Monday, November 23, 2015

How do you get your cat to eat a prescription diet for kidney disease?

When cats have kidney disease, they prefer larger vessels (like baths) to drink from. This is what greets me every time I walk into the bathroom/

Just in case vets ever get too lofty a view of ourselves, the companion animals we live with are here to ground us. I thought I was pretty good at advising clients how to care for cats with chronic renal insufficiency and renal failure, but my cat Michael reckons I need a bit of a challenge.

She has developed azotaemia. I knew it was coming. The polydipsia (excessive drinking) is a bit hard to ignore: we’ve reached a stage where I get in the bath and she jumps in with me so she can drink. Not exactly typical feline behaviour. I estimate she is putting away 500-750ml per day. That and the fact that she has had a number of blood and urine tests in the past few months, in addition to repeat abdominal ultrasounds.

One of the other obvious changes in her behaviour is a marked reduction in appetite. In her salad days (though she ate anything but), Mike was a rather large cat, a subscriber to the “seefood” (see food and eat it) diet. Now, no matter what I offer her, she wants to lick the gravy off everything and walk away, causing me no end of despair and frustration- especially when dietary management is the key to managing chronic renal disease in cats.

The big challenge is trying to introduce a prescription diet, which is designed to reduce the secondary metabolic effects of renal insufficiency. To modify a phrase, you can lead a cat to a bowl of a prescription diet, but (sometimes) you can’t make her eat.

So what are the options? Apart from keeping cats properly hydrated, which may require intravenous fluids or subcutaneous fluids (yes, EVEN when they are drinking that much), there are a few things the experts recommend.
  • Make sure there is nothing else going on. Living with a vet, Mike has been checked out for concurrent gastrointestinal disease, pancreatitis, thyroid disease, diabetes and just about anything else under the sun that might cause her to be off food.
  • Make sure you treat for nausea. Azotaemia makes cats feel nauseous and they may not eat. Anti-emetics can be helpful. Feeding cats something when they are nauseous risks creating a food aversion. Plus it also risks your cat vomiting and Mike always seems to be pointing at a rug when she vomits. (My theory is that cats do this to avoid splashback).
  • Try multiple brands of prescription diet. If one doesn’t work, offer another as they clearly taste different. Now some brands offer more than one flavour (e.g. chicken, seafood) and different forms (wet vs dry, casserole style vs pate style).
  • Use food fresh from the packet, i.e. at room temperature, or warm slightly for a few seconds in the microwave (let it stand to avoid burns). Like some other cats, Mike will never eat anything that comes from a fridge.
  • Add some flavour. One paper suggests low sodium chicken broth, tuna juice (not an option for Mike who loves seefood, but hates sea food), oregano, brewer’s yeast or a small amount of regular food.
  • Use appetite stimulants like cyproheptadine or mirtazapine, but when nausea is treated. According to feline specialist Andrea Harvey, they can also develop a food aversion if given appetite stimulants when nausea has not been addressed.
  • Pretend you aren’t actually feeding your cat. I did have some (limited) success placing the prescription diet on the coffee table when visitors were over, and pretending it was some sort of fancy dish. We then chatted amongst ourselves and, predictably, Mike snuck up on the table for a taste of the forbidden food. You just need to ensure your visitors know that the dish being served is not for human consumption!


Roudebush P, Polzin DJ, Ross SJ, Towell TL, Adams LG, Forrester SD (2009) Therapies for feline chronic kidney disease: what is the evidence? Journal of Feline Medicine and Surgery 11(3): DOI 10.1016/j.jfms.2009.01.004