Chronic kidney disease (CKD) is a common condition in cats as they age, leading to high mortality in end-stage disease. One common clinical sign subsequent to the loss of urine-concentrating ability of the kidneys is dehydration. Many veterinarians will prescribe subcutaneous (SC) fluid administration as a palliative treatment for CKD. No studies have examined its efficacy for cats.
With this study, the investigators’ purpose was to survey owners regarding their practices and experiences administering SC fluids at home to cats with CKD. The aim was to gain insight on ways to help more owners be successful with this procedure. The survey was web-based (the survey link was made available too through different Winn Feline Foundation communication channels), consisting of 45 questions evaluating SC fluid administration frequency, type of fluid and several other variables involved with fluid administration in cats.
The total respondents was 486 which 399 had administered SC fluids, the majority of the responses were from the USA (n=352; 75%), the UK (n=48; 10%), Australia (n=24; 5%), and Canada (n=21; 5%) plus seventeen other countries represented by 1-3 participants. Looking at breeds of cats, fifty-nine percent (n=276) were domestic shorthairs. The remainder were domestic longhairs (n=46; 10%), Siamese (n=22; 5%), Persian (n-=15; 3%) and other (n=109); 23%). Eighty-seven percent (n=409) of the cats were 10 years of age or older. Of those, cats older than 15 years were the most common (n=250; 53%). The majority of cats involved IRIS Stages 3 and 4.
The survey reported that 95% (n=446) of owners discussed administering SC fluids with their veterinarian. Of the 399 owners who reported administering fluids, 58% (n=230) were directed to other resources such as brochures, videos, etc, where the remainder were not. Veterinarians were the most common individual to recommend giving SC fluids.
Of the 399 owners administering SC fluids, 37 (9%) gave fluids twice daily, 156 (39%) gave fluids once daily, 121 (30%) gave fluids 3-4 times weekly, 57 (14%) gave fluids 1-2 times weekly and 28 (7%) gave fluids on a basis other than what was listed. Lactated Ringer’s was the most common fluid type administered (n=296; 74%), followed by normal saline (n=56; 14%) being the second most common.
On the frequency of assessing hydration, 136 (34%) assessed once daily, 55 (14%) addressed hydration twice daily, 26 (7%) assessed hydration twice weekly and 38 (10%) assessed hydration once weekly. The majority assessed hydration by checking skin tent/turgor followed by assessing mucous membranes followed by estimating water consumption.
Three hundred and twenty-two (81%) administered fluids between the shoulder blades with the remaining owners administered fluids in another location. The majority of individuals utilized a rotation for needle insertion on their cats along with the majority used a gravity/drip method for fluid administration.
A 20 G needle was used by 120 (30%) to administer fluids, followed by 111 (28%) using an 18 G needle, 87 (22%) using a 21 G needle and 30 (8%) used a 22 G needle. Owners reported that needle size had an effect on tolerance. The most common amount of fluids given was 100 ml with about half of the owners administering this amount. Forty-seven (12%) reported that they added potassium as a supplement to their cat’s fluids.
The majority of owners stated they gave their cats treats after fluid administration as a form of positive reinforcement. Most of these individuals feel that this increased tolerance of the procedure. The majority (60%) stated they warmed fluids prior to administration also most reported that this increased tolerance. The length of time of fluid administration also affected tolerance. Over 90% reported changing the needle after every fluid administration event. Three hundred eighty-two (96%) stated they re-used the same bag of fluids. The majority of respondents reported learning to give SC fluids very easy/quite easy or okay. After becoming more practiced at fluid administration, 155 of 399 (39%) respondents reported their overall experience with administration to be easy/no stress, somewhat easy or okay for them.
The authors cautioned that because there were a large number of cats with IRIS Stage 1 and 2 receiving SC fluids and considering how long many of these cats will receive fluids over the course of their lives, it may be best for veterinarians to determine the benefit of SC fluid therapy and the balance between quality of life and treatments.
In addition, the survey results suggest that owners were more likely to learn the most from in-person appointments with hands-on training over receiving other resources. Veterinarians should be careful to not let other resources become a substitute for such in-person training. Veterinary professionals can provide guidance and education about the importance of regularly changing needles and fluid bags, along with the benefit of rotating the location of needle insertion.
The survey highlights that a majority of owners offered positive feedback about their ability to learn and administer SC fluids to their cat with CKD. For some though, the procedure was very difficult. In consideration of the cat-human bond, it is important to evaluate the balance between quality of life and treatment interventions for patients with CKD and tailor such SC protocols to the preferences of the cats to achieve long-term success.
