, frozen raw, and/or dehydrated raw, with appropriate supplements, and a sprinkling of various high-quality canned food. He’s doing great, maintaining weight, and acting absolutely normal.
The thing is, CKD kitties need high-quality protein to maintain their body weight and system functions. Restricting protein (the point of which is really to restrict phosphorus) ultimately causes loss of body condition.
I’m going for maximum quality of life, rather than simply extending life, which is what the kidney diets do. They treat one aspect of physiology while neglecting the needs of the rest of the body. Now, he may not live as long as he could if I put him on a restricted diet. But when it’s time to let him go, I’ll know he’s had the maximum gusto and enjoyment from his life that I have the ability to give him. That’s just my personal preference. It’s not for everyone.
I haven’t changed Flynn’s food… He’s got a great appetite, his weight is stable, and he is not symptomatic. He does get a number of supplements, plus the blood pressure medicine (like mother, like son I guess!). He acts completely normal.”
[Note: See Dr. Hofve’s article on this topic for more information about the supplements she recommends.]
Very interesting. It’s great to hear how well your 15-year old CKD cat is doing!
So you do not specifically feed him a low-phosphorous diet. But if people can find a low-phosphorous cat food that has normal protein levels, is there any reason not to use it? Might it help?
“The phosphorus levels in a normal-protein cat food can vary widely, as you know, and sure, it’s a good idea to go with the lowest phosphorus foods you can find. However, be aware that those [phosphorus] levels will still be about double those of the more-restrictive veterinary renal diets.
The downside of the kidney diets is, cats don’t much like them, and, in my opinion, they don’t provide enough protein (or perhaps it’s just that cats won’t eat enough of them) to prevent muscle wasting.
I think the value of renal diets is for cats with significant symptoms, and in those cases they can help the cat feel better. Of course…extra fluids (IV or subcutaneous) will accomplish much the same thing, and fluids will also improve the cat’s appetite. Dehydration causes nausea and a nasty headache. I was exposed to an ammonia spill once, and I think it felt much like these kitties feel when the BUN (basically, ammonia) rises in their blood. I got an instant headache that felt like an ice pick going through my eye. While the acute dose of fumes I got was probably much worse than what the cats experience over time, I don’t doubt for a minute that they feel crappy!
I should mention that egg whites are pure protein with almost no phosphorus, so I got some organic egg whites and will be starting an experiment with adding egg whites to their food. Just to see what happens! It’s hell being the cat of a veterinarian!”
First, I want to thank Dr. Hofve for sharing her opinions and knowledge on this challenging subject in a straightforward and honest way. She demystified the phosphorous and protein issues and I really appreciated her point about how treating dehydration can make a huge difference in a CKD cat’s wellbeing and appetite.
Secondly, I want to thank you, cat-loving readers, for asking for fresh insights on this topic, as well as for any tips you might want to add here.
Resources for cat parents
- Dr. Hofve’s excellent, comprehensive article on feline CKD, which discusses some helpful supplements and providing subcutaneous fluids. (Dr. Hofve is no longer taking patients (she’s retired), but her site, Little Big Cat, is a gold mine for feline caretakers!)
- Feline CRF Information Center
- Phosphorous levels in various cat foods (only relevant IF your cat has CKD already):
- Dr. Lisa Pierson’s cat food phosphorous level tables
- Tanya CRF site tables and article on Phosphorous Control for cats with CKD
It worries me to see that a cat that has always eaten raw still got CKD. 🙁 After my beloved Bowie died of CKD I decided to feed only canned food and eventually transition to raw hoping to be able to avoid CKD in my current cats. I really hope as more and more people feed raw there will be a lot more data (even if it’s anecdotal) about how much it helps cats stay healthy and live longer. I actually re-discovered your blog recently by searching for info on whether raw food helps cats live longer. Bowie was only 12 when he died 4 years ago and I’m still devastated by his passing.
Treat the Cat !!! Get a Veterinarian who knows how to TREAT a Pet !!! Like your Human Doctor, “take two aspirins and call me in the morning”just won’t do !!! Knowing how to treat your Pet is PRIORITY ONE !!! Go online and research till your fingers have blisters from typing !!! Research, your local Veterinarian, and call or email People who are going through or went through a Pet with an illness, be a Fighter, don’t give up !!! Pray also,,, it never hurts but remember God answers Prayer according to his will and I know many times God’s will isn’t always what we want !!! Pray always and ask other Prople to please Pray for your sick Pet, if they disagree about Praying for sick Pets you might want to Pray for them !!!
In another article here, (link below) it clearly states that raw egg whites are not advisable under mistake #5.
“raw egg whites – contain a protein called avidin that can bind to certain B vitamins and prevent their absorption”
Right, but it’s only raw egg whites that have this issue.
Hi Dr. Jean,
Thanks for the informative post. Do you cook the egg whites or serve them raw?
Thanks Desi, Andrea + Jo!
I don’t know if you caught it, but she does describe her favorite CKD supps here: http://www.littlebigcat.com/health/kidney-disease-in-older-cats/
thanks for remembering willow. months ago i made comments on your blog about feeding only wet high quality low phos foodi and a good holistic vet and, sq fluids.. i mentioned Pierson and Tanyas CRF . I mentioned some brand names and was accused of being paid by the companies by one of your zealots with OCD. ii asked to be removed from your list. my cat is 3 1/2 years post diagnosis and doing well. the blog is now a rant about foods and scary.ingredients. Pierson and Tanyas both say the best food is what your cat will eat. they must eat…good high quality protein forcarnivores..the bloggers are obsessed with the least important elements and. forget reasonable solutions. it isnt what you intended i think. good luck in your future. Andrea
Andrea, well said! Glad to hear your kitty is doing great! And yes, many “zealots” often forget the all important mantra, “Above all, the cat must eat!”
Liz, this was a great article and idea on your part. Sure wish Dr. Jean would have talked in detail about the supplements she gives…and revealed the brands of canned cat food she feeds!
Dat wus vewy infuwmativ, fanks.
Luv and Hugs and Kitty kisses ♥♥♥