s cats age, they face an increasing risk of chronic illness. Senior cats, typically those over 10 years old, often develop multiple concurrent diseases that require a nuanced and proactive approach to diagnosis and treatment. Fortunately, advances in veterinary medicine have provided new tools to detect these conditions earlier and treat them more effectively.

The following will review the most common diseases in geriatric cats and explore the current advances in their management, equipping veterinary professionals with the latest tools to improve outcomes and quality of life for their feline patients.

Some believe that cats are more likely than other species to be affected by chronic renal disease because of their unique physiology which makes them vulnerable to toxic nephron insult, their lack of “spare” nephrons and their link to desert-dwelling ancestors, who evolved their kidneys to be good at filtering water by making them work very hard. Throw in the fact that our domestic felines live much longer than their wild counterparts, and the diagnosis seems less surprising.

Phosphorus management is another important strategy in these cases. An FGF 23 test is available as an early marker of phosphorus overload. Dr. Acierno stresses the value of IRIS (International Renal Interest Society).¹

Chronic renal disease leads to anemia in many CKD patients. In the past, erythropoietin was the primary tool used to manage this condition; however, there were limitations with long-term use of erythropoietin because of antibody production.

Now we have Varensin-CA1 (molidustat), a conditionally approved treatment for non-regenerative anemia for CKD patients. Molidustat stimulates a cat’s own erythropoietin production and is available in an oral suspension.

Intestinal dysbiosis is believed to be a contributor to CKD. As CKD progresses, the diversity of the GI microbiome collapses, leaving bacteria that can produce toxins to be absorbed in the colon and damage the kidneys. Dr. Acierno feels that prebiotics, probiotics and absorbents can play a role in management of CKD. He says Porus One is an intestinal binder that can help bind and remove these uremic toxins from the GI tract and is fairly well-tolerated.

These are not all the strategies that could help CKD patients live longer and better lives, and there are ongoing studies that may yield even more.

What’s New?

Radioiodine therapy (I-131) continues to be the gold standard, offering a potential cure. Recent protocol improvements have reduced hospitalization time, making the procedure more accessible; however, this treatment is still costly. Because this treatment is an injection, it reduces stress on the cat compared to surgical interventions.

Dietary management using iodine-restricted food is only effective when it is the sole food available to the patients. It is important to remember that even a single lapse can render this therapy ineffective; therefore, it may not be a suitable choice in all circumstances.

Surgical thyroidectomy has also seen improvements in technique, reducing risks of hypoparathyroidism and recurrence.

You will see that effective client education helps owners sift through all the options to find what is best for their own hyperthyroid cat.

What’s New?

According to Kirsty Oliver, VN, DipAVN (Surgical), CVT, CCRP, CVPP, cats can benefit dramatically from physical therapy and, sometimes, it is just a matter of creativity to get cats engaged in the exercises. Do not rule out the idea that a feline patient could respond to PT.

Solensia® (frunevetmab), a monoclonal antibody against nerve growth factor (NGF), represents a breakthrough in feline OA treatment. It offers monthly injections that may reduce pain and improve mobility. Opinions are mixed on this therapy, but it is a tool in the toolbox for managing feline pain.

As our awareness and knowledge about pain in cats grows, more tools come to light to help us manage it, including the American Animal Hospital Association’s “Pain Management Guidelines.”²

Continuous glucose monitors have also allowed owners more direct access to monitoring pets’ blood glucose readings. These devices can be placed on the skin of the cat, providing glucose measurements from the interstitial space which closely correlates the traditional blood glucose measurements. Stress is decreased for the cat by not having repeated blood draws, and the values are readily available for the vet team and owners.

Nutritional therapy plays a critical role, with high-protein, low-carbohydrate diets being shown to support remission. Alongside dietary management, intensive early insulin therapy is linked to increased rates of remission, particularly when initiated promptly after diagnosis.

Owner compliance (and cat compliance) still impact care, but these tools have made management easier.

In addition, advanced anesthetic protocols tailored for senior patients improve safety during dental procedures. And the use of regional nerve blocks enhances intra- and postoperative pain management, contributing to faster recovery and better quality of life.

Jan Bellows, DVM, DIPL, AVDC, ABVP, says that tooth resorption is specifically common in older cats and recommends we all teach our senior cat owners to apply a cotton-tipped applicator to the gums of their cats and if it seems to be painful, it is imperative to alert the veterinary team. He also emphasizes that any oral mass should be thoroughly investigated in these patients.

We should emphasize that owners of senior cats be not only aware of the possibility of dental pain in their cats, but also consider using some of the at-home care products that have been evaluated by Veterinary Oral Health Council (VOHC).³

Advanced imaging modalities (CT, MRI and contrast-enhanced ultrasound) are also improving, allowing for enhanced tumor localization, staging and surgical planning.

Craig Clifford, DVM, MS, DACVIM (oncology), cautions that each oncology patient should receive more standard database diagnostics before they are referred. He says, “These are veterinary tests, not oncology tests.”

Dr. Clifford also says that there are exciting developments on the horizon for cats in oncology. A study has been conducted on the use of Solensia® in managing pain associated with oral squamous cell carcinoma. He also mentioned that there is testing from a company called Imprimed that can advise clinicians which chemotherapeutic regimen will be most effective for an individual patient with feline lymphoma.

The future for treating and managing cancer patients grows brighter each day.

As veterinary medicine continues to evolve, so too do our capabilities in managing chronic disease in senior cats. From earlier detection tools and innovative pharmaceuticals to refined surgical techniques and quality-of-life assessments, today’s veterinary professionals are better equipped than ever to support aging feline patients.

Ongoing education, client communication, and individualized care plans remain the foundation for improving longevity and well-being in senior cats. Staying informed about these advances ensures that we can provide compassionate, state-of-the-art care to our most vulnerable feline companions.

1. International Renal Interest Society (IRIS). https://www.iris-kidney.com/
2. 2022 AAHA Pain Management Guidelines for Dogs and Cats. American Animal Hospital Association. https://www.aaha.org/resources/2022-aaha-pain-management-guidelines-for-dogs-and-cats/
3. Veterinary Oral Health Council (VOHC). https://vohc.org/