It is a great emotion for me to write for the first time about a subject that is very close to my heart.
I want to share with you the nutritional choices I made when I had to care for and support my cat with chronic kidney disease (year 2011).
Below you will find a subject that is still barely explored in veterinary medicine: malnutrition in the course of kidney failure, known as PEW, one of the strongest risk factors for adverse outcomes and death in cats and dogs with CKD.
The concepts and advice in this article apply to dogs as well.
Functional nutrition
For some years now, human medicine has been studying the importance of functional nutrition in chronic disease and how it plays a crucial role in counteracting malnutrition (PEW) in kidney patients.
What should a cat with kidney disease eat?
When my cat developed chronic kidney disease, alongside the medicinal mushroom Cordyceps, the Heel protocol and the various remedies for stomatitis, constipation and gastritis, I had to focus on optimising the diet. You should know that correct nutrition during chronic kidney disease ensures:
- Slower progression of kidney disease
- Prevention of muscle catabolism
- Delayed cachexia
I knew we would have to face periods of complete loss of appetite, an unavoidable stage in a cat at stage 3 or 4 of chronic kidney disease, so the goal was: ALWAYS FEED, and stay proactive.
Renal cat food or home-prepared food?
Which food for cats with kidney disease was the most suitable: a renal food with reduced protein content, a homemade raw meat diet with added supplements, a cooked BARF diet, or a semi-cooked one?
Quite a dilemma. Back in 2011, the articles you could find online about nutritional management in kidney failure were always in favour of a reduced-protein diet, the so-called renal cat food.
This article is entirely the result of study, research and personal experience. I would remind readers that on the web it is good practice to respect the authorship of an article by always citing the source.
The cat with CKD is at risk of malnutrition
I needed certainty when it came to nutrition, and the subject clearly had to be explored in depth. I know this disease and I know how complicated it can be to manage day after day. Alongside its very specific symptoms comes food refusal, a common problem in many cats with CKD.
Many owners look for solutions to counteract the loss of appetite: what to do when the cat will not eat renal food, will not eat wet food, or just sniffs the food and walks away.
The cat is not eating because of uraemia
If your cat is not eating because of uraemia and you want to try to help by changing the diet in favour of home cooking, you should know that:
- The formulation of the diet must leave no room for improvisation
- The diet must meet the cat’s energy requirements
- It must relieve the clinical signs of kidney disease
- It must reduce uraemic intoxication
- It must be low in sodium and phosphorus
- It must maintain acid-base balance
The diet must always be personalised on the basis of clinical and laboratory data. Remember that a cat at stage 1 or 2 of the disease must be treated and fed differently from a cat in the terminal phase of kidney disease.
According to the IRIS classification (International Renal Interest Society) my cat was at stage III of kidney disease, creatinine 251–440 micromol/l (2.9–5.0 mg/dl), therefore moderately impaired.
Homemade nutrition for a cat with kidney disease
Chronic kidney disease in cats: nutrition.
Food for cats with kidney disease must provide adequate calories, a reduced content of sodium and phosphorus, and enough energy to prevent endogenous protein catabolism, which translates into malnutrition and worsening azotaemia.
A cat’s energy requirement is roughly 50 to 60 kcal/kg/day, although there is a variation of about 25% depending on individual energy needs based on age, level of physical activity, concurrent disease (for example neoplastic cachexia) and neutering.
Homemade food for cats with kidney disease
From the very beginning my direction in terms of nutrition was to choose a home-prepared diet with the addition of supplements, vitamins, omega-3 fatty acids and Coenzyme Q10.
The reason was simple and natural: I wanted to guarantee my cat an adequate protein intake, one that would avoid muscle atrophy and loss of lean mass while at the same time preventing and counteracting inappetence. I began building a weekly dietary plan based on homemade purée whose main ingredient was egg white, a protein source that was certainly right for us: BIOLOGICAL VALUE 100 + AMINO ACID BIOAVAILABILITY + EXCELLENT DIGESTIBILITY.
Recipe for the cat with kidney disease
Read my recipe with cooked egg white blended together with a portion of chicken or turkey and pumpkin, a digestible and palatable meal. (Amounts and ingredients must be adapted to the animal’s clinical history, and the same applies to the choice of supplements.) For dogs it is possible to build a diet based on potatoes, black rice and egg white.
For cats with stomatitis, diarrhoea or constipation, you can read all the properties in the dedicated article PUMPKIN for dogs and cats: benefits + recipe.
From the very start I chose a mostly homemade diet, rotating the ingredients, varying the protein sources and opting for proteins with a biological value as close to 100 as possible, such as cooked egg white.
Egg white is an excellent protein source (each egg contains about 7 grams of protein, 5 of which are in the white).
Biological value (BV) is an index describing how efficiently the body uses and metabolises a protein. Meat has a high biological value, but FIRST PLACE goes to eggs: their amino acid profile and balance are perfect, and they are used as the reference against which all other protein sources are compared. The body is able to assimilate egg or egg white protein in its entirety.
A low-protein diet is a possible risk factor for malnutrition in cats with chronic kidney disease
During periods of inappetence, or when the symptoms of kidney disease were more marked, I offered a meal made of half a pouch of wet renal food and half cooked egg white + MAP.
During periods when stomatitis appeared with complete loss of appetite, I gave only wet renal food by syringe every 2 to 3 hours (I did not add egg white or any other protein source) + Stomorgyl therapy for 10 to 12 days + Fiuggi water (syringes of Fiuggi water) to counteract dehydration and help eliminate nitrogen waste.
If you do not have time to prepare homemade liquid meat to give by syringe, I recommend two products:
Tjure Mangia e Bevi liquid meat, more information here.
Or Kattovit Renal Drink, a meat cooking liquid with chicken breast fillet.
- A drink for cats with kidney disease, ideal in cases of low fluid intake
- Supports kidney function
- Encourages fluid intake: tasty meat cooking liquid with delicious pieces of chicken
- Rich in minerals: contributes to the animal’s health
- Free from artificial colours, flavourings and preservatives
While my cat was strictly on renal pet food, I added to the meal an amino acid supplement made by GUNA and used in human medicine, marketed in 2011 under the name SON FORMULA / Gunamino.
For optimal health a cat’s body requires about 20 amino acids, 11 of which are essential. Proteins must be digestible and at the same time have a high BV. The essential amino acids are: leucine, isoleucine, valine, tryptophan, phenylalanine, histidine, methionine, threonine, lysine, arginine and taurine.
Renal food + Master Amino Acid Pattern MAP/Gunamino
to avoid malnutrition and PEW.
Master Amino Acid Pattern for dogs and cats
ZERO nitrogen waste.
Once taken, MAP follows the anabolic pathway 100%, with virtually no production of nitrogen waste. MAP (Master Amino Acid Pattern®) is an exclusive composition of essential amino acids in crystalline, free, highly purified form.
It was discovered by an Italian, Maurizio Luca Moretti, a researcher in the United States. He was the one who achieved the goal pursued by many scientists working in nutrition: finding the ideal protein compound, one that is perfectly assimilable and bioavailable and produces no waste or toxins. MAP (Master Amino Acid Pattern) is a balanced, pre-digested, complete association of the eight essential amino acids. MAP™ is the result of 23 years of research by the International Nutrition Research Center (INRC). With Gunamino I avoided the loss of protein, protein energy and malnutrition.
It produces less than 1% of nitrogen catabolites, the lowest value of any known dietary protein. This characteristic makes it particularly suitable for those with liver or kidney dysfunction. Its use avoids excess nitrogen waste and consequently kidney overload.
- It is absorbed within minutes with no digestive effort
- It does not produce nitrogen waste
- It provides the maximum protein value in the smallest weight and volume compared with any other food
It has a Net Nitrogen Utilisation (NNU) of 99%, meaning that 99 parts are assimilated and one part is excreted as waste.
Gunamino Formula = Net Nitrogen Utilisation (NNU) 99%
Egg = Net Nitrogen Utilisation (NNU) 65%
Meat, fish and poultry = Net Nitrogen Utilisation (NNU) 32%
TIPS: I have been taking it myself for several years now. Going slightly off-topic here, but this is important and useful information.
Ten grams provide a nutritional protein value equivalent to 450 grams of meat, fish or poultry, and supply only 40 calories. It allows lean body mass to be regained or retained while reducing fat mass.
This product has undergone a double-blind, triple crossover trial which showed the absence of side effects, including those common to other amino acid combinations such as nausea, vomiting, cramps and abdominal bloating.
In this context its high nutritional value emerged. It should be underlined that protein digestion generally requires about three to four hours, whereas MAP is absorbed in the small intestine in just twenty-two minutes. It is in fact pre-digested and does not require the action of the enzyme peptidase, while it needs only minimal stimulation of biliary, pancreatic and intestinal secretions. This, together with its amphoteric nature (meaning it can act either as an acid or as a base depending on the pH of the environment it is in), makes it valuable for those suffering from gastritis, digestive disorders or IBD. I recommend buying Gunamino in tablet form, as the sachets contain sweeteners. To Gunamino, add arginine and taurine.
PEW: malnutrition in cats with kidney disease
Protein malnutrition syndrome – Protein Energy Wasting (PEW).
Why is protein-energy depletion associated with mortality in patients with CKD?
Protein Energy Wasting (PEW) is a pathological condition characterised by a progressive reduction of the body’s protein and energy reserves. PEW has a high prevalence among patients with CKD (chronic kidney disease / end-stage renal disease) and is closely associated with adverse clinical outcomes and an increased rate of hospitalisation, complications and mortality.
Protein-energy wasting (PEW), a new term proposed in human medicine by the International Society of Renal Nutrition and Metabolism (ISRNM), refers to the multiple nutritional and catabolic alterations that occur in chronic kidney disease (CKD) and are associated with morbidity and mortality.
Protein-energy depletion is a frequent condition, strongly correlated with mortality in patients with CKD. As in human medicine, cats and dogs with chronic kidney disease also need dietary protein, supplements and essential amino acids.
Maintaining good nutritional status in a cat with chronic kidney disease prevents so-called PEW.
References
Lawson, Jack, et al. “Renal fibrosis in feline chronic kidney disease: Known mediators and mechanisms of injury.” The Veterinary Journal 203.1 (2015): 18-26.
Markovich, Jessica E., et al. “Survey of dietary and medication practices of owners of cats with chronic kidney disease.” Journal of Feline Medicine and Surgery 17.12 (2015): 979-983.
Elliott, J., et al. “Survival of cats with naturally occurring chronic renal failure: effect of dietary management.” Journal of Small Animal Practice 41.6 (2000): 235-242.
Larsen, Jennifer A. “Controversies in Veterinary Nephrology: Differing Viewpoints: Role of Dietary Protein in the Management of Feline Chronic Kidney Disease.” Veterinary Clinics of North America: Small Animal Practice 46.6 (2016): 1095-1098.
Reynolds BS, Chetboul V, Nguyen P, et al. Effects of dietary salt intake on renal function: A 2-year study in healthy aged cats. J Vet Intern Med 2013; 27(3):507-515.
Disclaimer: This content is for informational purposes only and can in no case constitute the prescription of a treatment or replace a specialist examination or the direct relationship with your own veterinarian or physician. All information reported here derives from bibliographic sources, personal experience and clinical studies in the public domain. The information published on this site is released after careful verification of the sources, which are chosen with care and kept as up to date and official as possible. All information on special diets and food supplements for pets is for informational purposes only. This information serves as a general guideline; it cannot be applied to all pets or considered an alternative to professional advice. These pages present alternative and homeopathic remedies whose efficacy is not scientifically validated and which have no approved therapeutic indications. Products are not intended as substitutes for a varied and balanced diet and must be used within a healthy lifestyle.
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