Is your cat still anemic even after taking iron supplements? Has your cat received erythropoietin (EPO) injections, but the effects seem to be wearing off? Anemia is a common issue in cats with kidney disease. When EPO injections no longer help and iron supplementation doesn’t raise red blood cell counts, cat owners are often left feeling helpless.
But there is one often-overlooked solution: melatonin.
"Melatonin? Isn’t that a sleep supplement?"
If that’s your first thought, it’s a perfectly normal reaction. Melatonin is widely known as a sleep-regulating hormone secreted by the pineal gland.
But melatonin has another, lesser-known role: it stimulates hematopoietic stem cells in the bone marrow to support red blood cell production.
In cats with kidney disease, EPO injections sometimes fail not because of dosage issues, but because the bone marrow is no longer responsive. This is where melatonin comes in.
Greycoat Research: Data-Backed Care for Kidney Cats
Since 2024, Greycoat Research has provided over 1,000 kidney care consultations for cats with stage 2 to 3 kidney disease worldwide. Our approach is based on real-world caregiver data and guided by expert insights:
- Supplement consultations based on research by Dr. Toru Miyazaki of the Institute for AIM Medicine
- Practical guidance from Dr. Kim Jae-young, caregiver of Korea’s oldest cat (Minky, age 28)
- Clinical insights from Dr. Motoo Kobayashi, with 30 years of experience in feline kidney care
- Supplement and fluid therapy tips from clinical pharmacy expert Dr. Alex Shin
Melatonin’s Role in Bone Marrow Response
A sleeping cat. Melatonin is commonly thought of as just a sleep hormone, but actually performs another role.
Melatonin is more than just a sleep hormone. It acts on MT1/MT2 receptors in the bone marrow, promoting the survival and differentiation of hematopoietic precursor cells. It also provides antioxidant and anti-inflammatory benefits, helping to restore bone marrow function suppressed by oxidative stress and inflammation.
However, there’s an important caveat: metabolic acidosis.
As kidney disease progresses, a cat’s blood becomes more acidic. In this state, red blood cells break down more easily, and new ones are harder to produce. Even with melatonin, hematopoiesis may not occur unless the acidosis is resolved first.
| Melatonin Action | Expected Effect |
|---|---|
| Stimulates MT1/MT2 Receptors | Activates precursor cells and promotes red blood cell production |
| Antioxidant Effect | Protects bone marrow and mitigates oxidative suppression |
| Anti-inflammatory Action | Helps restore hematopoietic environment suppressed by inflammation |
Real Case: 'J' and the Limits of Iron and EPO
At Greycoat Research, we cared for a stage 3 kidney disease cat, J, weighing 4 kg. J’s HCT dropped to 13.2%. Despite receiving iron and EPO injections, his condition worsened to the point of requiring a transfusion, but no improvement was seen.
J's lab results before melatonin was administered.
We first stabilized J’s acidosis and then began co-administering melatonin (2mg/day) with EPO injections. After 4 weeks, J’s HCT returned to normal, and he resumed eating and climbing his cat tower. 2 months later, J continues to maintain healthy HCT levels without further EPO treatment.
J's lab results after melatonin was administered.
This case shows that melatonin can stimulate bone marrow response and work synergistically with EPO.
How to Administer Melatonin and Choose the Right Product
The currently recommended melatonin dosage for cats with kidney disease is 0.5 mg per 1 kg of body weight, once daily. This dosage is based on real-life care cases but still requires further study.
Melatonin is generally considered a safe supplement. In addition to supporting hematopoiesis, it may help reduce oxidative stress and support immune balance.
However, one critical point: do not use plant-derived melatonin.
Some products on the market use melatonin extracted from tomatoes, nuts, or grains. These often contain only 5–10% melatonin, with the remainder made up of substances like oxalates, lectins, or fat-soluble vitamins, which can be harmful to cats with kidney disease.
Cats with late-stage kidney disease have impaired ability to eliminate fat-soluble substances like vitamins A and E. This makes such supplements a potential burden. Always choose pharmaceutical-grade synthetic melatonin, and only use it under veterinary supervision.
A cat getting a checkup at a veterinary clinic.
Melatonin is not just a sleep aid. It has potential as a hematopoietic support supplement that can help restart bone marrow activity. However, for it to be effective, metabolic acidosis must be addressed first. The best approach is to use melatonin in combination with EPO injections.
Greycoat Research has documented several cases in which this combination improved anemia in cats with kidney disease. If your cat's anemia hasn’t responded to iron or EPO alone, melatonin may offer a turning point.
Get a Free Consultation Today!
Kidney disease is a progressive and irreversible condition that gradually impairs kidney function. Because many cats show no symptoms until significant damage has occurred, early detection and management is key to delaying its progression and preserving quality of life.
Greycoat Research has provided consultations for over 1,000 cats, with 97% of stage 2 and 3 cats showing improved kidney health after following our tailored management plans. If your cat has been diagnosed with kidney disease or has high creatinine levels, taking action now can lead to lasting improvements.
- Try AIM-based supplements, including Dr. Toru Protocol, along with additional kidney support.
- Monitor kidney health regularly and adjust treatment plans as needed.
- Schedule a free consultation with Greycoat Research for expert guidance.
