In this 7‑minute presentation Dr. Kevin Toman, a veterinarian with four decades of experience and a pet‑longevity specialist, outlines the seven most important things cat owners need to know about feline chronic kidney disease (CKD). He begins by identifying the two main pathophysiologic drivers – undiagnosed hypertension and chronic inflammation – and enumerates the most common inflammatory sources: dental disease, over‑vaccination (especially in indoor cats), and cat fights. He then stresses the importance of early detection, explaining why traditional BUN and creatinine are late markers and introducing newer, more sensitive blood tests (SDMA and cystatin B) and urinalysis for proteinuria. The third point revises dietary dogma: rather than a blanket low‑protein diet, the goal should be to maintain the cat’s body weight, using moderate protein or supplemental meat when needed. The fourth point covers water intake, noting the typical early increase followed by later decline and suggesting flavoring tricks to encourage drinking. The fifth point clarifies that no drug can restore kidney function; current medications only manage hypertension and proteinuria. The sixth point describes the kidney‑heart interplay, where CKD‑induced hypertension harms the heart, underscoring the need for blood‑pressure monitoring. Finally, he looks to the future, highlighting experimental stem‑cell therapy and the Japanese AIM molecule as promising avenues. He closes with contact information for owners seeking personalized help.
Chapters
Well, hey you guys, welcome to The Longevity Vet. I'm glad you're here. Today we're going to take a deep dive into the 7 things you should understand about your cat's chronic kidney disease, and yes, every one of them is based on my 40 years of veterinary practice. I'm Dr. Kevin Toman Toman. I've been a veterinarian for those 40 years, and I'm a pet longevity specialist. So let's get to work. The first question that many folks ask me is, why my cat? Why did my cat develop chronic kidney disease? And day in and day out, there are a couple of answers for most cats. First off is about 15 to 20% of cats have undiagnosed high blood pressure, just like us humans. And just like us humans, that high blood pressure will come back to wreak havoc on the heart and the kidneys. So whatever you do, please have your local veterinarian check your cat's blood pressure with each and every exam. Listen, it's a pain in the ass to check a cat's blood pressure, and so that's why most vets don't do it, but there's nothing more important if you're looking to try and head chronic kidney disease off the pass for your cats. The other common cause of chronic kidney disease for your cat is our old friend inflammation. In every species, chronic kidney disease starts as just simply a swollen and irritated set of kidneys, progresses through scar tissue accumulation, and that scar tissue prevents normal kidney function down the road. What are the most common causes of inflammation for your cat? First off, our old friend dental disease. Now listen, you've heard me talk about this before, and I'm here to tell you that every cat over 7 ought to be having an anesthetic dental done once a year with x-rays taken of every tooth in their body. So that we can accurately diagnose and treat problem teeth. If your veterinarian cannot take dental x-rays of every tooth, find a new vet because the technical term for that is malpractice. Moving right along, the other common source of inflammation associated with your veterinarian's work is the use of extra vaccines. Now listen, if your cat is an outside cat, continually getting into scrapes with other cats, then they should be getting every vaccine every year. But I have a real problem with older or with inside cats being given more vaccines than they need. Why? For two different reasons. First off, every vaccine is designed to do one thing, and that is to piss off your immune system and create inflammation. That's just simply the way they work. But that comes back to haunt our kidneys. The other thing you should understand is that a very small percentage of cats will develop fatal skin cancer at the site of the vaccine. Anytime you poke a, a sensitive cat with a needle, there is the chance that they will develop a specific type of tumor known as sarcoma, and that's why many veterinarians are choosing to vaccinate your cat against rabies way down low on the right hind leg and against leukemia way down low on the left hind leg. Because, get this, if they run into a tumor, it gives us a better chance to amputate the leg in an effort to save your cat's life. Now let's scratch our heads and think about that for just one minute. Why would we expose our indoor cat, for instance, to that risk? It just simply does not make sense to me. The third most common source of inflammation for our cats, especially outside cats, is cat fights. Anytime a cat goes out and picks a fight with another cat, comes back with scratches or a cat abscess, they by definition have, have created inflammation in their system, and over the longer term, that inflammation will come back to create kidney problems for your kitty. Point number 2 is early detection counts. Now listen, I've been a veterinarian for 40 years, and so I can tell you that back in the day, the only way that we could determine whether your cat had kidney disease was with a couple of blood tests known as BUN and creatinine. But here's the problem with that. Number one, they were inaccurate because if your cat is on a different diet or if your cat has more or less muscle in their system, then those tests could be— could lie to us. The other part of things, however, is that BUN and creatinine only increase outside of normal levels after you see about two-thirds of cat kidney function being lost. So in other words, they are very late indicators that your cat is getting into a jam. Nowadays, we have, we have two more accurate blood tests, two more accurate and sensitive blood tests than BUN and creatinine, and we can also use a urinalysis for early detection. Let me explain more. The blood tests that give us the earliest detection of chronic kidney disease in your cats are SDMA, or the blood test known as cystatin B. These are tests that can be drawn with just a couple drops of blood, guys. This is not a big deal, and it will provide an early detection, an early warning system that your cat's kidney function is not everything it's cracked up to be. And I mentioned urinalyses as well. Listen, under normal circumstances, your cat's urine should not have any protein in it. But as they start to run into kidney problems, the level of protein in their urine will increase and increase and increase. And so that's another way that we have of detecting chronic kidney disease early in the game. Why is that so important? Because that enables earlier treatment. And point number 3 that I'm going to chat about is just simply the dietary care of a chronic kidney disease patient. Another thing that has changed over the 40 years that I've been a veterinarian is the dietary management of these cats with kidney disease. Because I was taught that every cat with chronic kidney disease ought to be on a low protein diet. But about 15 years ago, there were studies in both human medicine and veterinary medicine that put the lie to that. That's just simply inaccurate. Not every cat should be on a low protein diet. Here's what's more important: when your cat, or for that matter, when a human starts running into chronic kidney disease, we want to feed them whatever it takes to maintain their body weight on on an even keel. If they are losing weight, we are condemning them to a shorter lifespan. So if your cat needs to stay on their, their original diet, if your cat won't accept any other diet and it takes their original diet to keep up, keep their body weight normal, then so be it. If we can get them switched over onto a moderate protein diet that again maintains that body weight for them, that's even better. But there are times when if we use a low protein diet and we start to see weight loss for these kitties, then we have to come back and supplement them with chicken or turkey or fish meat over the top in an effort to maintain that normal protein metabolism. What's the take-home message? The, the heavier your cat is, and this is not something you hear me say very often, but the heavier your cat is when the diagnosis of chronic kidney disease is made, the longer you will have them, so pay attention. Moving right along, the other thing that we should understand is water intake, and water intake varies significantly between cats with chronic kidney disease. Early in the game, it's not unusual to see water intake increase dramatically, but as cats go through chronic kidney disease, that water intake tends to drop. So there are times when we actually have to flavor the water with a little bit of baby— chicken baby food, or a little bit of sardine water, a little bit of tuna water, in an effort to go ahead and stimulate water consumption for our kitties. Okay, point number 5 is drugs, and unfortunately, I've got some bad news for you. There is no drug that will directly improve kidney function. There are drugs to minimize the inciting side effects, so we can start kitties with chronic kidney disease on drugs to control their blood pressure. We can start kitties with chronic kidney disease on drugs to control the amount of protein that they have in their urine, but the reality is that there's very little that you and I can do in the way of actual drug therapy that's going to solve your cat's kidney disease. It just isn't there yet. The other thing you should understand, point number 6, about, about chronic kidney disease in your cats is this: your cat's kidneys and your heart work in two very different and opposite ways. So if you have a cat who's developing chronic kidney disease, they're gonna use hormones, your kidneys are gonna release hormones to artificially increase your kitty's blood pressure, because that will enable your cat's kidneys to do a better job of filtering the toxins from your kitty's urine. But here's the problem with that, that high blood pressure that's caused by the kidney disease will negatively affect the heart. So again, it points us directly at this interplay between kidneys and heart and the importance of having your veterinarian monitor your kitty's blood pressure. Point number 7 is, what does the future hold for us? Well, there is some interesting— there's some interesting things coming up down the road. One is the use of stem cells in these kitties with chronic kidney disease. We've been working on that for the last 10 years or so, and there are some substantial results showing that these kitties are starting to improve after stem cell injections in there into their kidneys or into their kidney blood vessels. The other thing is that there's a fascinating study that's been done by a veterinarian over in Japan using, uh, it's called the AIM molecule or the AIM cells, and these are activated macrophages that seem to help to reverse the progression of chronic kidney disease. It is not licensed for veterinary use in either Japan or in the US, but it is coming, and that is probably the single biggest thing that I see on the horizon for our cats with chronic kidney disease. So listen, I stumbled and stuttered my way through this. I'm not a YouTube guy. I am a veterinarian, and I care about your cats. If you have a cat with chronic kidney disease, please reach out to me. Let's talk. If you have a question, email me at DrKevin@TheLongevityVet. I run a website called www.HelpingPetsLiveLonger.com. I will help you if I can, and we are all in this together. Thanks and have a great day.
