Tell me the Future

September 9, 2009 9:35 AM

Kitty with kidney issues gets daily fluids; now what?

I've posted about this cat before: AJ. She's my 14 year old geriatric cat. Earlier this year, AskMeFi helped get her kidney issues diagnosed (she had big kidney stones that blocked the tubes from kidneys to bladder; normal tests weren't working to show the cause of her problems). Those kidney issues have apparently permanently damaged her kidneys and I now give her a daily injection of 150ml of fluids.

She's once again the picture of feline health. Her coat is silky, eyes are bright; she eats well and demands treats on a regular basis (her food is now Wellness brand stuff) and she drinks lots of water. She has also taken over "Top Cat" status again and keeps the younger, heavier male in the house in line. She still misses the litterbox at least once a day, but she and I have worked out a truce: she pees on a towel on the bathroom floor.

My question is: what happens now? Assuming that her kidneys never heal from this damage and that the doctor and I keep her on these daily fluids, will she just continue living this way until some other old-age symptom takes her out? Or will her kidneys continue to decline and result in her death? I'd much appreciate anecdotal answers from folks who have gone through this sort of thing with their pet(s).

I know, I should just ask her doctor, but I get tongue-tied around him and he ends up not giving me the information I'm really seeking - essentially, he says: "We'll wait and see." Fine, but, gosh, some foreknowledge would be nice.

posted by LOLAttorney2009 to pets & animals (17 comments total)

I knew a cat that lived for 5 years with a condition similar to this. How are you giving it fluids? The one I saw actually got an IV. It was a cat in a business, so the "pop can fund" went to pay for the cat's food and vet bills. It eventually passed away, but I was amazed at how long the cat lived like that.
posted by cjorgensen at 9:45 AM on September 9

You can always get a second opinion from another vet. Or write a list of questions to ask him next visit. It helps to have it written down, in case you do get tongue-tied.
Her kidneys will continue to decline, it's my understanding that they don't 'get better' but they will probably decline slowly, since she's responding so well to the fluids and special diet. He's saying "we'll wait and see" because at that age, that's all you can do. Her kidneys will continue to decline, but probably slowly, since she's responding so well to the fluids and special diet. He's saying "we'll wait and see" because at that age, that's all you can do. She might live a couple more years like this, or something else could go wrong, and she'll die sooner. (I'm not trying to be cold, I understand completely, I lost my kitty companion of 17 years last spring, and his sister 2 years before that. It sucks, but they aren't immortal. And emotionally, foreknowledge won't help very much. You're probably going to have to make some tough decisions, and nothing can prepare you for that.)
As far as peeing on a towel, go ahead and invest in some puppy training pads. They aren't cheap, but they're worth it if you're gone during the day. It smells less, and is much easier to clean up.
posted by Green Eyed Monster at 9:45 AM on September 9

I worked as a vet tech, am on my way to vet school, and I personally have lost 3 cats to renal failure. What will happen? In my experience, her kidneys will continue to decline and she will get to a point that you will want to have her humanely euthanized. I'm sorry, but that will be the path. It may happen that old age may get her first. Not likely, but it might happen.

I had one cat that went in a month, another in 6 months, and the third cat lasted about 3 months, post diagnosis.

Do you have her BUN and CREA levels on her bloodwork? I might be able to tell you more with that.

My advice: the missing the litterbox and copious quantities (polyuria) will increase. Just pay attention to how she seems to feel. She will get to a point where she is showing signs of nausea, will eat less, and become lethargic. You don't, in my opinion, want her to get to the point where she can't lift her head. You should be able to tell when she is letting you know that she's ready to go. I love my kitties dearly, but don't want them to suffer.

Similar to what Green Eyed Monster says, you can get the bed pads that they have for incontinent people, and they are a lot cheaper than puppy pads (and do the same job!).

I have seen a lot of people hang on because they aren't ready to let go, and the animal is the one who pays the price. Not saying to euthanize tomorrow, but be aware of how your cat is doing (you seem like a very concerned pet parent). I'm sorry you have to deal with this.
posted by bolognius maximus at 9:54 AM on September 9

G.E.M., thanks for reminding me about the puppy pads. I've been meaning to buy some. You're right: emotionally, foreknowledge won't help ease the pain of her eventual loss. But it might ease my anxiety and "what's next? where's the next chapter?" feeling.

cjorgensen, she gets the fluids via subcutaneous injection. Takes about five to ten minutes each night. She hates the needle stick (as do I) but patiently sits with me while the fluids drip. It helps that it's uninterrupted one-on-one time (I lock the other cat out of the room) and she gets treats during it.
posted by LOLAttorney2009 at 9:55 AM on September 9

Our cat "TC" (too cute) lived an extra year with us injecting fluid. He had some kidney disease that progressed and eventually his kidneys failed completely. If your cat's kidneys are damaged but not getting worse, your results might be better. Still, an extra year for a cat is a lot.

He was a pretty good sport about it, we had to laugh right after filling him up as the water would slosh around under his belly until it was absorbed.
posted by cosmac at 9:59 AM on September 9

Bolognius maximus, her CREA level, taken two weeks ago, was 163 (norm is around... 10 to 15, IIRC). Right now, she's eating more and plays by herself or with me; she certainly seems happy. I know that there are some pet owners who hang on longer than they should; I'm not one of those. :) I hope to protect her from unnecessary suffering.
posted by LOLAttorney2009 at 10:10 AM on September 9

We have a cat who has gone for 2 years now with every two weeks (we just moved to once a week due to the heat) and his levels have remained the same for the most part.

We make sure he has plenty of fresh water.

He looks a lot better and his dandify has improved.
posted by bottlebrushtree at 10:11 AM on September 9

My cat, Paca, came down with kidney failure when she was 15. I worked with two vets (one who was very aggressive with treatment, one who was way more conservative with treatment plans) and together we developed a protocol that involved fluids every other day, a vitamin additive once a week, and she also received blood pressure medication.
This intervention kept her alive, active and very happy for almost 4 more years. She did eventually have a "crash" (basically her kindeys just got to a point that nothing else would help) -- it was a quick deterioration, and I had a vet come to the house and put her down on her favorite pillow in front of the woodstove she loved to lay in front of.
I don't at all regret any of the intervention, and I belive she wasn't put out by the treatments.
Good luck, and I wish you and AJ the best.
posted by Tomboy at 10:17 AM on September 9

Our cat is 17, and he was diagnosed as having kidney impairment about a year ago (his kidneys process at about 75% of normal). We give him IV fluids once a week - he hates it bitterly, and is somewhat not happy with us for a while after it's done, but it has also kept his levels consistent and stopped the decline the doc was seeing.

During this year, his eating/drinking/peeing habits have not changed, and he's been a perfectly healthy cat otherwise. The doctor has said that at some point, poor Mr. Kittypants' kidney decline will outstrip our ability to dose it ourselves with fluid, but he has also said that the day that will start to happen is off in the distance somewhere that he can't see, and so not to worry about it at this point.

We get his kidney functions checked every three months, which kitty of course hates, but the consistent levels of processing we're seeing has reassured us that the doc is right, as long as we keep hydrating him things are staying more or less status quo healthwise.

And, following with what cosmac said, every time we hydrate (we give 100 ml every week), he gets a big ol' lump of fluid under the scruff of his neck, that also occasionally slides down to his left front leg until it's absorbed - it looks quite comical for the hour or so it takes to absorb.
posted by pdb at 10:20 AM on September 9

We had two cats that went a few months between starting daily subcutaneous fluids and seeming so miserable that we put them down. On the other hand, my father-in-law's cat went, I think, a couple of years happy years getting daily fluids. One difference is that our two cats were older purebreds of a not particularly healthy variety. His was a relatively young and vigorous mutt when his kidney problems were diagnosed.
posted by Good Brain at 11:26 AM on September 9

I should also add to my post that contributing to Paca's comfort taking fuilds was warming the fluids in a hot water bath first (never in a microwave, of course!), and rotating her IV sites.
I never injected her in the area between her shoulders. I rotated sites on her left and right sides above her belly and in the area between her front and back legs. This seemed to be very confortable for her.
posted by Tomboy at 11:48 AM on September 9

Just in general, I recommend always taking a list of written questions to the vet (and the people doctor too!). That way you remember what to ask, and you can write down the answers.
posted by radioamy at 11:50 AM on September 9

Our cat lived about 18 months from the time we began administering subcutaneous fluids. For more than year, he seemed happier and healthier that he had been for quite some time. During the last several months, it was clear that despite the consistent fluids, his kidney function was deteriorating and he gradually became more listless and towards the end not particularly interested in food. We worried about our ability to recognize when the appropriate time would be to euthanize him, but in the end we knew and I feel confident that we did the best thing for him. The folks at felinecrf.com have some great resources to learn more.
posted by Lame_username at 12:28 PM on September 9

There are a LOT more options than just fluids! Prescription diets alone can add years to the lifespan (they have terrible ingredients, especially compared to something like Wellness, but they are formulated and extensively tested and proven to help). Meds like calcitriol can help enormously as well, and your vet should be monitoring blood pressure regularly and medicating your cat if it's high (high BP and kidney failure go hand in hand). If all your vet has you doing is fluids, you need another vet who is actually current with everything we have available to us now (my last kitty died of renal failure 10-ish years ago, all I did was fluids and diet THEN, your vet's advice is a decade out of date if all that is being suggested to you is fluids). Start here for info. Cats with renal failure can have years of quality life added if they are treated aggressively by a vet who knows what they are doing. And none of the treatment is super-expensive.
posted by biscotti at 1:02 PM on September 9

My kitty lived about 2 1/2 years with daily sub-Q fluids. She had some ups and downs, but did really well until the last couple of weeks of her life, and I finally lost her at the end of June. She did have to go in and stay at the hospital twice to get more intensive fluids, but overall home care was all she needed. The monitoring is important; I had to change her medications a couple of times based on fluctuations, and she responded really well.

And yes, the kidneys will continue to deteriorate, but your kitty can still have some good happy years ahead of her. I am very grateful for the extra years I got with my cat, and the nightly fluids were a small price to pay for that! And even if your cat doesn't care for the fluids, sounds like she's being good about it, and I have to say that my cat got very used to it and completely unconcerned about it -- she saw it as extra cuddling time.

Good luck with your cat -- hope she's one of the ones who does very well and stays with you for a long time!
posted by OolooKitty at 4:18 PM on September 9

Oh, and one of the medications I was giving her was a toxin binder; this is a really helpful medication and possibly something your cat should be getting too.
posted by OolooKitty at 4:19 PM on September 9

Our cat lived an extra year or so in renal failure with daily subcutaneous fluid injections. She was happy and OK until the end when she just crashed.

Along with the fluids, she needed special food (Science diet makes a formula for kidney trouble - I forget the name) and occasionally binders as OolooKitty mentioned. And regular vet check-ups. Every month or two when we went on vacation, we left her with a boarding vet where they were able to give her much more fluid than we could and she'd perk up for a couple of weeks after that.

Biggest problem was getting her to eat - the special food tasted bad and her favorite treats were off limits.

Our vet was brutally honest and told us (correctly, as it turned out) exactly what to expect. I'm grateful for that and I think you should consider a vet that will tell you something more than "we'll wait and see."
posted by mmoncur at 1:43 AM on September 10