Pets

First off, , there are things you can try to bring your kitty around to more stable health. Sorry for the length, but there’s a lot of nuance to this. I learned about diet needs for CKD after poring over Tanya’s CKD site: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat

Initially, our Tweedles was diagnosed in March 2020 with stage 4 renal failure and improved to stage 3 within a year. Her levels have been hovering just above stage 2 for the last 1.5 years. It has required care commitment and a ton of luck, but it is worth trying! Luckily, her heart health has been good the whole time, but she did develop hyperthyroidism 1.5 years ago — my big advice for that is getting liquid meds from a compounding pharmacy.

Backstory:
She had precipitously lost weight over maybe 10 days time and had been puking small amounts of clear liquid at increasing frequency over those days. Also had been ‘loafing’ — a sitting posture in cats that is an indicator of decreased kidney health.

She was diagnosed with stage 4 kidney disease and her vet prescribed Renal K+ powder, renal formula wet food and a referral to a specialty vet hospital. The regular vet set our expectations low, but the specialty vet gave her a chance IF we administered daily subcutaneous fluids at home. That’s right - daily injections of saline under her skin. It was scary at first, but! it is doable and our sweet kitty now comes and sits for her treatment without prompting.

We also used Mirataz gel to stimulate her appetite. Also, per her hospital vet, an acid reducer like pepcid or omeprazole dissolved in water given with an oral syringe, helps reduce stomach upset and improves appetite.

What I learned in those early months is that it is more important for them to take in calories (even if not the perfect renal food) than breakdown their own muscle for energy. So, here’s the diet tricks I used for her:

Putting weight on in the first 2 weeks:

I combined turkey baby food with water, high calorie gel, and duck fat (kidney cats need a higher ratio of fat to protein or carbs than a typical cat diet). I used a 5ml oral syringe to give her the mix by hand after she got a smaller syringe of a partial, crushed omeprazole, water, and ham baby food. For the duck fat — I bought a jar of pure ol’ duck fat, let a scoop of it liquify at room temp, then would draw it up in 5 ml oral syringes. Would refrigerate the drawn syringes of fat, then take one out a few mins before needing to mix with food. She’d get her nasty meds with the one syringe, then a 5 ml syringe of the mixture in several squirts to the mouth. I think this set her up to eat the food I put in her dish.

In her dish, I would combine one of the following pouch foods mixed with like 2 ml of duck fat, and ~ 3 ml high calorie gel: Fancy Feast Broths Adult Cat Wet Food; Friskies Lil' Soups; Hartz Bisque

In her regular wet food bowl, I would put out the combination mentioned below during this two weeks time, but the packet food mix and syringed mixture were essential, imo.

After the first 2 weeks:

The high calorie gel wasn’t needed and we didn’t need the omeprazole as often. We got her a robotic bowl (SureFeed Microchip Pet Feeder) that weighs food as it’s consumed, to help monitor her eating rate, and to keep her chunky monkey brother out of her food. I bought a variety pack of Royal Canin renal foods and found that initially she like the E wet food. I would mash that E flavor food with some preferred flavor of fancy feast and 1-2 teaspoons of water and a measured dusting of the Renal K+ powder stirred in. We put out fresh wet food 2-3 times per day. Now, this was all at the start of the pandemic and I had two other adults in the house full time to help make this all work. Ask for help with your cat’s care - spouse, niece, neighbor, friend to help cover these early days. The routines can get easier as you build systems.

By 2 months later, she preferred Royal Canin D renal wet food, with water and Fancy Feast. Silicone lids for putting partial cans in the fridge were indispensible.

Since the end of the first year, both of our cats each eat 1/2 can of Fancy Feast mixed with 2 tablespoons of water, twice a day. We also put out renal formula dry food. You absolutely can add water to cats’ wet food. Start small and work up the quantity over time. Got my niece’s cat started on water in wet food as a kitten, and lol, he loves it/knows no difference.

Please talk this over with your vet — is what worked for my sweedle Tweedles, but can tailor an approach for your kitty’s heart health issues.