Expert: Jessica - 5/30/2010

Question
My cat, pinky, who we have had for the past 18 years, had just been diagnosed by a vet with severe kidney failure. Her levels are 4 times higher than a normal cat. She stopped eating, drinking water, has lost so much weight and is constantly tired.

We had a bad experience with the vet who diagnosed her hence I would like to get a second honest opinion.

They had recommended her to be hospitalized for 2 days and get an IV however we are not sure if this recommendation has been stemmed from a real concern for her health or just to make more money. A new vet had bought the existing practice that we use to take pinky too.

Money is not an issue...we are just concerned that based on her age (18) she may not be able to survive the ordeal in the hospital. Our old vet had always been a little cautious with her in terms of not wanting to give her unnecessary medication or even sedating her for a wart removal because of her age.

She is very frail and we love her soo much ! We aren't mentally prepared to see her go however, we also don't want to chance her dying in the hospital (unhappy) because we were not able to accept that she needs to move on.

What do you suggest we do? Please take into consideration her age? Frailty. She gets very very very upset going to the vet and I think she also has a high blood pressure. Are there any alternatives we can have while she is at home?

I have also been nursing her every few hours. I feed her by hand new medicated wet food (less phosphorous) and I give her water every 1- 2 hours via syringe. She seems to be a little better however I know this is not going to help her with her kidney failure.

How long do we have with her? No one seems to know. She has been diagnosed as being in her end stage..

How safe is anesthesia or sedating an old cat? Please give me some advise as we need to consider what would be the best step for her...We do not want to make her miserable.

Please reply soon as we would like to make a decision ASAP.

Answer
Hi Aliza.  I’m so sorry to hear this.  I think the decision will be a very difficult one to make, and only you can be the one to make it ultimately, but there is some information that might help you in your decision.

First, there are two kinds of kidney failure – chronic and acute.  Some tests might be run and a history taken on the cat if there is a suspicion that acute renal failure might be the case.  Acute failure can sometimes be reversed, but the most common type in older cats is chronic renal failure, and this is an irreversible condition.  You may be able to slow the progression of the disease for a while and even have the cat feeling better sometimes, but when a cat reaches end stage renal failure, it is a steep uphill battle to get them to a point where they will have any quality of life left.  If there is to be ANY hope of this, IV fluids should really be part of the game plan.  This I agree with your vet on.  I’m not sure how bright of an outlook you were given, though.  Sadly, most cats in this condition at this age will not overcome their immediate illness.

IV fluids must be given in the hospital, as you know.  However, no anesthesia or sedation should need to be used in order to place an IV catheter by a vet who has any experience with cats.  This kitty should not be undergoing any anesthesia or sedation for any reason.  

This is not to say it never happens, but in my personal experience, no cat has ever bounced back from end stage renal failure once they’ve stopped eating.  I have had cats hospitalized for IV fluids for a couple of days, and rather than bringing them home, I’ve had to meet them at the hospital to be put to sleep.  I regret that their last days were spent in the hospital instead of at home with me.  But if you don’t try the treatment, there’s no way you may end up with that possible miracle.

One possibility that might help you is to try giving the kitty some fluids at home.  The vet can show you how to give her fluids subcutaneously, instead of intravenously, at home.  This helps flush toxins from the system and can lower kidney values in cats with moderate kidney failure.  But because the fluids aren’t going directly into the bloodstream like with IV fluids, giving fluids sub-q doesn’t often cause a great turn around in cats with very advanced kidney failure like yours, unfortunately.  Since it causes very little discomfort, it’s inexpensive, and it can be done while she rests comfortably at home, there is little reason not to give it a try, though.

Kidney failure treats each of its victims very differently.  Some cats diagnosed with slightly elevated levels will die within weeks while those diagnosed with extremely high levels will live equally as long.  It all depends on how well the individual compensates for her illness and how the kidney failure is affecting other body systems.  This is why guessing at a life expectancy is so difficult.  If a cat isn't eating her full ration of food, however, this generally indicates that her body is winding down, and she probably has less than a week or two.

I think looking at this realistically, if you are most concerned with knowing you did all you could to try to save her, you would have to hospitalize her and go with the IV fluids for a couple of days at least.  If it’s most important that, instead, her last stays be spent surrounded by her loved ones, you should keep her at home and make her as comfortable as possible until it’s time to put her to sleep.  We are never quite ready to part with our beloved kitties, and it’s so hard when the cat’s spirit is still so strong.  Sadly, renal failure wins all its battles, and the only choice we are left with is when to let go and say goodbye.

I wish you strength as you go through this difficult time.

Jessica