Water plays the most important role for CKD patients 

One of the key roles that water plays in managing CKD is its ability to help flush out toxins from the body. These toxins can accumulate in the bloodstream due to impaired kidney function, leading to discomfort and other complications. 

Ensuring that cats with chronic kidney disease (CKD) have an adequate water intake can greatly contribute to their well-being and overall quality of life.

When toxic build-up occurs, it can lead to various discomforts such as mouth ulcers, nausea, excessive acid, and a decrease in your cat's appetite. This often poses a challenge for CKD parents when it comes to feeding their cat. Ensuring that your cats intake enough water will help flush out toxins and make them feel much better and your cats will have a better appetite.

My CKD cat Voodoo, who was diagnosed with only one kidney function, has been able to maintain a normal lifestyle for the past 7 years. This is due to his consistent intake of water, normal appetite and playful activity levels. Despite his condition, he appears and behaves just like any other cat. His appetite worsened only 2 months before he crossed the rainbow bridge. His kidneys deteriorated rapidly, and we only started using sub-q fluids in his final days due to his pre-existing heart problem. We didn't want to put any additional strain on his heart.


How to determine if your CKD cats are consuming enough water.

A CKD cat ideal is to drink around 70ml water per Kg(body weight). Wet food contains at least 75% moisture.

I add water or soup to my cat's meals and feed them 6 small meals a day. This way, they don't need to consume a lot of water at once. As a result, I haven't seen my cat drink water on their own anymore.


Food

Moderate in protein and low in phosphorus diet aims to reduce the workload on the kidneys while still meeting the cat's nutritional needs. Feeding CKD wet food is recommended. Wet food has a higher moisture content.


Phosphorus 

The phosphorus levels in cats with chronic kidney disease (CKD) will gradually increase over time.
High phosphorus levels will make cats discomfort, such as:

Lack of appetite
Nausea or vomiting
Unexplained weight loss
Weakness
Depression or lethargy
Excessive thirst
Rubber jaw (weakening of the bones due to excess blood phosphorous, causing tooth loss and soft jaw bones)
Muscle tremors
Twitching

Limiting phosphorus intake is vital for CKD cats as impaired kidney function can lead to an inability to efficiently eliminate excess phosphorus from the body. Elevated levels of phosphorus can further damage the kidneys and contribute to other complications associated with CKD.

Use a phosphorus binder if it is necessary. It is better to keep the Phosphorus level under <5.0 mg/dL / <1.6 mmol/L or at least <6.0 mg/dL / <1.9 mmol/L.


Supplements to help reduce CKD toxicity

Some supplements would held bind or trap waste products. Such as:
AIM is a protein in the blood that supports kidney health by removing the waste that accumulates in the body. The problem is, AIM could get stuck up with immunoglobulin (IgM) antibodies so that it can't destroy the dead cells and other debris in a cat, causing kidney problems and renal diseases. It is the A-30's job to disassociate the AIM from the IgM and activate it. 
https://www.u-tokyo.ac.jp/focus/en/features/z1304_00039.html

Native bacterial would able to trap creatinine and absorbed excess nitrogen from the gut, is then excreted with the stool. 

Activated charcoal may be a viable alternative to dialysis. The reason: It binds to urea and other toxins, reducing the number of waste products that filter through kidneys.


Supplements to balance electrolytes

A damaged kidney might not be able to balance electrolytes sufficiently. Based on regular blood tests and providing the right amount of supplements. For example, low potassium levels in cats can cause symptoms such as weakness and fatigue.


Nausea and Excess Stomach Acid

When cats suffer from chronic kidney disease (CKD), they often experience symptoms like nausea, excess stomach acid. Those also tend to decrease a cat's appetite. There are medications available that can help alleviate these issues:

Cerenia is an antiemetic used to treat vomiting and motion sickness. Cerenia works on the source of vomiting in cats - the brain.

Omeprazole or Slippery Elm Bark for excess stomach acid.


Fish oil and Q10

It is an excellent supplement for keeping pets healthy, as it helps protect against many systemic inflammatory diseases. Additionally, it can give your pet a beautiful coat and effectively reduce shedding and skin irritations.


Brushing your cat's teeth

Poor dental hygiene can contribute to the development and progression of CKD in cats. The buildup of plaque and tartar on teeth can harbor bacteria, which may enter the bloodstream through inflamed gums. These bacteria can then potentially affect the kidneys, leading to inflammation and damage over time.
Regularly brushing your cat's teeth is one effective way to prevent dental issues and potentially reduce the risk of CKD. 


Pancreatitis

It has been found that cats with kidney disease are more likely to develop Pancreatitis than cats without kidney disease. These diseases can cause a wide range of symptoms, including vomiting, diarrhea, weight loss and lethargy. That's why a cat with kidney disease should be monitored more carefully to avoid overworking the pancreas. More info about Pancreatitis in cats:
https://ckdcats.org/blog/Fix-Unexplained-Persistent-Vomiting-and-Diarrhea-in-Cats


Blood Urine

Urinary crystals, although tiny, do not typically cause discomfort unless they aggregate to form larger stones within the urinary tract. Following is an an article about how to treat blood urine in cats.
https://ckdcats.org/blog/Treat-Blood-Urine-in-Cats


High Blood Pressure

Cats with chronic kidney disease (CKD) have a higher risk of developing high blood pressure. Regular check-ups and providing appropriate treatment.