Introduction
Kidney disease is a common condition in older cats, with some studies suggesting prevalence rates between 1-3% in the general cat population and higher in geriatric cats over 15 years old. Kidney disease, also known as chronic kidney disease (CKD), is characterized by the gradual loss of function in one or both kidneys over time. This can lead to an accumulation of waste products in the blood, electrolyte imbalances, and other systemic issues. The kidneys play an important role in regulating hydration, blood pressure, removing toxins, and producing hormones so when their function declines, it can have wide-ranging effects on the body. Cats with kidney disease often exhibit increased thirst, weight loss, vomiting, diarrhea, and other symptoms. The exact cause of CKD is not always known but may be related to chronic inflammation or age-related changes in the kidneys themselves. Diagnosis is made through bloodwork, urinalysis, and imaging tests. While kidney disease cannot be cured, it can often be well-managed through dietary changes, maintaining hydration, medications, and regular veterinary monitoring. However, it is a progressive disease that will continue to worsen over time. Kidney disease presents many challenges for cats and their owners – it requires commitment to specialized care and monitoring of the condition long-term. Ongoing management and eventually determining when to euthanize due to poor quality of life becomes part of the journey. This article explores the considerations around living with and making decisions for cats with chronic kidney disease.
Quality of Life Concerns
As kidney disease progresses in cats, it can greatly impact their quality of life. Severe kidney disease often leads to experiences of pain, nausea, and overall discomfort. According to PetMD, cats with end-stage kidney failure may show signs like vomiting, diarrhea, decreased appetite, weight loss, and lethargy.
Per the VCA Animal Hospitals, kidney disease can make cats feel unwell, and they may demonstrate that through changes in behavior, activity levels, and eating habits. For example, a cat may stop using the litter box or begin hiding more often.
The Veterinary Nurse notes that cats with chronic kidney disease frequently deal with concurrent issues like hypertension, dental disease, hyperthyroidism, and arthritis, all of which can further reduce quality of life. Managing pain and other symptoms is an important part of caring for a cat with kidney problems.
Overall, assessing quality of life impact is essential when making decisions about a cat with advanced kidney disease. Factoring in pain, discomfort, and day-to-day experiences can help determine the best next steps for care or euthanasia.
Treatment Options
There are several treatments available for cats with chronic kidney disease (CKD) that aim to slow progression, relieve clinical signs, and extend survival. The main treatments focus on hydration, diet, and medication.
Fluids help flush toxins from the body and prevent dehydration. Vets often recommend administering subcutaneous fluids at home. This involves injecting fluids under the skin using small needles. Most cats tolerate the fluids well.
Prescription kidney diets restrict phosphorus and protein levels. Restricting phosphorus helps prevent secondary hyperparathyroidism. Limiting protein reduces workload on the kidneys. However, severely restricting protein can cause cats to lose muscle mass, so finding the right balance is key.
Medications commonly prescribed for CKD include ACE inhibitors to control blood pressure, antacids to reduce gastric ulcers, potassium supplements if levels get too low, anti-nausea meds, and phosphorus binders. Treating anemia with erythropoietin injections is also an option.
According to the Cornell Feline Health Center, “Most cats are effectively managed for months to years with conservative medical management” [1]. While treatment can’t cure kidney disease, it can provide cats a good quality of life for a longer time.
[1] https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/chronic-kidney-disease
Prognosis
The prognosis for cats with kidney disease depends significantly on the stage of the disease and whether treatment is pursued. Without treatment, cats with stage 3 or 4 kidney disease typically only survive a few months. However, with consistent veterinary care and treatment, life expectancy can be prolonged by years.
According to Animal General, cats with stage 3 kidney disease and receiving dental care and IV fluid support as needed, can live 2-3 more years. The Veterinary Nurse reports cats classified as stage 3 at diagnosis survived on average 1.86 years, but some survived as long as 5.75 years with treatment.
While kidney disease is chronic and ultimately fatal if left untreated, cats can live happily for years with proper veterinary care. Treatment focuses on maintaining quality of life and slowing further kidney deterioration. With treatment, many cats with kidney disease can continue enjoying life for months or years.
Financial Considerations
Treating chronic kidney disease in cats can be quite costly. According to Embrace Pet Insurance, long-term management of the condition may range from $100-500 per month depending on the medications prescribed and frequency of fluid therapy. Factors like special renal diets, frequent vet visits, lab tests, and hospitalization can also increase costs substantially.
As reported by CNBC, kidney disease ranks as the second most expensive condition for cats, averaging $649 per year. For owners on a budget, the financial burden can be significant. Some may find themselves forced to make difficult choices regarding treatment or even euthanasia if the costs become unmanageable.
While cats can live for years with proper management of kidney disease, owners must carefully weigh quality of life considerations against the ongoing costs. Creating a financial plan and utilizing insurance, charity care, payment plans, or other assistance can help ease the monetary strain. But the expenses may still present a hardship for many.
Euthanasia
Euthanasia may be an appropriate option for cats with end-stage kidney disease that are experiencing a poor quality of life. According to PetMD, euthanasia may be considered when the cat has stopped eating, has uncontrolled vomiting, and is struggling with severe lethargy, weakness, confusion or unmanaged pain (1). Cloud9Vets states that euthanasia should be considered when your cat’s kidneys are no longer functioning, they have lost significant weight, and treatments are no longer effective at relieving symptoms or improving quality of life (2).
The euthanasia process involves an injection of an overdose of anesthetic drugs, which quickly results in loss of consciousness followed by respiratory and cardiac arrest. It is a peaceful, painless way for a cat to pass away. Many veterinarians will administer the injection while the owner holds and comforts the cat. Euthanasia allows owners to be present for their cat’s passing, avoiding a traumatic death from kidney failure.
Closure for Owner
Making the decision to euthanize a cat is extremely difficult and often leaves the owner dealing with complex emotions like grief and guilt. It’s important for the owner to know that euthanasia can provide a peaceful closure and prevent further suffering when the cat’s quality of life is significantly diminished.
Grieving is a natural part of the process and owners should allow themselves to fully experience the emotions that come with losing a pet. Feelings of guilt are also common, but owners should try to focus on the happy times they shared with their cat and remind themselves that euthanasia was the final act of love they could provide.
To help cope with the loss, some owners find comfort in holding a memorial service, creating a tribute such as a photo album or donations in the cat’s honor. Connecting with others who understand the loss can also help ease the grieving process. While the grief may feel overwhelming at times, it does slowly subside. The cat will always hold a special place in the owner’s heart.
Making the Decision
Deciding when to euthanize a cat with kidney disease can be an extremely difficult decision. Here are some key factors pet owners should consider:
Quality of life – Assess your cat’s ability to enjoy basic activities like eating, grooming, and socializing. Marked lethargy, inability to keep food down, and obvious discomfort are signs quality of life is greatly diminished. According to PetMD, when a cat can no longer experience any joy from life, euthanasia may be the most humane option. [1]
Unmanaged pain – Cats are masters at hiding pain. Noticeable signs like vocalizing when touched, altered gait, aggression, and loss of litter box habits can indicate your cat is in chronic discomfort that cannot be managed medically. Euthanasia may spare your cat further unnecessary suffering.
Lack of appetite – Anorexia is common in late stage kidney disease. Your vet may recommend euthanasia if your cat is not eating enough to sustain themselves, despite medical intervention. According to Cloud9Vets, euthanasia prevents cats from starving or metabolizing their own muscles.
Prognosis – Has your vet indicated your cat’s prognosis is grave even with continued treatment? If kidney values are not improving and your cat’s health is declining rapidly, euthanasia may be the most compassionate choice. Ask your vet for an honest assessment.
Financial concerns – Treating late stage kidney disease can become very costly. Euthanasia may be the best option if you cannot afford or access treatments that could sustain your cat’s quality of life. Never feel guilty about this reality – your cat knows only your loving care, not cost.
[1]“When to Euthanize a Cat with Kidney Disease”, PetMD, Accessed 23 Feb 2023. https://www.petmd.com/cat/general-health/when-to-euthanize-cat-with-kidney-disease
Alternatives
Rather than immediately opting for euthanasia, there are some alternatives pet owners can consider to potentially improve quality of life for a cat with kidney disease.
One option is rehoming the cat to a loving home without other pets that can provide dedicated care for a special needs cat. This may relieve some of the stress and financial burden on the current owner while allowing the cat to live out its remaining time in comfort.
Another possibility is having the cat join a managed colony of other cats with chronic medical issues that are cared for by dedicated volunteers. This allows the cat social interaction with other cats and people while receiving medical care and nutritional support.
While euthanasia may eventually be necessary, first exploring alternatives like rehoming or specialized colonies can potentially extend and improve quality of life for a cat with kidney problems.
Conclusion
Deciding when to euthanize a cat with kidney disease is a difficult decision that requires carefully weighing quality of life considerations, treatment options, prognosis, and financial factors. While a diagnosis of kidney disease does not necessarily mean immediate euthanasia, there often comes a point when prolonging a cat’s life would only extend their suffering. Assessing your cat’s ability to eat, drink, groom, urinate/defecate, and their overall happiness and comfort level can help determine when quality of life has diminished to an unacceptable degree. Consulting with your vet on prognosis and projecting treatment costs compared to your budget is also important. In the end, focusing on your cat’s best interests and providing relief from pain and suffering, even when extremely difficult for the owner, is one final act of love and kindness.
[1] https://www.petmd.com/cat/general-health/when-to-euthanize-cat-with-kidney-disease
