When to Euthanize a Cat with Kidney Disease

When your senior cat was diagnosed with chronic kidney disease (CKD), you may have felt worried, confused, and overwhelmed.

Getting a diagnosis of CKD is never easy. Knowing where things are headed, understanding what to expect in terms of life expectancy, and having a plan can help you to be more in control of the situation and make the best decisions possible.

The most important thing you should know is that a diagnosis of CKD does not mean you need to immediately euthanize your cat. Whether your cat is in the early stages or more advanced, here’s some guidance on how to evaluate your cat’s quality of life as well as questions to ask your veterinarian.

How Does Chronic Kidney Disease Affect a Cat’s Body?

The kidneys act like a recycling plant for the body. They sort through the blood as it passes through them and return useful items to the bloodstream while placing waste items into the urine to be eliminated.

Veterinarians diagnose CKD when they see that the kidneys are not functioning properly. For example, the kidneys start allowing waste materials to build up in the bloodstream and eliminate items that the body needs to keep. As the disease progresses, vets can see these mistakes increase in severity when looking at a cat’s blood and urine samples.

Many cats can tolerate these mistakes without symptoms up to a point. But after a while, the signs start to show up. There may be more urine clumps than usual in the litter box, or your pet may have a smaller appetite and lose weight. Some cats have vomiting and/or diarrhea. Cats can have various symptoms, but the diagnosis is usually clear when veterinarians look at laboratory tests.

A system called IRIS (International Renal Interest Society) staging helps determine the options and prognosis for each stage of the disease.

Discuss IRIS staging with your veterinarian and talk over all options so you can get a good idea of your cat’s current condition and what to expect.

What Is the Life Expectancy of a Cat with Chronic Kidney Disease?

The life expectancy for cats diagnosed with chronic kidney disease varies dramatically, depending on the stage and what treatment options you select.

If you are committed to treating your cat and they are in the early stages of the disease, they could live for years with CKD. I’ve seen animals survive for over 10 years with attentive care.

Another major factor in determining life expectancy is whether your cat is otherwise healthy or has some dysfunction in other organs. Older animals with multiple diseases often do not live as long, but with consistent and careful care, even these cats can live 2-3 years or more.

It is very common for older kitties to have CKD in combination with an overactive thyroid or hypertension. Frequently, none of these diseases alone are immediately fatal, but they do mean that there are more challenges to address to get your cat stable and happy again.

Those diagnosed in the advanced stages of CKD or living in situations where treatment is not possible generally do not live long—perhaps weeks to months.

Address all the options for treatment as soon as possible after diagnosis. This is the time when your cat needs the most aggressive treatment.

How Do You Know When to Put Down a Cat With Kidney Disease?

Knowing when to let a kitty with CKD go is difficult, especially if you have gone all in on treatment. Sometimes pet parents can suffer from caretaker’s fatigue and the outlook appears impossible, so a fresh perspective is needed.

Perhaps a family member or friend visits and is shocked at how much your cat has changed or the level of care you need to provide, and it causes you to second-guess your decision. As hard as it is, the best—and maybe easiest—way to make decisions is often to look at the world through the eyes of your cat. In other words, evaluate your cat’s quality of life, or QOL.

In human medicine, we can easily consult with the patient in most cases to determine what is or isn’t working about a treatment protocol and make adjustments accordingly. That is certainly more challenging when we need to rely on nonverbal cues from a cat’s body language and behavior.

Evaluating Your Cat’s Quality of Life

The simplest and most basic question comes down to enjoyment. Is your cat still enjoying life on average, although some will be good days and bad days? Do they still enjoy their food, even though they might be picky? How about a long nap in the sun or a chin scratch on your lap? Are these things still pleasurable for your cat?

It helps to create a list of things that your pet usually enjoys, and then use a calendar to rank each day on a scale of 1-10. You could give each thing a ranking from 1-10, then add up the rankings and take the average to get an overall ranking for the day.

This lets you spot trends. If the days are trending from 7-10, your cat is probably still pretty happy. If they’ve dropped into the 5-7 range, things are becoming questionable. And if the days are ranking below a 5, you have some hard decisions to face.

Here are some specific areas to consider:

Appetite: Although many kitties with CKD are prescribed a prescription diet as part of their protocol, at some stages, it becomes important to just keep them eating.

• Is your cat eating enough to maintain a stable weight?

• If they are losing weight, how quickly is it dropping?

• Do they still enjoy eating, even if they may be picky?

• When you break out the “good stuff,” like some roast beef or a can of tuna, does that spark some interest?

• Are you able to get calories in, even if you need to give your cat an appetite stimulant?

Attitude: Pay attention to your cat’s daily routine, attitude, and behaviors.

• What’s your cat’s daily routine? Is it close to what it was a year ago? Do they get up, have a snack, use the litter box, and go back to bed for several hours? Or is your cat uncomfortable and pacing or restless?

• Does your cat sleep all day long without any interest in getting up to follow the sun as it moves about the house?

• Does human interaction seem enjoyable? Playtime might be a lot to ask, but willingness to play is a big plus in the quality of life column.

• Are grooming sessions as enjoyable as they once were, or are they starting to seem painful? Many cats with CKD start to have difficulty getting on and off furniture as they lose muscle mass, but do they still have the desire to get on the couch and the forbidden kitchen table?

Medications: Most cats with CKD will wind up on medications, which vary with the stage of the disease. With some cats, this can be multiple medications, such as subcutaneous fluids, phosphorous binders, electrolyte supplements, and special diets, amongst others. If they have other diseases, even more medications may be involved. Judging how well your patient tolerates the daily stress of treatment is an important factor.

• How stressful is the process of giving medications to your cat? Can it be tweaked or streamlined? Although it sounds extreme, some cats even benefit from a feeding tube. This allows you to provide calories and medications all at once with minimal stress and can be hugely life-extending for some cats.

When you notice that these basic categories are starting to consistently drop to a level that indicates that your kitty isn’t happy with life anymore, it’s time to consider euthanasia.

What Are the Final Stages of Kidney Failure in cats?

Typically, as the stages of CKD progress, you can tell that your cat is not feeling well despite your treatment attempts:

• Their appetite no longer responds to appetite stimulants.

• Their weight seems to be melting away.

• They drink and urinate excessively (in the very end stages, they often stop drinking and urinating altogether).

• They may develop vomiting and diarrhea.

• In very extreme states, they can start to get painful ulcerations in their mouth.

Usually, you will see these drops in quality of life pretty readily, and the scores you give to the categories of appetite and attitude will drop to unacceptable levels. Then you know a decision is near.

Palliative Care, Hospice, or Euthanasia for Cats With CKD

When your cat is diagnosed with CKD, your instinct may be to think that it’s time to let them go. But once you sit back and look at your options, it becomes evident that you do have some choices based on how far along the disease is.

You may find yourself on a roller coaster ride, going through good days and bad days, having caretaker fatigue and then getting a second wind. Keeping records and notes will help you be objective and accountable, because it’s much easier to make decisions when you can set emotions to the side long enough to think through the options with your cat’s best interests in mind. Your veterinarian will also be able to provide tailored advice and guidance based on the objective changes they see in your kitty.

And sometimes, things that had been progressing slowly will suddenly destabilize and change. Make sure you’ve discussed the options with your veterinarian. Here are some questions to ask:

• How quickly can you be seen if your cat’s condition changes?

• Who do they recommend for after-hours care?

• Is there an internal medicine specialist you can consult?

Palliative Care Stage

Immediately after diagnosis, most cats with early to middle stage disease will go into palliative care. During the palliative stage, vets are usually the most aggressive at looking at all of the options available and sorting out the choices that are the most likely to gain ground.

First, you would work with your veterinarian to come up with a plan that would slow the disease as much as possible while letting your cat have the best quality of life possible.

Sometimes these two things are at odds. For example, if your cat needs subcutaneous fluids to improve their hydration up but they aren’t about to allow you to give them at home. So perhaps the middle ground is having a veterinary technician make a house call on a regular basis to help, or maybe you even take your cat in for the quick procedure at the hospital a few times per week.

Hospice Stage

As the disease progresses and the options become more limited, you start to enter the hospice stage. Time becomes limited, and the primary goal is maximizing your cat’s quality of life.

The goals at this stage have shifted—we are no longer considering how long we can keep your cat with you, but simply how comfortable we can make them. We might be sacrificing time for quality, but again, if we are asking your cat’s opinion in this, we probably already know the answer.

Perhaps during palliative care, your cat was eating a prescription kidney diet. But now, as their appetite decreases, you may need to feed them whatever they will eat. Or maybe your cat hated the chalky phosphate binder that they were taking, and you have decided with your veterinarian that you aren’t going to stress them out with that going forward.

Euthanasia Decision

With time, it becomes clear that even hospice care and your efforts to improve your cat’s quality of life are beginning to fail. As hard as it is, you will need to accept that the kindest thing to do is to let your cat go, and the question of euthanasia comes into play.

This is always something difficult to consider, and many of us feel guilt or uncertainty about making the decision. However, cats with CKD can linger for long periods of time, and when it becomes clear that we can no longer improve their quality of life, the best thing to do for your cat’s sake is often always the hardest.

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