Dietary management of the cat with early chronic kidney disease

Chronic kidney disease (CKD) is a highly prevalent disease and common cause of morbidity and mortality in older cats. It is estimated to affect up to 30–40% of cats over the age of 10 years (Lulich, 1992) and is the cause of death of over 13% of cats (O’Neill et al, 2015). There are thought to be a number of potential underlying aetiologies contributing to disease, but the risk factors, other than age (Sparkes et al, 2016), and causes associated with the development of CKD are still not well elucidated and most cases are classified as idiopathic in origin. There is, however, an increasing awareness that early diagnosis and management of CKD can slow down the progression of disease and have a significant impact on longevity as well as quality of life. This has a number of challenges and controversies associated with it. Dietary management, ideally with a therapeutic renal diet, is arguably the most important aspect of treatment for cats diagnosed with CKD in International Renal Interest Society (IRIS) stage 2 onwards (Polzin and Churchill, 2016), and generally accepted as such by most veterinarians. However, given that until relatively recently veterinarians have not been able to identify early CKD (IRIS stage 1 disease), and that there are a limited number of studies looking at management of cats at this early stage in disease, the best diet for these cats is still unknown. This article explores the current understanding of therapeutic strategies and the impact this can have on progression of the disease, with a particular focus on dietary management, exploring potential dietary changes and at what point they should be made.