Euthanizing Cats With Kidney Disease: When Is It Time?

Deciding when to euthanize a cat with kidney disease is a difficult and personal decision. Cats with kidney disease can sometimes live for years after their diagnosis, but the condition is life-limiting and, in the later stages, can cause cats significant pain and suffering.

The first stage of kidney disease is often marked by increased drinking and urinating, lethargy, and loose stools or constipation. As the disease progresses, cats may experience vomiting, diarrhoea, loss of appetite, drastic weight loss, difficulty moving, and persistent breathing difficulties.

If a cat's quality of life is dramatically affected, and they are suffering more than they are faring well, it may be time to consider euthanasia. Owners can assess their cat's quality of life by asking whether their cat is still enjoying life, eating enough to maintain their weight, and taking pleasure in activities they used to enjoy. If the bad days are outweighing the good, it may be time to let your cat go.

Quality of life scales

There are various quality-of-life scales for pets available, and they generally work by asking you to rank your cat's daily life on a scale of 1-10. For example, you can consider whether your cat is pain-free, clean, still eating, responsive, and able to move around independently. If the numbers add up to more than half the total, most scales will rank your cat's quality of life as acceptable. Once they drop lower than half, it's probably time to talk to your vet about euthanasia.

Appetite

• Is your cat eating enough to maintain a stable weight?
• Do they still enjoy eating, even if they may be picky?
• Does your cat still enjoy treats, such as roast beef or tuna?

Attitude and behaviour

• Has your cat's behaviour changed recently?
• Does your cat still enjoy human interaction?
• Is your cat sleeping more or seem lethargic throughout the day?
• Is your cat hiding or seeking isolation?

Medications

• Is your cat taking the correct dosages of medications?
• Are you able to administer medications as prescribed?

It's important to remember that even if you use a quality-of-life scale, the decision about when to euthanise your cat is a personal one, and you know your cat best. You can also ask your vet what they would do in your position to get a more informed view of the situation.

Signs it's time to euthanise

Making the decision to euthanise your cat is an incredibly difficult and personal one. It's important to consult with your veterinarian, who can give you a clinical perspective and provide guidance. However, as you know your cat best, you are the best judge of their quality of life.

• Loss of appetite and weight: Cats, especially older ones, may lose their appetite and stop eating. They may also experience vomiting and diarrhoea.
• Chronic pain or terminal illness: If a terminal disease is compromising your cat's ability to function, euthanasia can be an option. For example, with end-stage kidney failure, your cat may suffer from seizures, severe dehydration, vomiting and general weakness.
• Difficulty moving: If your cat is experiencing mobility issues, it may be time to consider euthanasia.
• Loss of interest in routine activities: If your cat is losing interest in playing or eating their favourite treats, this could be a sign that they are unwell.
• Behavioural changes: A previously affectionate cat may seek isolation and exhibit significant behavioural changes or lethargy when it is time for euthanasia.
• Quality of life: Ask yourself whether your cat is having more good days than bad. Consider whether they still seem happy, interested in interacting with you, eating, and comfortable. You can also use a quality-of-life scale to assess your cat's daily life, ranking it on a scale of 1-10.

How to decide

Deciding when to euthanize your cat due to kidney disease is a very difficult and personal decision. It is important to understand that a diagnosis of chronic kidney disease (CKD) does not necessarily mean that euthanasia is required.

The first step is to have a thorough discussion with a veterinarian to understand what to expect in the coming weeks and months after diagnosis. It is also important to discuss treatment options with your veterinarian. Cats with chronic kidney disease can sometimes live for years after diagnosis, especially if the disease is caught early and managed appropriately.

If your cat is in the advanced stages of CKD or is in a situation where treatment is not possible, their life expectancy is typically weeks to months. In these cases, it is important to monitor your cat's quality of life and keep their comfort in mind.

Some specific questions to consider when evaluating your cat's quality of life include:

• Appetite: Is your cat eating enough to maintain a stable weight? Do they still enjoy eating, even if they are picky? Do they show interest when offered special treats?
• Attitude: Has your cat's behaviour changed recently? Do they still enjoy human interaction? Are they sleeping more or seem lethargic throughout the day?
• Medications: Are you able to administer any prescribed medications as instructed by your veterinarian?
• Physical condition: Has there been a drastic weight loss, difficulty moving, persistent breathing difficulties, or other signs of discomfort or illness?

If your cat's quality of life is declining despite treatment, it may be time to consider euthanasia. Remember that this decision is personal, and you know your cat best. Your veterinarian will be able to provide guidance from a clinical perspective, but the final choice is yours.

Treatment options

If your cat has been diagnosed with kidney disease, there are several treatment options available to help manage the condition and improve their quality of life. Here are some of the key treatment options to discuss with your veterinarian:

Dietary Changes

Modifying your cat's diet is an important aspect of treating kidney disease. A therapeutic diet that is restricted in protein and phosphorus, and high in vitamin D, omega-3 fatty acids, and water-soluble vitamins can help improve your cat's condition and slow the progression of the disease. Wet food or canned food is generally recommended over dry food as it helps with hydration. Homemade diets with approximately 40% protein calories and 60% fat mixed with supplements such as fish oil have also proven to aid in recovery.

Medications

There are several medications that can be prescribed by your veterinarian to help manage specific symptoms and slow the progression of kidney disease. These include:

• Phosphate binders: These help to lower the amount of phosphorus absorbed through the gut wall, as high blood phosphorus levels can affect your cat's well-being and accelerate disease progression.
• Antibiotics: Cats with kidney disease are more prone to bladder infections, which can lead to kidney infections. Routine urine cultures are recommended to monitor and treat these infections.
• Potassium supplementation: Cats with kidney disease tend to lose potassium in their urine, leading to muscle weakness, stiffness, and poor hair quality.
• B Vitamins: Supplementation with water-soluble vitamins like B12 is important as the failing kidneys cannot concentrate urine, leading to depletion of these vitamins.
• Anti-emetics: Anti-vomiting medications can help reduce nausea and improve your cat's appetite.
• Blood pressure-lowering drugs: Many cats with kidney disease have high blood pressure, which can lead to further kidney damage. Medication can help manage this condition.
• Medication to reduce proteinuria: Proteinuria is a condition where protein is lost in the urine, which can accelerate kidney disease.
• Treatment for anemia: Anemia is common in cats with kidney disease due to a decrease in red blood cell production. Newer drugs can help stimulate bone marrow production and improve this condition.
• Subcutaneous (SQ) fluids: In the later stages of kidney disease, cats may not be able to drink enough to maintain proper hydration, and subcutaneous fluids can improve their quality of life.

Other Treatments

In addition to dietary changes and medications, there are other treatments that may be recommended by your veterinarian:

• Intravenous or subcutaneous fluid administration: This can help address dehydration, which is common in cats with kidney disease.
• Surgery: In some cases, surgery may be required to remove any blockages or obstructions in the urinary tract.
• Angiotensin-converting enzyme inhibitors: These may be used to treat urinary protein loss.
• Erythropoietin replacement therapy: This can help treat anemia by stimulating red blood cell production.

It is important to work closely with your veterinarian to determine the best treatment plan for your cat, as each case is unique. With proper management and care, it is possible to slow the progression of kidney disease and improve your cat's quality of life.

Owner's perspective

Owners of cats with kidney disease may find themselves in a difficult position, having to decide whether to euthanize their beloved pet. This decision is never easy, but it can be especially tough if your cat suffers from a health condition that can persist for years, like chronic kidney disease.

Firstly, it's important to understand kidney disease in cats. Kidney disease is one of the most common medical conditions in older cats and occurs when the kidneys, which normally function to filter waste products from the blood, start to malfunction. As the kidneys lose their functionality, the waste products that would usually be filtered build up in the body, eventually impacting other body systems and poisoning the cat from the inside.

Symptoms of kidney disease in cats include:

• Increased drinking and urination
• Vomiting
• Weight loss
• Decreased appetite
• Blindness
• Diarrhea
• Constipation
• Lethargy

If your cat is displaying these symptoms, it is important to consult a veterinarian, who can advise on the best course of action.

When it comes to deciding whether to euthanize, there are a few key considerations. Firstly, it is important to assess your cat's quality of life. Are they still enjoying life, despite some good and bad days? Do they still take pleasure in eating, sleeping in the sun, or enjoying a chin scratch? Owners can create a list of things their cat usually enjoys and rank each day on a scale of 1-10, with one being the worst day and 10 being the best. If the days are ranking below a five, it may be time to consider euthanasia.

Another factor to consider is your cat's physical condition. Are they experiencing anorexia, discomfort, dehydration, or weakness? Are they refusing to eat, leading to significant weight loss? Are they suffering from vomiting and diarrhea? These could be signs that your cat is in pain and their quality of life is diminished.

The financial and emotional costs of treatment are also important considerations. Treatment for kidney disease can be expensive and time-consuming, and it is important to assess whether you have the necessary resources to provide ongoing care.

Ultimately, the decision to euthanize is a personal one, and there is no one-size-fits-all answer. Owners know their cats best and are the best judges of their cat's quality of life. Consulting with a veterinarian can provide valuable clinical perspective and guidance, but the final choice rests with the owner. It is a difficult decision, but one that should be made with the cat's comfort and well-being as the top priority.

Frequently asked questions