My elderly mutt was diagnosed with chronic renal failure back in July. I thought then I was going to lose her, but she has been responding very well to sub-cutaneous fluid therapy, and I discovered she’d eat the K/D dry food if I mixed a little baby food in it. So it’s now been about 6 months, and she’s still going strong. I do have to give her 1500-2000 mls of fluid a week (and she gives me the worst guilt trips while I’m doing it!), but besides that she seems fine. I get her BUN and creatinine tested once a month or so, and they are still high, but the vet says as long as she seems happy and active and is eating, we’ll just continue on.
My question is, how long will we continue on? Has anyone else gone through this with a dog? How long were you able to keep your dog going? How did you know it was time to stop and just gracefully say good-bye?
Only one of my friends and acquaintances has gone through this with a dog (lots have with cats), and her dog was diagnosed with a brain tumor which killed her a lot quicker than her kidneys were going to. I’d love to hear from anyone who’s gone through this.
That’s a question for your ethics, and your budget.
Sounds like your dog is stable in her chronic renal failure at the moment, and there’s no reason why with appropriate therapy and care she might not stay that way for a very long time.
Have you discussed medication options with your vet, or is she not at that stage, yet?
Animals can have renal dialysis, just like people, although generally it’s peritoneal dialysis not haemodyalisis (although I’ve heard that haemodyalisis is available in the USA), and this can prolong life and quality of life for longer than you’d otherwise expect. It’s not cheap, though.
How do you know when it’s time to stop?
High BUN and Creatinine are not generally speaking good things, but they have to be pretty damn high to start making the animal feel really rotten.
Generally speaking, you can tell when an animal’s quality of life has deteriorated to a point where you’d consider whether it’s worth continuing to treat them. They don’t move around much, don’t eat much, and just generally aren’t very interested in life any more. Some animals never get to this stage, they die of an acute renal crisis brought on by sudden dehydration (due to hot weather, for example) or not being able to tolerate a drug, or some other renal insult.
Many dogs and cats with CRF die of other diseases before their kidneys start to affect them severely.
If your dog is seemingly enjoying life and your budget is not being exceeded, there is no reason to not continue treating her.
There’s a web site and listserv for folks who are dealing with canine kidney disease. There’s acres of info on the site and plenty of support for dealing with it:
Does feline renal failure count? My mother’s cat was born with one small kidney and had to go on subcutaneous fluid at four years—she lasted quite happily on that for two years. When she was six, she failed very suddenly (and painlessly) and died on her way to the vet.
So the dog may make the decision for you. If it’s any comfort, my mother’s cat was quite happy right to the end and went quickly and quietly.
I can’t speak about the renal failure, but just last week I had to put my dog down. He was almost 14 years old. His condition was due to a ruptured disc in his neck. He was slowly losing coordination and control of his legs, and it was getting noticably worse. When he was 10, he had the same problem, and responded very well to surgery. That gave him 3 more years of good health. This time, he was still otherwise in very good condition, so I opted to have surgery again after consulting with two vets. Unfortunately, after the surgery he was unable to get up. After 5 weeks of cortisone medication, it was clear that he wasn’t ever going to get up. Now, he wasn’t in pain, and I could have cared for him indefinitely. It was clear that he wasn’t very happy though, and frustrated that he couldn’t move (he wasn’t paralyzed, he could move he is legs, had control of his bladder and bowels, he just didn’t have the coordination to get up, though he tried.) So keeping him going at that point would have been more for me than for him. We put him down right after the vet said that he probably would never get up.
It wasn’t easy for me or my wife. It seemed a bit sudden to me, but I think that once the decision is made to do it, it’s better to get it done as soon as possible. I could have delayed it a few days, spending a last bit of time with him, but again, that would have been for me, not for him.
I’m sorry that you are going through this. A friend described it to me as ‘the hardest kindness’, and that is exactly how it feels. It’s not an easy question to answer, and ultimately it’s your decision. Whatever you do, do it for her, not for yourself.
I’m another with experience with feline renal failure. The bad news is that our Tuffy only lived four months with the disease. The better news is that it probably was his diabetes that actually proved fatal.
Tuff had a stomach tube, which I think is fairly common for cats with kidney disease. It made it very easy to make sure he had appropriate fluids and, even more important for the diabetes, it meant he could be fed and injected even when he wasn’t “hungry.” Sub-q fluids (before he was tubed) were something he didn’t mind in the slightest, so I guess I don’t see them as anything extraordinary. (He also came every morning for his shot, like furry clockwork.)
Knowing when to stop is hard. I’d base it as much on quality of life as I could. In hindsight, we should have let Tuff go before we did, but his disease progression was quite atypical.
He can keep going like this for quite some time, assuming he’s staying well-hydrated and doesn’t have other health conditions or stresses on his kidneys. I’ve seen people keep CRF cats who were in horrible, horrible shape going for close on a year before they got to the euthanasia point, but it required pretty fervent dedication to making sure kitty got fluids every day or two and a lot of time encouraging kitty to drink. (Catsip, a lactose-free milk thingy marketed for cats, is apparently really good for this sort of situation, as cats will absolutely gorge themselves on it.)
If he’s got other problems, the renal failure can complicate treatment, and the combination can sometimes kill them quite quickly. It’s a crapshoot, really.
Thanks for the replies, folks. She originally got really sick while I was on vacation, and I thought I would have to come home and have to put her to sleep. Now every day I still have her with me is a gift. I’m trying to map out for myself now just how far I’m willing to go for her–but there’s this huge gray area between where I am now and too far.
I guess we’ll keep going as long as she seems happy, and make the next decision as it comes. Unless, like Eve’s mother’s cat, she makes the decision for me.
Another with feline renal failure. My kitty didn’t last long at all, but my sister-in-law has been doing the fluid therapy for years on her cat, with no ill effects thus far.
My little dog, Dick (it’s a long story) had CRF. He actually lived for about 2 years, happy as a clam. FWIW, we switched him to a vegetarian diet - veggie soup for breakfast and dinner. Grilled portobello mushrooms for a treat. That made a huge difference - meat is hard to digest and for a dog (or person) in CRF eating it can make them feel really sick which would be a drag if it happened every day. You may want to consider the veggie route - our vet said it extended his life, and improved his quality of life immesurably.
Finally, when he was 15, he just kind of ran out of steam. He quit getting out of bed and after a few days we decided the time had come.
I still miss him - he was a great dog. (And you’ve never seen a dog move faster than Dicky lunging for a portobello mushroom.)
Current thinking suggests that protein starvation is not a good thing for dogs with renal failure (it used to be advocated because protein converts to nitrogenous waste products which need to be excreted by the kidney).
Special diets for dogs with renal disease (eg Hills k/d, Eukanuba renal diet) are the cutting edge in this area.
