CKD and sub-q fluids

Hello, Our cat has CKD, early Stage 4, creatinine level of 5.2. Aside from drinking a lot of water, and consequently peeing a lot, she isn't showing symptoms of dehydration. Gums and eyes are fine, she's alert and active. Her skin snaps back quickly when pulled. Our vet has recommended that she be given sub-q fluids once a week. I have two questions about that. 1. If the cat isn't dehydrated, what is the purpose of the sub-q fluids? 2. If sub-q fluids are needed, what is the logic for giving them only once a week? Wouldn't it make sense to give them more frequently? Thank you for your consideration. Best, Ray

Hello! Obviously I am not the clinician in charge of your cat and as such will not be making medical recommendations for this patient.  However, fluid therapy for chronic cases is an inexact science, aimed at balancing quality of life with a need to maximise hydration. (On one side of the scales, a continual drip would be the best way to keep any cat hydrated, but is not consistent with an excellent quality of life.  Furthermore, putting large amounts of fluid into a vein in one go can result in much of it being urinated out again;  on the other side of the scales, insufficient hydration can exacerbate the kidney condition.  Ideally, a little water supplementation all the time would be useful, but it is not reasonable to have frequent low-intensity drips a home.   I found this article online, which you may find interesting, containing one set of guidelines about how this balance may by achieved.  (his is an American article.  I assume that you are in the States from the Units you are using). The page is:   https://felinecrf.org/fluid_therapy.htm And the article:  https://www.aaha.org/globalassets/02-guidelines/fluid-therapy/fluid_therapy_guidelines.pdf I hope that this helps a little;  it seemed relatively patient friendly. We also have our own overview of chronic kidney disease in cats in our blog:  https://vethelpdirect.com/vetblog/2020/11/25/chronic-kidney-disease-in-cats/ I hope that these resources help.

As ever, I think that the best way to answer these questions is to ask your own clinicians;  I expect them to say something alone the lines they are trialing a method of maintaining both hydration and a good quality of life;  that injecting s/c fluid weekly may not be ideal, but may help to maintain a level of hydration in a less than ideal renal system.  The obvious question would then be, how much do they feel that it helps and whether there are articles supporting that (this is where the articles above may come in useful). However, it is usually best to let them speak for themselves.

Perhaps the clinicians felt that some degree of top-up is better than nothing and agreed on this as a compromise?