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Signs and Stages of Kidney Failure in Cats (And What to Do)

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Dr. Mark is a veterinarian. He works with dogs, cats, exotics, and livestock.

Learn about the signs and stages of chronic kidney disease and how to make a cat with kidney failure more comfortable.

Learn about the signs and stages of chronic kidney disease and how to make a cat with kidney failure more comfortable.

Signs of Kidney Disease in Cats

There are some problems that mimic chronic kidney failure in cats, so the best thing you can do is take them to your vet if you notice any of the following symptoms:

  • weight loss (also common with hyperthyroidism)
  • poor appetite (also seen with dental problems)
  • dehydration, (eyes sunken in, skin stays in place when you pull it up—also seen with diabetes)
  • constipation or diarrhea (also seen with hairballs)
  • vomiting, or sometimes just nausea (also seen with allergy to the food)
  • drinking more than normal (also seen with diabetes)
  • urinating more than normal, sometimes outside the litter box (also seen with diabetes)
  • foul breath (also seen with periodontal disease)
  • ulcers in the mouth (also seen with calicivirus infections)
  • pale gums (also seen with liver disease)
  • depressed, with less energy than normal (also seen with arthritis)

Some veterinarians and experienced cat owners can tell you if a cat has kidney disease just based on these signs and how things are going at home, but no one can tell you for sure how bad it is until you have things checked out by a vet.

How Can I Check My Cat for Kidney Disease?

In order to diagnose kidney failure, you will need to take your cat to your veterinarian for a physical exam and bloodwork.

Bloodwork will tell you if your cat has anemia and how well or how poorly the kidneys are working. Another test (SDMA) will even tell you if there are any problems before there are many clinical signs. Your vet will probably do x-rays at that time to look at the kidneys and may also want to do an ultrasound.

The results will allow your vet to tell you what stage of kidney disease your cat is in.

What Are the Four Stages of Kidney Failure in Cats?

Stage 1 (Mild)

Cats may have no clinical signs but do have a higher creatinine and a normal SDMA (this stands for symmetric dimethylarginine, a newer test to diagnose the severity of kidney disease). Less than 66% of your cat's kidney functions have been lost, and sometimes just improving the diet will allow your cat to maintain their weight and avoid progressing to the next stage for many years.

Stage 2 (Elevated)

Cats have a mild increase in waste products in the blood, which means that the kidneys are not filtering well anymore. The creatinine and SDMA are both mildly elevated, and cats might start to show some clinical signs. About 65–75% of the kidney's functions have been lost.

Stage 3 (High)

There is more waste in the blood (based on the blood tests), so cats have more of the problems (listed below). The signs are mild early but become more severe as the cat reaches the next stage. About 75–90% of your cat's kidney functions have been lost.

Stage 4 (Severe)

Some of these cats cannot walk around anymore and will not be able to control their bladder. They may not want to eat and just hide most of the time. By this point, many cats need to be on appetite stimulants, feeding tubes, and fluids for dehydration. About 90% of the kidney's functions have been lost.

No matter what stage your cat is at, there are things that can be done to slow their decline.

How to Manage Feline Chronic Kidney Disease

Although there is no cure, there is a lot you can do at home to slow down the progression of the disease.

Never Feed Dry Food Again

Cats with kidney failure cannot concentrate their urine and lose a lot of what they drink in the litter box. The only way to keep them hydrated and keep things from getting worse fast is by providing the extra water; canned food is the best way to keep your cat hydrated.

If your cat will eat it, you can also try adding a tablespoon of water to their food each time you give a meal.

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Feed a Prescription Diet

By providing enough protein but limiting the amount of phosphorus, your cat can live longer and have better quailty of life. (1)

Feed Your Cat Every Morning, Evening, and Night

As kidney disease progresses, cats will become more nauseous and vomit or refuse an occassional meal. Feeding several times a day is one way to help your cat meet their energy needs.

Supplement With Fish Oil

The omega fatty acids in fish oil will not reverse kidney disease, but they might slow it down. Some cats also find this stimulates their appetite, but stop using fish oil or use less if your cat develops diarrhea.

Give Slippery Elm Bark for Nausea

This herb is not for kidney failure, but it is very good for nausea. It is safe and can be mixed in the moist food.

Provide Plenty of Water With a Drinking Fountain

It is hard to get cats to drink enough even in regular circumstances, and since cats with kidney disease lose so much water in the urine, hydration is even more important. Water fountains provide an alternative source of cool running water and stimulate a cat to drink more.

Offer Water in a Flat, Plate-Type Dish

If your cat develops whisker fatigue and is reluctant to use their regular bowl to drink, it is a big problem. Using a flatter dish can help. Not all cats find these bowls necessary, but it does help in many cases.

Provide Multiple Dishes of Water

Besides the kitchen, have another water bowl near the area where your cat likes to hang out during the day. It also helps not to change them all at the same time as some cats prefer warmer water, some cooler. It is also a good idea to keep an extra water dish in the kitchen and drop an ice cube in it whenever possible.

Supplement With Natural Prebiotics and Probiotics

Prebiotics help cats with kidney failure gain weight. (2) All the toxins in a sick cats blood also kills the bacteria in the gut. Cats love the taste of fresh non-flavored yogurt, and the live bacteria in the food will help establish a normal flora so that your cat will have less nausea and other GI upsets.

Other therapies and medications can be prescribed by your vet as the kidney disease progresses:

  • Fluids: As the kidneys get worse, sick cats become more dehydrated and will need to get fluids every few days. Your vet will prescribe the correct amount, but they can usually be given at home where the cat is more comfortable.
  • Nausea Medications: The toxins in the blood cause nausea. There are several medications that can help.
  • Appetite Stimulants: When the cat will no longer eat, even when the food is warmed up or fed by hand, a prescription appetite stimulant will be needed. If you notice that your cat is eating less, it is a good idea to keep track of their weight and start this therapy as soon as possible.
  • Phosphate Binders: High phosphorus levels will make your cat very sick, so the mineral is limited in prescription foods. Eventually, a phospate binder may also be needed.
  • Anemia Therapy: Cats with chronic kidney failure no longer produce the hormone to make blood cells and become anemic. They need an injection of a hormone once a week to replace the hormone that their kidneys no longer produce, but it can be given at home.
  • High Blood Pressure Medication: The majority of cats with kidney disease have high blood pressure (3). Medications can help prevent secondary problems.

The medications and other therapies listed above will work and allow your cat to have a decent quality of life and live longer. But are there homeopathic options sold at pet stores that work?

Are There Home Remedies for Renal Failure in Cats?

Homeopathic cures will not stop your cat's kidneys from getting worse, nor will they improve their quality of life.

There have been over 1,800 studies on the benefits of homeopathic medicine for this condition, and a review of the several hundred that do not rely on "facts" from people that have wasted money on these cures prove that they do not work.

Before purchasing one of these bottles at your pet store, you can find out how they are made and why they do not work. There is no cure for chronic kidney disease in cats, and homeopathic cures are not cures at all.

If you provide more water, feed your cat a diet that is better for the kidneys, and use the medications recommended by your veterinarian, your cat can live longer with failing kidneys.

How Long Can Cats Live With Kidney Disease?

Studies have shown that cats live about 4 years fewer than healthy pets without kidney disease (usually about 2 or 3 years after first being diagnosed). (4) It depends a lot on how early it is diagnosed and how aggressively you choose to test and follow dietary changes and other recommendations.

If your cat is already at stage 4 by the time they are diagnosed, they may only live a few months.


  1. Hall JA, Fritsch DA, Jewell DE, Burris PA, Gross KL. Cats with IRIS stage 1 and 2 chronic kidney disease maintain body weight and lean muscle mass when fed food having increased caloric density, and enhanced concentrations of carnitine and essential amino acids. Vet Rec. 2019 Feb 9;184(6):190.
  2. Hall JA, Jewell DE, Ephraim E. Feeding cats with chronic kidney disease food supplemented with betaine and prebiotics increases total body mass and reduces uremic toxins. PLoS One. 2022 May 24;17(5):e0268624.
  3. Kobayashi DL, Peterson ME, Graves TK, Lesser M, Nichols CE. Hypertension in cats with chronic renal failure or hyperthyroidism. J Vet Intern Med. 1990 Mar-Apr;4(2):58-62.
  4. Boyd LM, Langston C, Thompson K, Zivin K, Imanishi M. Survival in cats with naturally occurring chronic kidney disease (2000-2002). J Vet Intern Med. 2008 Sep-Oct;22(5):1111-7.

This article is not meant to substitute for diagnosis, prognosis, treatment, prescription, or formal and individualized advice from your veterinarian. Animals exhibiting signs and symptoms of distress should be seen by a veterinarian immediately.

© 2022 Dr Mark

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