Kidney failure, possible hospitalization, then what?

[sidneykitty]

My 17-yo cat was diagnosed with early kidney disease last summer at her checkup. Her semi-annual checkup in December showed she progressed to stage 2 and we started SQ fluids twice a week. I did not notice much improvement or a change in her after giving fluids like I expected. The last few weeks she has been eating a lot less, so I took her to the vet last week. Her kidney disease progressed rapidly to stage 4 and kidney failure, much faster than I ever expected and I am completely devastated.

Instead of hospitalizing for IV flushing right away, we opted to start antibiotics in case an infection was the culprit (pending culture results which may or may not shed light) and treat her at home with aggressive fluids, cerenia and mirataz. Her respiratory rates are good, all around 20. She had been doing well the last few days until she barely ate anything yesterday. I understand if she stops eating, we will have to hospitalize her and am looking at bringing her in today if she doesn't eat something soon. If the antibiotics haven't made a big difference, then it seems we are not dealing with infection, but rather, something that cannot really be fixed.

I'm wondering what the possible outcome is for her coming home from hospitalization. I understand flushing the kidneys can rid her body of toxins, help the kidneys function better and make her feel a bit better in the short-term, but longterm, she has still lost a lot of lost kidney function and that isn't going to change. Is she going to wind up in this same scenario again in a few weeks, a month down the line, two months? Of course, no one knows what might happen, but I guess I wonder, is it worth putting her through this now to buy us a little more time? I don't want to give up but I don't know what to do and having a difficult time making decisions.

I'm just wondering if anyone has experiences of similar cases to share or just general support. It's so hard to imagine life without her but I don't want her to be ill for my sake and I'm cautious of pushing too far. I guess I'm not even entirely sure if I'm facing the end soon or not, which is making it extra hard to see what's best.

Please no judgment for our decisions, we made them with the full support of the vet, lots of consultation and discussion and consideration what was best for us and for Amber, and we thought the home care approach was worth trying to reduce the stress on her being in hospital as long as she was eating. If it were pancreatitis or something else curable, then I'd have had her in there in a heartbeat.

 

[catmom2wires]

Anything done with kidney failure is a short term treatment. Toxins never stop being produced and I would think that changes from hospitalization would last days vs weeks. Kidneys are very finicky organs and once they shut down, the rest of the body will follow in short order.

 

[sidneykitty]

Yes, that's my understanding...thank you. I guess I'm at a point where I'm not sure what the point of hospitalizing, given the stress and cost, is, if it won't change the outcome... even though it's breaking my heart to even think it. I have seen/heard of so many cats live with ckd for so long, and this happened so fast for her, I'm just in a bit of shock really, and to be honest, I'm feeling a little cheated and upset about it not that anyone could have known.

 

[sivyaleah]

Trying to figure out how long to treat and how is very difficult with kidney disease, as you already are aware. Some cases can take years to get to a point where overall health is seriously compromised. Other times, it happens fast. Either way, assessing quality of life is a good way to help decide if the patient still has some good days ahead or if they are suffering. If you trust your vet, having an honest, open conversation on their opinion can be helpful in deciding what the best treatment might be.

I think a good first step is to do an online assessment. This one, is really simple and to the point.

Quality of Life | Lap of Love

The site has a lot of really good info related to quality of life issues.

You sound like you are thinking realistically and have your cats best interests in mind. When I went through this we considered our cat as being in a hospice situation. Keeping him as comfortable, engaged and loved as possible but fully aware a time would come when we would have to make a bigger decision. I think for us, when that time came it was easier to make because my husband and I had fully talked out what we would do and in what instances. No matter how much time one has with loved ones, it's never enough and it's no different for our pets.

For us the ultimate act of love was being open to making the hard decisions so our boy didn't suffer. My thoughts are with you as you navigate through the choices to be made.

 

[sidneykitty]

sivyaleah , thank you so much for sharing your information, insight and experience. It means a lot to me. I think we've opted not to hospitalize even if she stops eating as there really is not point, ultimately, hard as it is for me to say. I wish I could fix her but there is no fixing this and it's breaking my heart. I love her so much. So yes, we are essentially looking at hospice type care, keeping her as happy and comfortable as we can in what time I assume remains. I hope to try behaving as normal as possible myself so as not to stress her out or cause her upset with my own heartache, to treasure what time we have left rather than focusing on the bad. I hate thinking about life without her, its unimaginable, but I don't want to make her suffer for my sake.

She wound up finally eating some today, which seemed like a little miracle... I picked up a different appetite stimulant to try in case the Mirataz is not as effective anymore and will see if that helps any. I've had relaxing cat music on for her much of the day though I don't know if it helps her or not. She is due for another checkup Thursday and I imagine we'll get more labs to see where she is at and go from there.

I'm up in the air whether an ultrasound is something I'm interested in. It will tell us more, but it won't change anything. I almost feel it would be more like closure for myself and/or possibly helping inform us on when to make the final decision later, rather than any real benefit to her, if that makes sense...

 

[sivyaleah]

sidneykitty It sounds like you are handling this similar to how we did. This is one of those diseases where it's got a clear progression especially once the kidney(s) lose function.

Not eating is probably the most devastating thing to watch. For us, that was the clearest sign. Our boy ate fairly well through his entire illness (and btw, he also had a few other concurrent problems) and we always took hope in that he continued to eat decently. He did well overall in fact until the last 2 days he was with us. Once he fully resisted food we knew it was only a matter of short time before he faded and we did not want to witness this happening. I take some small comfort in that we got him to eat a small amount of Kobe beef burger the night before we let him go. By the next morning, however, he had declined so much that it was obvious what our decision would be that day.

We opted not to treat him further once we were told his kidneys were in the process of shutting down completely. We did discuss with our vet who only suggested administering some extra sub-q (which was being done regularly at that point anyway) and a couple of other supportive help (I can't remember off hand what that was now). Other tests were obviously suggested but she knew us really well and knew Casper really well and was honest in her opinion that there really wasn't anything that would prolong his life at that point and why go through the cost.

It's all so difficult and confusing. Too many of us here have been through this exact scenario. Try not to second guess yourself now as hard as it may be. Be gentle with your decision and yourself. Sometimes, one does not know when it's time and needs guidance from others to clearly see the picture in whole. Getting stuck in grief by having regrets, to me, is a miserable way to live. I do hope you are able to come to a good decision sooner than later.

 

[FeebysOwner]

Cats can - and do - rebound - and then relapse, repeated times; so, it is always hard to know when a relapse isn't going to once again lead to another rebound. There are other factors that can play a role in kidney levels dramatically increasing, so, another set of labs might be well worth it. If she does well with ultrasounds, it may be a good idea to go through with that as well. If she is not consistently on an anti-nausea med (in addition to the appetite stimulant), that might be another thing to consider. From all that I have read and studied; it is a rarity that CKD cats don't end up on both.

I don't know if you are familiar with Tanya's web site, but sadly they do have a section on what to expect when the end is near and how to try to cope with it.
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Saying Goodbye (felinecrf.org)

I want to say that I hope there are signs that your girl is headed for a rebound, but I know that can't happen forever.

 

[sidneykitty]

I'm reaching a stage of acceptance this morning. The hardest part is watching her do her normal behavior and activities, show interest in her special treats (special food I normally give her cisapride in), but then not eat a normal amount of food to sustain herself, and knowing what that means. The new appetite stimulant (cyproheptadine) didn't seem to make much difference yet, but I read that it can take a few doses to kick in. It certainly made her dozy last night and her little tongue was poking out... as an experiment, I gave her a few drops of CBD oil yesterday (it had been Rx'ed by the vet before and was part of her usual regime until her appetite waned and I stopped giving it in her food) to see if that would make any difference. She did eat after, but it is hard to know if that had anything to do with it or not and I'm cautious to pair it with certain meds, like Mirtaz, due to interference.

Yes, she is on Cerenia. I know kidney cats can wax and wane, making it so difficult. I hope I will know when I know. It was much easier to decide with my first cat, as she had breathing trouble at the end. When her respiratory rate went up and she had trouble breathing and wouldn't eat even Temptations, I knew. It feels less clear with Amber. I don't want to make a decision too soon or too late...I think I will feel better when I know more after labs at the very least. Thank you for the link to Tanya's page, I've been on her site before but I've avoided reading that particular one, though I'm vaguely aware of some of the end-symptoms, it's a good reminder and I appreciate you sharing it, FeebysOwner . I also hope she may rebound but I am not sure it will happen. I cautiously hoped the antibiotics would help but I knew it was only a small chance.

Thanks to you both for your support and everything.

 

[stephanietx]

It's so hard when they're older and having kidney problems because they can be fine one day and then go downhill the next. What we did with our girl is offer her smaller meals more frequently. My husband and I decided beforehand what measures we would take with our kitties regarding end of life and illnesses. That helped guide us when the time came and health did decline. It's not an easy road.

 

[sidneykitty]

Thank you.

My partner and I have had some discussions about what we want to do, etc., and we are both on the same page. It's about what's best for her.

Yesterday, she entered the extremely frail, limp phase. I'm not sure how to explain but I think if you've all experienced the weak, limp, elderly cat you know what I mean...I've never seen her like this before and it's heartbreaking. She's always been so vibrant and vocal, affectionate and head-booping literally everything but especially us. She hid under the bed last night but eventually came out at bedtime to cuddle both my partner and I, tucking herself in at his feet in his "nook" like she typically does...she barely touched any food yesterday, everything I cooked, every can I opened, treats, catsip, even tuna, she just licked at a few things but didn't really EAT them. She was drinking water but starting to do the head droop over the water bowl, staring at it and not drinking, though she would finally take a few sips eventually.

I am flabbergasted this morning, she has at least walked over to food I put down and eaten it of her own volition without coaxing. She's chatty again and following me around the house. I read on Tanya's site they can often have a final rally before the end... I don't know, I was so sure yesterday we were approaching the end and maybe we still are. It's so hard. Maybe the cypro is finally kicking in? I'm kicking myself if so because I opted to skip her dose this AM thinking it wasn't making a difference and just making her dopey...but I can always give it later or ask the vet to do so. At least I hope to get a little more information after her checkup today which may or may not shed light on her situation...

 

[sidneykitty]

Thank you.

My partner and I have had some discussions about what we want to do, etc., and we are both on the same page. It's about what's best for her.

Yesterday, she entered the extremely frail, limp phase. I'm not sure how to explain but I think if you've all experienced the weak, limp, elderly cat you know what I mean...I've never seen her like this before and it's heartbreaking. She's always been so vibrant and vocal, affectionate and head-booping literally everything but especially us. She hid under the bed last night but eventually came out at bedtime to cuddle both my partner and I, tucking herself in at his feet in his "nook" like she typically does...she barely touched any food yesterday, everything I cooked, every can I opened, treats, catsip, even tuna, she just licked at a few things but didn't really EAT them. She was drinking water but starting to do the head droop over the water bowl, staring at it and not drinking, though she would finally take a few sips eventually.

I am flabbergasted this morning, she has at least walked over to food I put down and eaten it of her own volition without coaxing. She's chatty again and following me around the house. I read on Tanya's site they can often have a final rally before the end... I don't know, I was so sure yesterday we were approaching the end and maybe we still are. It's so hard. Maybe the cypro is finally kicking in? I'm kicking myself if so because I opted to skip her dose this AM thinking it wasn't making a difference and just making her dopey...but I can always give it later or ask the vet to do so. At least I hope to get a little more information after her checkup today which may or may not shed light on her situation...

 

[sidneykitty]

Thank you.

My partner and I have had some discussions about what we want to do, etc., and we are both on the same page. It's about what's best for her.

Yesterday, she entered the extremely frail, limp phase. I'm not sure how to explain but I think if you've all experienced the weak, limp, elderly cat you know what I mean...I've never seen her like this before and it's heartbreaking. She's always been so vibrant and vocal, affectionate and head-booping literally everything but especially us. She hid under the bed last night but eventually came out at bedtime to cuddle both my partner and I, tucking herself in at his feet in his "nook" like she typically does...she barely touched any food yesterday, everything I cooked, every can I opened, treats, catsip, even tuna, she just licked at a few things but didn't really EAT them. She was drinking water but starting to do the head droop over the water bowl, staring at it and not drinking, though she would finally take a few sips eventually.

I am flabbergasted this morning, she has at least walked over to food I put down and eaten it of her own volition without coaxing. She's chatty again and following me around the house. I read on Tanya's site they can often have a final rally before the end... I don't know, I was so sure yesterday we were approaching the end and maybe we still are. It's so hard. Maybe the cypro is finally kicking in? I'm kicking myself if so because I opted to skip her dose this AM thinking it wasn't making a difference and just making her dopey...but I can always give it later or ask the vet to do so. At least I hope to get a little more information after her checkup today which may or may not shed light on her situation...

 

[sidneykitty]

oh gosh can an admin delete my duplicate posts (and this one if you like)? my laptop often triple clicks when I don't mean to and it seems to have done so twice this time! thanks.

 

[stephanietx]

I'm glad your girl has rallied and I'm glad you're on the same page regarding her care. That's so helpful! I hope she continues to do well.

 

[Margot Lane]

Love your cat (didn’t see name) ALL YOU CAN. They will appreciate it. As other wiser cat people have already posted, kidneys are very finicky, although science is improving all the time, thank goodness. Cats are troopers as you know. They will love you right back, and KNOW that you care (which you obviously do). Being in the moment is important here, and you are a good cat owner: no judgement.

 

[sidneykitty]

Well I think that was a last rally, as I sort of suspected... Amber's labs were not good, everything got worse, creatinine and BUN both increased significantly, so we are having someone come to our home tomorrow to euthanize her. The good part was that she presented quite well to her condition - generally well-hydrated and such for her state so we've done the very best job we could have to make her feel less awful.

I'm glad, in a way, that she rallied a little this morning. It was so nice to see her be her more peppy self again at least for a little while. She has still barely eaten anything real and I know she cannot go on like this. I know this is the right decision, and there is some comfort in that, despite how much it breaks my heart to think about life without her. I work from home and I have loved being able to be with her and have her around so much and it is going to be very difficult to adjust to life without her. She shaped my days, coffee and cuddles in the morning, and reading and relaxing time cuddles at night.

She was with us for seven wonderful years and gave us so so so much love and I am so thankful for that. I'm so glad she came into my life rather unexpectedly. I know I gave her everything I could, spoiled her, loved her deeply, she has been my best friend. Now it is time for me to give back to my Ambie one last time.

 

[sidneykitty]

We said goodbye yesterday. I miss her terribly but I know it was the best thing for her. Someone came to the house and she looked so peaceful after.