Kidney Disease: Stage 4 of 4

Cats who have advanced to or are diagnosed with Stage 4 Chronic Kidney Disease typically show significant symptoms including nausea, vomiting, weight loss, decreased appetite. Our goal is to alleviate these symptoms and manage kidney disease progression to improve and extend quality of life for your cat.

What defines Stage 4 Chronic Kidney Disease in cats?

  • Blood creatinine greater than 5.0 mg/dL
  • Elevated SDMA (> 38ug/dL)
  • Inadequate urine concentrating ability
  • +/- Protein loss in urine

How do we substage Chronic Kidney Disease Stage 4 in cats?

  • Urine Protein:Creatinine measurement in two samples, at least two weeks apart, then every 2-3 months
  • Systolic blood pressure monitoring, over up to 1-2 weeks

With proper treatment of the above, cats can improve and move from a higher Stage of CKD to a lower one.

How do we treat Stage 4 CKD in cats?

Treatment must be tailored to each individual cat. It is aimed at slowing the progression of CKD and prolonging kidney function and quality of life.

In general:

  • Discontinue all drugs that may be harmful to the kidneys if possible.
  • Screen for any treatable conditions like kidney or bladder infections and treat appropriately
  • Perform radiographs and/or ultrasound to rule out stones, masses, or other lesions as causes for loss of kidney function
  • Measure blood pressure and urine protein to creatinine ratio (UP/C)
  • Feed a clinical renal diet.

Management of dehydration:

  • Have fresh water available at all times for drinking
  • If ill and fluids are lost, correct dehydration promptly with appropriate IV or subcutaneous fluid therapy
  • Maintenance fluids may need to be administered regularly

Systemic hypertension:

  • Goal of a systolic blood pressure below 160mmHG
  • Calcium channel blocker, such as amlodipine and/or telmisartan
  • Consider dietary sodium restriction
  • Once stable, recheck blood pressure every 3 months

Proteinuria (protein in urine):

  • Feed a clinical renal diet, prescribed by your veterinarian
  • A Renin-angiotensin-aldosterone system (RAAS) inhibitor, ACE inhibitor, or other prescription medication may be prescribed

Control phosphate Intake:

  • Begin a clinical renal diet, prescribed by your veterinarian
  • Begin phosphate binders, such as aluminum hydroxide, if necessary, as prescribed by your veterinarian for a goal of <6.0 mg/dL

Treat potassium deficiencies:

  • Begin a potassium supplement such as potassium gluconate
  • Begin a clinical renal diet, prescribed by your veterinarian

Treat secondary anemia:

  • Anemia due to Chronic Kidney Disease may be treated at a certain level
  • Ongoing monitoring during treatment and fluid therapy is essential

Metabolic acidosis correction:

  • Appropriate renal diet
  • Supplementation when necessary (sodium bicarbonate or potassium citrate)

Aid in quality of life with symptomatic treatment:

  • Antiemetics and anti-nausea medications
  • Appetite stimulants
  • Other medications and supplements to entice cats to eat, only if approved by your veterinarian

Monitoring Stage 4 Chronic Kidney Disease:

  • Chronic condition exam every 3 months
  • Reassess blood chemistries every 3 months
  • Reassess blood phosphorus and calcium every 4-6 weeks until stable, then every 3 months
  • Reassess blood pressure and urine protein every 3 months
  • Home observation for decreased appetite, increased thirst or urination, increased vomiting, lethargy

When should I feed a kidney prescription diet?

If your cat is in Stage 4, a prescription kidney diet will most likely be prescribed. Please never make diet changes for your cat without consulting with us.

Additional considerations for cats in Stage 4 Chronic Kidney Disease to discuss with your veterinarian:

  • Alternative feeding methods such as esophageal feeding tubes and others
  • Referral for dialysis
  • Renal transplantation

We are here to help you understand all of your options to keep your cat healthy. We know you bring your cats to us because you love them, and we are grateful to be a part of their care.

Schedule an Appointment with one of our Feline Veterinarians 

Information also available at IRIS – Kidney Guidelines Website

Madison East Side

Cat Care Clinic - East

1006 E. Washington Ave.

Madison, WI 53703


Directions to East Clinic

Madison West Side

Cat Care Clinic - West

322 Junction Rd.

Madison, WI 53717


Directions to West Clinic
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COVID-19 Care Updates • Modified August 1, 2021