General's Story: Reflections and Lessons Learned While Caring for an 18-year-old Cat with Stage 4 CKD

Spending day after day with a cat in the late stages of chronic kidney disease (CKD) is never easy. The cat’s condition fluctuates constantly, and the owner must always be ready to make a choice that could change everything.

This is my personal recording of my own experiences looking after General, an elderly cat with stage 4 CKD, from January to November of 2024. More specifically, I want to share what I’ve learned while looking after General during his last days.

It is my earnest hope that the lessons that I learned at such a great cost to myself and General can help those in the same predicament that I was once in.

 


SubQ and IV Fluids to Lower BUN Levels

As BUN levels rise, cats become more prone to uremia (where waste products accumulate in their blood), causing severe kidney damage. As such, keeping BUN levels down is vital for cats who are in the later stages of CKD. In such cases, subcutaneous (SubQ) fluid injections are effective at lowering BUN levels. Most households with cats suffering from CKD are presumably already relying on daily SubQ injections to treat their cats.

However, owners should be careful when administering SubQ fluid injections to cats with late stage CKD. This is because there are slight differences between the most common types of fluids used in SubQ injections.

Owners must carefully check to find the right type and amount of SubQ fluids for their cats in accordance with their blood test results to prevent the possibility of imbalances. The two factors that merit special attention in blood test results are the electrolyte levels and PH of the fluids, and owners should make adjustments to the fluids they administer after discussing their cats’ conditions with their trusted veterinarians.

Cats with no heart or lung-related issues can handle approximately 30 - 50 ml per kg of fluids a day, though this can be increased under the care of a veterinarian. In General’s case, my cat was 4 kg, and sometimes received up to 360 ml of SubQ fluids a day (90 ml per kg).

However, any increases in SubQ fluids should be gradual and under the supervision of a veterinarian through period blood tests to ensure that the treated cat does not suffer from side effects such as electrolyte imbalances. The cat’s kidney and lung conditions should also be monitored consistently, as the fluids may affect the aforementioned organs.

In addition, intravenous (IV) fluid injections are also recommended if possible. IV fluid injections should be administered twice a week at a veterinary clinic, and are even more effective at lowering kidney levels than SubQ fluid injections.


Vitamin B12 Injections to Prevent and Manage Anemia

Owners who are able to take their cats to the veterinarian periodically should also look into Vitamin B12 injections for their cats.

Anemia occurs frequently in cats with CKD, and Vitamin B12 can help prevent and manage the condition. Though it can be administered as a supplement, direct administration through injections are far more effective.

General himself received shots every other week when I took him to the veterinary clinic. Please consult your veterinarian to discuss whether your cat can benefit from Vitamin B12 injections.


MCT Oil for Weight Management

Most cats with late stage CKD end up gradually losing their appetite over time. Even when they do eat, they often end up vomiting the food back out, as vomiting is a common symptom of CKD.

This loss of appetite and inability to keep food down results in a calorie deficiency, leading to weight and muscle loss. The muscle loss occurs because the body begins to break down muscles to use for energy. This leads to a rise in BUN levels and puts a burden on the cat’s kidneys.

To prevent this from happening, MCT oil can be used to supplement your cat’s calorie intake and reduce both weight and muscle loss. Owners should try mixing MCT oil into their cat’s food and feeding it to them. In some cases, cats may be resistant to the idea of eating, necessitating forced feeding.

With General, I added around 3 g of MCT to each pouch of Royal Canin cat food I gave him, and I gave him up to 2 pouches of cat food a day.

One thing to note, however, is that MCT oil is metabolized in the liver. As such, it is not advised to feed MCT oil to cats with liver issues.


Human Medications for Weight Management

Another approach to weight management can be done through the use of medications meant for human use to partial effect, though this should only be done after consulting your cat’s veterinarian.

With General, I fed him Ketosteril, a drug meant to reduce weight loss in humans with kidney disease.

Ketosteril contains keto amino acids, which allowed General to retain his muscles despite his reduced protein and amino acid intake. Keto amino acids are BCAAs (Branched-Chain Amino Acids, amino acids that help build muscle) with the amino group removed. This means that they minimize nitrogen intake while helping the body maintain muscles.

General was given 1/4 of a capsule of Ketosteril every day, with the powder being mixed into a pouch of his wet cat food. Judging from my personal experience, I believe that it played a role in reducing his weight loss.

However, Ketosteril also contains calcium, and is not recommended for cats with hypercalcemia (high levels of calcium in blood).


Substances to Avoid in Late Stage CKD

Throughout the past 11 months, General was fed over 100 different types of substances through the supplements I administered to him. Some of these substances actually put him in temporary danger instead of helping his health.

I wish to list these substances here, so that others don’t have to make the same mistakes that I did when caring for General.

  • Fucoidan, Beta-glucan, Alpha-glucan (AHCC)
    These substances help activate the immune system. Due to the relationship between the body’s immunity and kidney health, I administered the substances to General as well as TT, another cat of mine who had stage 2 CKD. When administered in suitable amounts, they seemed to have some effectiveness in increasing their immunities and energy levels.

    However, too much of the substances led to a rise in General’s white blood cell levels, putting him at risk of a cytokine storm. This was critical, as cats in end stage CKD suffer from uremia, making them susceptible to inflammation and cytokine storms. Thus, owners should take care to avoid excessive administration of fucoidan, beta-glucan, and alpha-glucan.

  • NMN, NR, Pterostilbene, Fisetin, Spermidine
    The substances above have become acclaimed recently for their anti-aging properties. They activate AMPK pathways and SIRT to restore DNA and provide support to mitochondrial and cellular health.

    I believe General also benefited somewhat from these substances. However, he also experienced temporary drops in energy levels due to his lower blood sugar and pressure. His weight also dropped, and I believe that the cause may have been excessive activation of AMPK.

    Thus, while the substances can help cats, there is still not enough data on their effects and appropriate dosages.

  • Glycine, Glutamic Acid, Aspartic Acid, Arginine
    These common amino acids are often found in kidney supplements, but excessive intake may do more harm than good. Your cat may initially see noticeable improvements, such as higher energy levels, after being given a large amount of supplements containing these amino acids.

    However, after long-term and high-quantity administration of such supplements, TT and some other cats temporarily experienced elevated proBNP levels and hypertrophic cardiomyopathy (HCM). I was only able to lower TT’s proBNP levels by adjusting her dosage and suspending the administration of some of the substances.

    However, there have been reported cases where other cats were not so lucky, and passed away due to HCM. While amino acids are vital for feline kidney care, some of them may cause neuro-excitotoxicity or HCM in cats if administered excessively (time and quantity-wise).

  • Cysteine, Cystine, NAC (N-Acetylcysteine)
    Some owners have recently turned to cysteine, cystine, or NAC for their cats in order to activate the AIM within them. While it is true that some studies have suggested the possibility that these substances can help trigger AIM, improper administration can also have severe repercussions on cats.

    The common ground between these substances is that they call contain sulfur. Thus, when they are metabolized in the body, it leads to the creation of sulfuric acid. This, in turn, lowers the pH of the body, leading to issues such as metabolic acidosis and inflammation.

    General himself suffered from metabolic acidosis after being administered the above substances. I accordingly adjusted the dosage and also gave him sodium bicarbonate to manage his metabolic acidosis. Cats with CKD have trouble regulating the pH within their bodies, and thus require special care.

Choosing the right supplements and administering them properly are, I believe, the most important aspect of CKD care for cats. Even now, there is still no cure for feline CKD. All we can rely on are supplements and injections to manage our cats.

One thing I’ve come to realize over my research into supplements over the past few years is that there is balance to all things. All supplements, even the effective ones, have side effects. I suppose you could say that a lack of side effects implies a lack of results. Therefore, painstakingly delicate care is necessary to minimize the side effects while still ensuring your cats benefit from supplements. This includes finding the right dosage, understanding and considering the potential interactions between supplements, and making adjustments according to your cat’s condition.

Both human and cat bodies are like an orchestra. The moment one instrument fails to play properly, the music is thrown off balance, resulting in a cacophony. Like a stalwart conductor, cat owners must also maintain balance within their cats as the situation demands.

So when it comes to choosing the right supplements and dosages, balance is the most important aspect.


Stem Cell Therapy for Cats with CKD

Some owners looking after cats with CKD may be wondering about the potential for stem cell therapy. In veterinary clinics, stem cell therapy generally refers to extracting stem cells from other cats of the same species, cultivating the stem cells, and then injecting the stem cells into the sick cat.

Reports on the effectiveness of stem cell therapy are conflicted. Some experts claim that it is highly effective in treating CKD, while others claim that its effectiveness is unclear and that the treatment may result in severe side effects. Opinions are also divided on the degree of the potential side effects - some express that there is a risk of cancer or tissue fibrosis.

In General’s case, my cat received over 10 stem cell therapy injections. I was fully aware of all the potential side effects of the therapy after discussing my options with multiple professionals, but I decided to go ahead with the treatment all the same.

After his first session of stem cell therapy in January, General’s creatinine and BUN levels dropped dramatically, and continued to fall even in February. Back then, I honestly believed it was a miracle cure for him. However, after 2 months of periodic injections, there were no further improvements in his kidney levels. My personal assumption is that the decrease in inflammation led to partial improvement and recovery of his kidney functions.

Seeing as there were no further improvements, I temporarily suspended stem cell injections, only resuming them when General’s uremia worsened. However, the injections had no effect, and General’s condition continued to deteriorate.

Stem cells contain growth hormones, cytokine, and transmitters known as exosomes. I believe these substances can help soothe inflammation in the kidneys and activate kidney cells. However, they may not be enough to help cats who have struggled with CKD for much of their lives. The toxins resulting from severe uremia can prevent these beneficial substances from serving their purpose, making it difficult for them to delay the progress of CKD.

Speaking from my personal experience with General’s case, I believe that stem cell therapy can help cats with CKD who suffer from mild uremia and inflammation, but may not provide much help to cats with severe uremia from long-term CKD.


X-ray and Inflammation Tests (SAA, fSAA) for Complication Management

Constantly heightened BUN levels may lead to inflammation within. General himself suffered from concerning anemia-related levels in October. As anemia is a common symptom of CKD, I was mostly worried that his CKD was getting worse.

However, the truth was that General was suffering from pneumonia. At the time, my main concern was with his blood tests. If I’d pushed for an inflammation test or an X-ray, perhaps he would have been properly diagnosed with pneumonia, and he would still be with us here today.

It’s true that cats with CKD require constant visits to the hospital. However, this can in turn create a major blind spot in your cat’s care, as you are liable to focus solely on CKD and its related symptoms. Hence, I believe it is important to take your cat to the veterinary clinic every now and then for tests to detect and care for non-CKD-related complications, such as the aforementioned inflammation and X-ray tests.


Is Dialysis the Last Hope for Feline CKD?

When it seemed like everything was hopeless for General, I considered both hemodialysis and peritoneal dialysis as last-ditch options for General’s survival. However, after consulting a trusted veterinarian, I ultimately chose not to go through with them.

I was told that dialysis could extend General’s - that is, a cat with late stage CKD - life by about a week. However, the process to put General on dialysis would require general anesthesia to insert catheters, and the catheters themselves would be difficult to keep in for a long period of time. Furthermore, I was informed that the inserted areas would suffer from inflammation.

According to the veterinarian, dialysis would be more beneficial for cats with acute kidney injury (AKI) than cats with CKD, whose kidneys have already been damaged and require steady care.


Nasogastric Tubes, Appetite Stimulators, and Antiemetics

Most cats with CKD suffer from periodic vomiting and weight loss, but many cat owners find it difficult to properly provide the appropriate treatment, as it involves force-feeding their cats. The pain of having to feed their cats against their will can cause them to harbor doubts and wonder if this forced method of life extension is the right thing to do.

During the early period of his care, General had to deal with nasogastric tubes and liquid food. Nasogastric tubes can be a fairly touchy object. Some veterinarians are against the practice, believing that the risks outweigh the potential benefits. Thankfully, the tubes helped General greatly. It meant that I didn’t have to feed him against his will in the early stages of his treatment. After General recovered his energy and the tubes were removed, General was willing to feed himself. Thus, the choice to rely on nasogastric tubes can be a matter where the veterinarian’s personal philosophy on treatment and the owner’s ability to take care of their cat influence the final decision.

General, age 18, with nasogastric tubes.

With appetite stimulants, however, I do think there is quite a bit of merit to using them. Once a cat has been fed against their will, they develop a mental resistance to the idea of eating and food. Thus, even after they have regained some of their vitality, their dislike of food may persist, and they may refuse to eat. Therefore, using appetite stimulants to encourage a cat to eat by themselves can improve their experience and perspective of food.

The same goes for antiemetics - drugs that treat vomiting and nausea. Vomiting is a common symptom in cats with CKD, and can become even more frequent due to issues such as pancreatitis. The worst part of vomiting is that it leaves cats with a feeling of discomfort that makes them feel like vomiting again and again.

I fed General a wide variety of supplements, and he’d often vomit after taking them, sometimes immediately vomiting them back up. When he did, I’d provide him with subQ fluids to keep him from being dehydrated, and give him antiemetics. While there are downsides to antiemetics, such as a dependency on them, I still believe that it is worth being able to provide a cat with proper food and supplements.

Thus, the greatest advantage of appetite stimulants is the mental care they provide for cats by allowing them to voluntarily feed themselves, freed from their negative memories of eating. Even cats are prone to giving up when they lack the mental fortitude.

Thus, proper application of appetite stimulants and antiemetics can help you care for your cat’s physical and mental health.

When's the Right Time to Say Goodbye?

After General passed away, I was an emotional wreck. Even a simple video of an old cat on Instagram could cause tears to stream down my eyes, and I’d find myself remembering General and becoming despondent while doing trivial tasks at home.

According to conversations I’ve had with the veterinary experts working alongside Greycoat Research, most cats can sense when it’s their time to go. When they do, they seek out cool, dark, and wet spaces. Whether it’s the laundry room, a storage room, the garage, or some other room they’ve never been to, they’ll slowly make their way to the corner and curl up.

It is at that moment that we must make the choice on how we will part from our cats.

Some may choose to send their cats off at the hospital they’ve been admitted to. They may choose to euthanize their cats to ensure their passing is as painless as possible. Or, heeding the veterinarian’s advice, they may bring their cat back home, so their final moments can be surrounded by their loved ones.

That was my choice as well. I brought General home so he could say his final goodbyes. My choice was influenced by the veterinarian’s statement that General’s mind was too dazed to properly feel pain. I simply wanted to let him go surrounded by warmth.

Yet, after General passed away, I came to regret my decisions. I began to think that letting him go at a veterinary clinic would have been so much easier on him… And yet, I do not think I’ll ever know the right answer to my conundrum back then, or if there even is a right one.

Questions, Answers, and a Choice

Perhaps the most difficult thing about looking after a cat with CKD is that there is no clear answer, no perfect cure for the disease. The disease causes your cat’s condition to change rapidly, requiring you to constantly stay alert so you can respond accordingly.

While veterinarians are the ones who diagnose and prescribe medicine to your cats, you yourself are responsible for actually taking care of them. And since cat care is a field that requires some amount of expertise, many cat owners freeze up in shock and worry when their cats are first diagnosed with CKD.

I felt that same fear and concern in 2019, when my beloved cat TT was first diagnosed with CKD in 2019. And I felt it once more in 2024, when I began to look after General, a cat with stage 4 CKD.

Over the past year, I’ve been able to talk with over 400 cat owners while offering them consultations on feline health care. Though every cat and owner were different, there was one common ground between them - what they needed, and what I could give them. And that was the help and advice they needed to make their own choices.

Greycoat Research’s consultation service for cats with CKD was established for this very purpose. As such, we encourage you to contact us when the time comes for you to make the choice for your own cat. We at Greycoat Research will stand by your side and help you decide the choice you need to make for you and your cat.

General the cat, born in 2006, became known online for his valiant struggle against stage 4 chronic kidney disease (CKD) at the elderly age of 18 after being taken in by YouTuber Claire Luvcat in January of 2024. Despite his age and disease, General's health slowly began to improve under Claire's care, and the old cat displayed an astonishing fondness for snacks and cheeseburgers, and putting the younger cats in their place. General passed away in November of 2024 after complications resulting from CKD, and is greatly missed by those who loved him dearly.

Claire Luvcat is a passionate advocate for proper cat health care and a YouTuber with a total of 7+ million subscribers on her various cat-related channels. Her 11 cats have earned the adoration of fans all over the world with their adorable and quirky antics. After one of her cats, TT, was diagnosed with CKD in 2019, Claire threw herself into finding ways to help not just TT, but other cats around the world suffering from CKD as well. Her efforts led her to cooperate with many veterinary experts and establish Greycoat Research, which provides dietary supplements that help delay the progress of CKD in cats.