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Posted On Sep 19, 2025

Updated On Oct 16, 2025

The Power Of Diet In Managing Chronic Kidney Disease In Cats

Internal Medicine

Chronic kidney disease (CKD) is one of the most common conditions affecting older cats and modifying the diet in these patients can significantly impact both their quality of life and survival time. Nutrition is not just supportive care — it should be considered an integral part of the management plan for cats with CKD. 

We know that kidney diets can alter outcomes. Cats with CKD who are fed a therapeutic renal diet have been shown to live longer and feel better than those on standard maintenance diets:

  • In one U.S. study,1 45 cats with CKD were randomly assigned to either a renal or maintenance diet. After two years, none of the cats on the renal diet experienced a uremic crisis or died from their kidney disease. In contrast, six cats on the maintenance diet had a uremic crisis and five were euthanized due to their kidney disease.

  • A larger European study2 of 321 cats with CKD found that cats fed a conventional diet survived approximately 7 months (on average) and cats fed any one of seven different kidney diets survived an average of 16 months. A kidney-specific diet more than doubled survival time.

Kidney diets are carefully formulated to address the complications of CKD and to protect the kidneys from further damage. Key features of these diets include:

  • Controlled protein content
    Protein restriction reduces the buildup of nitrogenous waste and azotemia. Although controlling azotemia doesn’t slow disease progression it does improve how cats feel. Because owners often make end-of-life decisions based on perceived quality of life, helping cats feel better can ultimately extend their lives.

  • Potassium supplementation
    CKD can cause low potassium (hypokalemia), which in turn can perpetuate damage to the kidneys. Modern kidney diets include potassium, making potassium supplementation rarely needed.

  • Phosphorus restriction
    Elevated phosphorus accelerates kidney damage. If a CKD cat is hyperphosphatemic (or has elevated FGF-23 [>400 pg/ml] despite a normal phosphorus), starting a kidney diet is indicated. Rechecking FGF-23 levels after a few weeks helps determine if further steps — like adding phosphate binders — are needed.

  • Enriched with omega-3 fatty acids
    Omega-3s help preserve kidney function, reduce inflammation, and slow progression of disease. Virtually all therapeutic kidney diets are high in omega-3s.


The best of diets won’t help if a cat refuses to eat actually eat it. It’s important to keep in mind that cats can form negative associations if the new food is first offered while they're in the hospital - when they’re stressed, sick, or nauseous. Keys to success with respect to transitioning to a renal diet include:

  • Refrain from starting the kidney diet in hospitalized patients. Let cats eat whatever they will while hospitalized. Introduce the new diet after they are discharged and home - in their normal environment.

  • Offer small, frequent meals rather than one or two large ones. 

  • Warm the food to enhance aroma and palatability.

  • Provide variety. Send home multiple flavors and brands of kidney diets. Cats often accept one for a while and then refuse it, so rotating options can help maintain appetite.

Diet is a cornerstone of treatment for cats with chronic kidney disease. It improves quality of life, helps to minimize complications, and increases survival time (nearly two-fold). 

Learn more about Improving the Quality of Life for Cats with Chronic Kidney Disease and these On Demand presentations on the topic of CKD in dogs:


References:
1. Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats. JAVMA 2006; Vol 229(6). https://doi.org/10.2460/javma.229.6.949

2. Retrospective study of the survival of cats with acquired chronic renal insufficiency offered different commercial diets. Vet Record 2005: Vol 157: 185-187. https://doi.org/10.1136/vr.157.7.185