Cat dying of kidney failure -- what to expect?
April 14, 2014 5:38 PM   Subscribe

I brought my 18-year-old cat home to die instead of having him euthanized because I'd rather he spend what little time he has left somewhere he feels safe and loved instead of somewhere he feels scared and uncomfortable. I'd like to hear from others who have been through this with their cats so I know what to expect over the next few days of kitty hospice care.

Requisite pictures here. (He looks derpy because he was shot in the face as a kitten 17 years ago.)

His kidneys got really bad really fast. They were OK a month ago when he went to the vet for a UTI, then when was retested this weekend after I took him to the emergency vet for vomiting he got the worst kidney test results that his regular vet said he's ever seen. His vet was surprised that my cat is even still alive and thus said it won't be very long (a few hours or days) until he dies. He gave him some IV fluids for his dehydration and a painkiller shot for his arthritis (we'd been avoiding painkillers previously because they'd stress his kidneys, but now that he's dying anyway we figure that he might as well not be in pain) in the clinic before sending him home with me.

That was 12 hours ago and the cat is still alive, awake, and alert. He hasn't slept at all since coming home -- he keeps starting to nod off but then jerks back awake like he's fighting against falling asleep.

I've been offering him food and fluids in bed (holding the plate/bowl up to his face so he doesn't have to get up) about once an hour and he has eaten a lot of tuna and a little salmon (but rejected chicken, canned cat food, and his dry cat treats) and has drunk some tuna-flavored pedialyte and water.

When he gets restless I put him in the litter box -- he has peed 4 times since getting home -- and then lift him back into bed because he is too wobbly to climb in and out on his own.

I have liquid metacam painkiller to give him every 12 hours for however long he lasts. It seems to help a lot -- this afternoon after the painkiller kicked in he was feeling well enough to go outside and walk around a bit. We sat out there for a couple hours until the wind got too cold and I brought him back inside to lie on his heated sleeping pad in bed next to me. He seems to prefer that to my lap or chest -- his temperature has been very low (the emergency vet had to keep him in a special warming cage all weekend) so I've also got him covered up and that seems to be keeping him warm.

He has hardly purred at all today (once when I first got him home and snuggled him in bed, and once when the inlaws came over to say goodbye to him) but he's not crying either. As far as I can tell, he's not in pain, just groggy, disoriented, weak, and too wobbly to stand or walk.

For those of you who have had cats die at home from kidney failure, what can I expect to happen over the next few days? A friend of mine recently had his cat die from kidney failure and he said his cat was having seizures on the last day, but his cat had other medical conditions that my cat doesn't so I don't know if that's normal for cats dying of kidney failure?

I'd also appreciate any suggestions for how to make him as comfortable and happy as possible. I don't have anywhere else I need to be or anything else I need to do this week besides be here for my cat.

posted by Jacqueline to Pets & Animals (33 answers total) 9 users marked this as a favorite
As someone who has had cats die at home and die with veterinary assistance, I can't overstate how much worse a 'natural' death can be for a sick cat. I totally understand and sympathize with not wanting your cat to die in a strange place, but I would strongly encourage you to reach out to vets in your area who might perform housecalls for a peaceful euthanasia. You don't want to see your cat go out in an hour-long fit of seizures.

I'm really sorry you have to deal with any of this.
posted by Jairus at 5:45 PM on April 14, 2014 [70 favorites]

You sound like a brave and loving friend to your dear old cat. Please remember that many vets make house calls for euthanization, and that you and your sweet derpy kitty don't have to go through this the hard way.
posted by ottereroticist at 5:50 PM on April 14, 2014 [7 favorites]

Agreed with Jairus and ottereroticist about looking into having her euthanized at home. We had our 20-year-old kitty with kidney failure euthanized at home, and she was so dehydrated at that point that the vet couldn't find a vein. I hate to think how awful she must have felt in her final days. My only regret is that we did not do it sooner.

I'm so sorry to hear about your kitty--I'm tearing up right now just remembering how hard it was with ours and knowing what you must be going through.
posted by whistle pig at 5:54 PM on April 14, 2014 [2 favorites]

I'd also appreciate any suggestions for how to make him as comfortable and happy as possible.

Call your vet and see if you can arrange a house call for euthanasia. This is the last, best and most loving gift we can give our beloved companions.
posted by DarlingBri at 5:58 PM on April 14, 2014 [4 favorites]

OK, I will inquire about in-home euthanasia options tomorrow morning when the vets are open. I don't want him to suffer or be scared and if they can do it at home then that would be acceptable.

In case he deteriorates rapidly before I can get a vet over here, what can I expect as we near the end? How can I best comfort him?
posted by Jacqueline at 5:58 PM on April 14, 2014 [6 favorites]

Our 17 year old cat went through this. He was a mixed indoor/outdoor cat for his entire life, and lived a very happy and healthy life until his kidneys began to suddenly and rapidly fail. We were exploring options with the vet and were administering him some medication at home. Within days, he had a stroke, and that was the most awful thing to see. He did not appear to be in much pain, but it was clear his quality of life was nowhere close to the vivacious Neighborhood Protector he used to be. We had him euthanized at that point. I think the kindest thing you can do for your (absolutely adorable and handsome kitteh--OMGTHATTONGUE!) is do what's best for him, and that most likely means to euthanize him ASAP, and not wait it out.
posted by raztaj at 6:03 PM on April 14, 2014

Make a warm nest of towels in a corner or box and put him in it undisturbed. Right now he wants warmth and quiet. Touch may actively be painful for him - hold your hand to him and see if he indicates he wants to be touched. Offer him with water and small nibblets of food. Dim the lights. Keep other pets and people away. Once he's not able to eat or take interest in anything outside, it's time to let him die gently.

I've had cats die at home, in quiet and horrible circumstances (injuries), and for the quiet ones, that's what seemed to stress them out least.

They tend to lose bowl control, and I found it easier to put them on a towel nearby, then transfer them back to the clean nest or vice versa, just swapping in and out.

At home euthanasia is wonderful. So much better than at a vet's, and well worth the extra cost. If you don't have somewhere to bury your cat, often they will take the cat with them - prepare a favourite blanket or something to wrap him in afterwards and a canvas bag lined in plastic bags to carry him in for the vet.
posted by viggorlijah at 6:05 PM on April 14, 2014 [1 favorite]

Oh and purring isn't a sign of pleasure only. Sick and dying cats often purr and it's a sign of pain or fear. Look for signs like he is seeking company/comfort, or observing the world, his ears are up and his muscles look unstressed. The heating pad sounds like a great idea.
posted by viggorlijah at 6:08 PM on April 14, 2014 [1 favorite]

I am very sorry for what you and your cat are going through.

As a fellow living thing, though: if I were in the position your cat is in, I would very strongly prefer that my life be promptly ended by intravenous injection of barbiturates, which is how cats are euthanized by veterinarians.

The procedure for euthanizing feline companions is very, very different from the lethal injection protocol used in ending the lives of condemned humans. It is much gentler, more humane, and guaranteed not to be painful once underway. It will almost certainly not be easy for you, but it will likely be the kindest thing you can do for your cat.

In the mean time, are you able (if your vet recommended) to administer subcutaneous fluids to your cat? It is my understanding that doing so can help cats with kidney disease feel better, at least temporarily.
posted by Juffo-Wup at 6:36 PM on April 14, 2014 [4 favorites]

I'm so sorry. I know that this is difficult, I lost my 19 year-old cat to renal failure. We had a lecture at my veterinary school about at-home euthanasia. Lap of Love is a service that specializes in hospice and at-home euthanasia. They have two vets in Virginia, this one and this one. This is, as others have said, the kindest thing you can do for your beloved pet.
posted by bolognius maximus at 6:43 PM on April 14, 2014 [2 favorites]

"This page discusses the signs you may see towards the end, the factors to consider when deciding whether to euthanise and what to expect if you do choose euthanasia." It also includes a description of an "unpleasant natural death" and a "peaceful natural death" from feline renal disease. Having read both, I would absolutely choose at-home euthanasia again (having done so two months ago).
posted by unknowncommand at 6:51 PM on April 14, 2014 [2 favorites]

You and your kitty are in my thoughts.
posted by fiercecupcake at 7:05 PM on April 14, 2014 [1 favorite]

unknowncommand: That website is great and exactly the information I need to figure out how to best time his death. Thank yoi!

It feels like right now is too soon -- he's still eating, drinking, using the box, rubbing his head against my hand for scritches, and enjoying his warms. I took him outside for a bit just now to listen to the crikets and smell the nighttime breeze, and he perked up and looked around whenever he heard something that might be prey. So, given that he's still very much engaged with the world and doesn't seem to be in pain, I don't think he's ready to go yet. He's very weak and stumbling but I don't mind helping him eat, drink, and use the box.

So when I call the vets tomorrow I'll find out how much advance notice I have to give to schedule an in-home euthanasia. If they do same-day appointments then I want to give him as much quality living time as possible. This cat has survived too much (being shot in the face, run over, and poisoned) and is such a fighter that I really don't want to end his life prematurely.
posted by Jacqueline at 7:13 PM on April 14, 2014 [2 favorites]

One thing you might remember is cats don't really look at the future the way we do. We think of holding onto life as one more opportunity to see a sunrise, one more opportunity to visit our favorite park, one more opportunity to see our nephews and nieces and laugh at the funny faces they make. Animals don't make plans. They live utterly in the moment. It's not just about whether they're still able to do their favorite things, but also whether they're having more bad moments than good moments.

One of my parents cats they let go too long. She was blind and deaf and confined to the partly-finished basement because she would fall down stairs. But she still liked to eat and get skritches so my dad held onto her. But one night they came back from dinner to find her on her side in a litterbox, paralyzed and half-unconscious from a stroke. Were the moments she had up until then worth that panic and pain? I don't think cats think about it like that--I think for her, she was just stroked-out, lying in her poop, alone. It would have been kinder to let her go.

Remember it is sometimes hard to tell if cats are in pain. If he is hunched up a lot, curled up very tight, or holds himself in awkward positions that can be a sign he is really hurting.

I am so sorry you're going through this. It is the hardest thing about owning pets.
posted by schroedinger at 7:37 PM on April 14, 2014 [4 favorites]

OK, my experience with this was not like the folks above. The vet wanted me to put my old (19 years) cat in the "hospital". I asked if she had renal failure, the vet said yes, and I asked what good would it do to put her in a hospital when she was going to die no matter what? Sheepish grin returned, I guess it would make money for the vet.
They skin-popped her with a bunch of fluids, and we went home. She was wobbly, yes. She loved to lay on my chest in bed, I'd finally realized this was for warmth because of her kidney failure. (She had always liked being cuddled, even to the point of being held like a baby and her tummy rubbed.) We went to bed abut 10, I put her on my chest and stroked her gently. Sometime around 2 or 3 I felt her pass, a couple small jerks. At home, in her favorite place in the world, on top of her person. Would not have had it any other way.
posted by rudd135 at 7:46 PM on April 14, 2014 [8 favorites]

I had an elderly cat with kidney failure, and on his last couple of days he was a lot worse off than your kitty sounds right now. He pretty much lay on the pillow and looked pathetic, although he would eat a little bit and drink a little bit. He didn't have the alertness that you describe your cat having. He just looked old and scrawny and really, really tired.

When he started peeing where he was lying down and didn't seem to care about it, we knew it was time to take him to the vet. In retrospect, we could have taken him sooner, but we wanted to have him for as long as we possibly could, because we loved him so much.

It's really hard to say goodbye to a beloved cat, but I think you'll know when yours is ready to go. It sounds like he is hanging in there for now. Treat him like royalty and love every minute you have left.
posted by vickyverky at 9:27 PM on April 14, 2014

One of my cats died at home from renal failure. (I had a euthanasia appointment but it wasn't soon enough; she died in the middle of the night before.) I would never choose this, because there's no way to know how it will go, but it honestly seemed like she just died in her sleep. She was curled up in her bed and just stopped breathing.
posted by Violet Hour at 9:54 PM on April 14, 2014

Unfortunately, it looks like in-home euthanasia is not available where I live (bumfuck rural central Virginia). My cat's vet doesn't offer it and says the only vet in the area who did retired recently. I've searched multiple online directories and the nearest vet I can find who does in-home euthanasia is over 100 miles away.
posted by Jacqueline at 6:57 AM on April 15, 2014

Could you make a very comfortable box for your cat at home, and then (after a few days) transport the cat in that box to the vet's office so the cat not only doesn't have to move but is nestled comfortably into its comfy spot when it is time to euthanize?

You might also try calling the vet who retired recently. Couldn't hurt.
posted by Madamina at 7:50 AM on April 15, 2014 [3 favorites]

First let me echo that I am very sorry you are going through this.

I like Madamina's suggestion. We had a vet come and do a house call for our cat who had mouth cancer - and with pain medicine we felt good about giving her another month before having the vet come in. (It was also easier for her cat family to see her before the company took her away to be cremated.)

If he is still enjoying life, then enjoy the time with him. When he's obviously suffering, then it's time. If you get to the point where you need to take him in, it's very cold in the vet's office, but if you create a box that smells like you (it has a sweater or something) and is comfortable for your cat, then have him pass in it at the office, it will be easier for him.
posted by mitschlag at 8:27 AM on April 15, 2014

This is such a hard, heartbreaking thing to go through.

Your vet may have emergency spots reserved every day for animals who are injured or dying (mine does); when my late lamented cat went from declining rapidly to failing on all levels, they were able to see me that same day, walked me through the decision to run more tests, medicate/hydrate/force feed/catheterize, or to let her go. It really was time to let her go because there was no quality of life left for her - all that was left was confusion, pain, debility, and decline.

I held her as they injected her, and she quietly and painlessly died. They also took care of her after death; I chose to have her cremated and to sprinkle her ashes in her favorite spot in the garden, and they handled it all for me.

I think you are doing the right thing, to give him as much comfort and support while he's still involved in the world and alert to it. The thing to do is to make sure you are doing what is best for the cat, even if you aren't ready to let go. That was the hardest part for me. I let reason and logic make the best decision for my cat, even though my heart broke.
posted by julen at 11:18 AM on April 15, 2014

We had to euthanize my little girl due to this just a few months ago. We used SQ fluids successfully for some months and she was well and happy, and then began urinating in odd spots - something she had never done in her life. From there, within a very short span of time - days, really - she went downhill. I had her scheduled for a euthanasia and almost needed to reschedule for an earlier time because she was clearly in great pain. It was very difficult for me and for her. The idea of letting her die without vet intervention would have tormented me because it would clearly have been a prolonged agony for her.
posted by PussKillian at 1:07 PM on April 15, 2014

I wouldn't just take your vet's word that the only vet that did that is now retired. I would call around to all the vets in your area, tell them your story, and see what they say. If you are very rural, I can't imagine this would take very long. You might also try any local livestock vets or veterinary students.

I personally am a graduate student in biomedicine and work with mice. I have the tools and chemicals necessary to perform humane euthanasia and would do it for you I wasn't a state away. Maybe try thinking outside of the box?
posted by sickinthehead at 4:15 PM on April 15, 2014

I have nothing to add, Jacqueline, but to say that you and your kitty are in my thoughts. My own sweet kitty died at home in July and I'm in tears reading all of the stories of the ends of these beloved cats' lives and thinking of my own Zeke. Good luck to you and your kitten.
posted by Wet Hen at 6:15 PM on April 15, 2014

We went through this recently. One of our cats had kidney failure and had to be euthanised on Monday, so I understand what you're going through.

Death by kidney failure is unpleasant, and I urge you to try and end things humanely when the time comes. When they stop eating, the end is not far way.
posted by HiroProtagonist at 10:23 PM on April 15, 2014

One thing I wanted to add because you may not know this:

Euthenasia is (or can be) a two-stage process. My deeply beloved dog Eimear was not a fan of the veterinarian's office and found visits stressful, so on paper that was not an ideal place to be when we decided there were no good treatment options left for her and that the most compassionate thing to do was end her pain immediately.

In reality, she got a sedative with pain relief immediately and spent her last few minutes with me completely at peace, alert and in no pain before the heart-stopping drug was administered. You can read another comment I made about how the end worked and how far from my imagined scenario I found it; I really would encourage you to help your beloved cat skip the discomforts and distress of a "natural" death when the end is inevitable.
posted by DarlingBri at 3:56 AM on April 16, 2014

UPDATE: I'm glad I brought him home instead of having him euthanized when he received his terminal diagnosis on Monday because he actually seems to be getting better!

The timing and speed of his recovery makes me suspect that his UTI spread to his kidneys and that his bad kidney function numbers might have been due to a kidney *infection* instead of total kidney failure. The emergency weekend vet gave him an injection of a different antibiotic than the one he'd been on previously and the rate at which he's getting better looks very much like a response to antibiotics to me.

He's walking around (he was too weak to even stand before), very alert, purring when I feed him treats, and even woke me up early this morning by digging around in the trash can for my fried chicken bones.

He almost certainly still has kidney problems (it's almost a given with cats his age) but it might be chronic renal failure instead of end-stage renal failure. The website that unknowncommand referred me to has examples of cats who crashed with higher BUN numbers than my cat but then went on to live another couple of years with a good quality of life thanks to daily subcutaneous fluids.

So now I just have to fight with my vet (or get a new vet) to get him to give me a prescription for sub-Q at home (which is a totally mainstream treatment and recommended by the Cornell College of Veterinary Medicine as "the best thing you can do for your cat at home" for cats with CRF) instead of insisting that I bring my cat into his office for fluids (which I definitely cannot afford to do on a daily basis) because that's his policy. :(

I'm trying not to get my hopes up too much but I'm cautiously optimistic that my cat might not be dying after all.
posted by Jacqueline at 10:03 AM on April 16, 2014 [1 favorite]

That's wonderful news! My 18+ year old kitty had a similar crisis back in October and daily sub-Qs did wonders for him. It's not at all difficult to do at home, the supplies are relatively cheap, and it really makes a world of difference. Tanya's CRF page has tons of good advice about it. Best of luck!
posted by platinum at 10:34 AM on April 17, 2014

Brief update: He continues to get better. I found a new vet who set me up to give him subcutaneous fluids at home and those seem to be helping him stay hydrated and thus feel a lot better. He's also back on the antibiotic that seemed to kick off his recovery after the emergency weekend vet gave it to him a week ago. He's semi-active now: walking around, giving affectionate head bumps, purring, etc., which are all things he wasn't doing a week ago.

The only worrying symptom remaining is that his appetite is poor and he's lost a lot of weight so I'm temporarily supplementing his food intake by syringe-feeding him a slurry of kidney-supportive canned food mixed with omega 3 fish oil (for the caloric density) to put some weight back on him and hopefully jump-start his appetite again (cats get into a downward spiral where not eating leads to no appetite which leads to not eating...).

The website has been my guide through all this and is a literal lifesaver.
posted by Jacqueline at 7:06 AM on April 19, 2014 [4 favorites]

Sad update: After getting better for a week, he took a turn for the worse yesterday and died in my arms early this morning. When I woke up around 4am he seemed cold so I pulled him under the covers with me, curled around him to warm him up, and fell asleep petting and scratching his head while he wheezed in my ear. When I woke up again at 6:30am he was silent, limp, and gone.

He was the best cat I've ever known and the best friend I've ever had. I will love and miss him forever.
posted by Jacqueline at 4:19 AM on April 23, 2014 [4 favorites]

I'm so sorry for your loss. A cat could ask for no better death.
posted by ottereroticist at 7:35 AM on April 23, 2014

I'm sorry your friend is gone, but I am happy his last hours with you were full of peace and love.
posted by schroedinger at 12:44 PM on April 23, 2014

Geez, I'm sorry to hear that, Jacqueline. But I am glad that his last few hours were so perfect.
posted by Juffo-Wup at 6:50 PM on November 3, 2014

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