Chronic Kidney Disease in Dogs: Treatment/Palliative Care options and how to know when it’s time for Euthanasia

Chronic kidney disease (CKD) is a progressive, irreversible condition that affects a dog’s kidney function over time. The kidneys filter waste in the blood, balance electrolytes, and maintain hydration. When the kidneys begin to fail, toxins build up in the bloodstream, leading to a range of health issues.

CKD is most commonly seen in older dogs, but it can also develop due to genetics, infections, toxins, or other underlying conditions. CKD progresses and cannot be cured, but its symptoms can often be managed for some time to maintain a good quality of life.

Treatment Options/Palliative care for dogs with CKD

Unfortunately, we cannot cure or reverse chronic kidney disease. It is progressive and ultimately terminal in all cases. However, there are many things you can do to keep your dog comfortable, happy, and leading their best life for some time. Each treatment has benefits and drawbacks, discussed below.

1. Dietary Management
The first thing your vet will probably tell you is to put your dog on a prescription kidney diet. They are lower in protein, phosphorus and sodium while high in omega 3s to help dogs feel better and keep on weight.

Pros: They can make dogs feel better and sometimes even slow the progression of kidney disease.

Cons:

• Many dogs refuse to eat these diets.
• There are some newer “fresh” pet food companies that make fresh or custom kidney diets you can try that your dog may enjoy more.
• If your dog refuses to eat a special kidney diet, it’s more important that they at least eat SOMETHING (even if it’s not a special diet) so they can keep on weight and feel strong.
• If your dog won’t eat the kidney diet, talk to your veterinarian about alternatives.

2. Fluid Therapy
As kidney function declines, dehydration becomes a major concern. Subcutaneous (SQ) fluids can be administered at home to help maintain hydration and flush toxins from the bloodstream.

Pros:

• Fluids can help dehydration, improve energy levels, and help dogs maintain a good quality of life for longer.
• It can often be started at once a week or so and increased up to daily as needed.
• They also can often be given by you, at home so no vet visits required!

Cons:

• Some dogs can be challenging to give fluids at home to because they are reactive to the needle
• If large dogs are given fluids frequently it can become costly and time-consuming

3. Medications and Supplements
Several medications can help dogs with kidney disease feel better, leading to a better quality of life for longer. There are several categories of medications and which medications to use depends on your dog’s symptoms.

• Appetite stimulants: for example, Entyce (capromorelin). These can improve your dog’s appetite to help eat better, keep weight on, and have more energy.
• Nausea medications: Nausea medications not only can prevent vomiting but can sometimes improve appetite as well. The most common nausea medication we prescribe is maropitant (brand name: Cerenia). It is administered once daily.
• Phosphate binders: If your dog’s phosphorus is high, your vet may prescribe a phosphate binder. These are often powders mixed with food that dogs eat pretty readily. Brand names include Epakitin and Rx Vitamins Phos-Bind.
• Blood pressure medications: Some dogs with kidney disease may develop high blood pressure, in which case your vet may prescribe a medication such as an ACE inhibitor.

4. Environmental management

It is important to provide a comfortable environment especially as CKD becomes more advanced. Some things you can do to help your dog include:

• Ensuring soft, warm bedding for joint comfort.
• Keep water and food easily accessible to prevent unnecessary exertion.
• Avoid stressors such as loud noises or frequent disruptions.

5. Quality Time and Emotional Support

• Spend time engaging in activities your dog enjoys, such as gentle walks or simply resting together.
• Monitor their mood and signs of discomfort to adjust care as needed.

How to Know When It’s Time for Euthanasia

A decision every pet parent will have to face when dealing with CKD is how to know when it’s time for euthanasia.

I highly recommend making a comprehensive end of life care plan for your pet as soon as they have been diagnosed with CKD. This includes:

• Deciding which treatments you would or would not pursue, for example:
  • Would you hospitalize your pet when the disease is very advanced?
  • Do you want to ensure your pet has a home euthanasia instead of passing away in the hospital?
• An objective set of criteria for euthanasia.

It is much easier to make these decisions when you are in a relatively calm frame of mind. When we are facing an immediate crisis of possibly losing our pets, it’s easy to make the wrong decisions in a panic.

I also recommend keeping a daily journal of your dog’s quality of life in a journal. I recommend simply putting a smile for a good day and a frown for a bad day. The journal can also be a place where you write new memories you made with your dog each day. It is important when facing the end of life to live in the moment and cherish every single day.

Our comprehensive quality of life scale (https://pawsatpeace.com/quality-of-life-scale/) can help you assess your dog’s quality of life. This quiz can be taken once to give you a snapshot of your dog’s quality of life, or taken multiple times to assess trends over time.

Finally, the most compassionate choice is to give your dog a peaceful goodbye before too much suffering has set in. If you do this, you can give your dog the gift of a peaceful last day, and they don’t need to know the severe suffering that often accompanies end-stage CKD. ‘

When you are starting to see more bad days than good days, it’s a good time to give them a beautiful send-off. When clients wait too long, they often end up having to rush their beloved dog to the emergency room for euthanasia.

Signs That Euthanasia May Be the Kindest Option:

• Persistent loss of appetite, nausea, or vomiting: If nausea medications are no longer helping and your dog refuses food and water, they may be experiencing significant suffering.
• Extreme Weight Loss and Muscle Wasting: A dog who has lost too much body condition may start to have multiple organs fail leading to an emergency situation.
• Lack of Interest in Life: If your dog no longer responds to their favorite activities, seeks out affection, or engages with their surroundings, their quality of life may be too poor to continue.
• Sores in the mouth: When kidney disease becomes very advanced, dogs can develop extremely painful sores in the mouth. These indicate the disease is end-stage and are incredibly painful, so if your dog is developing mouth sores I recommend euthanasia.
• Seizures/disorientation: Occasionally, end-stage CKD can cause seizures or cognitive problems. If you are seeing this I recommend euthanasia right away.
• Breathing Difficulties or Severe Weakness: If your dog struggles to breathe or stand up, euthanasia can prevent further distress.

Conclusion

Chronic kidney disease is a devastating diagnosis, but with proper treatment and palliative care, dogs can still experience love and comfort in their final months.

If you are not sure what to do and would like more guidance and support, we offer comprehensive teleconsults with compassionate veterinarians. We will review all your dog’s medical records and history, discuss all your options, and help you formulate the most compassionate and loving plan for your family.

And when it does come time, Paws at Peace offers in-home euthanasia to help your dog pass peacefully at home, surrounded by family. Home euthanasia can provide your dog with a gentle and dignified transition without the stress of a veterinary visit.