Chronic Kidney Disease: What to Expect and How Veterinary Hospice Care can Help
Chronic kidney disease (CKD) affects many senior cats and dogs, as well some younger pets, too. CKD is a chronic, progressive and irreversible condition, however, with proper veterinary care, individualized to your pet’s condition, symptomatic and supportive care can help your pet feel better, improve some of the secondary sequelae of CKD, and have a good quality of life!
What is kidney disease?
Kidney disease is the gradual loss of kidney function, persisting for over 3 months. CKD is categorized into 4 IRIS (International Renal Interest Society) stages, based on 2 or more blood checks. The blood values allow your veterinarian to categorize how progressed disease is, and make the best recommendations monitoring and treatment for your pet.
Often, CKD is advanced before you notice outward signs of illness in your pet: On labwork, it takes more than 75% loss of kidney function before your kidneys lose their ability to concentrate urine! One of the first changes you may notice is your pet drinking and urinating more frequently. Other symptoms of CKD develop as loss of kidney function progresses.
Generally pets in stage 1 or 2 of CKD may seem fairly normal, whereas most pets in stage 3 or 4 will be more noticeably ill. CKD typically progress to terminal kidney failure over months to years. Early diagnosis affords the greatest potential to slow progression of CKD in pets.
Chronic Kidney Disease Affects the Whole Body:
The kidneys help to filter toxins out of the body. When the kidneys are damaged, toxins and nitrogen build up in the blood, shown on bloodwork, this causes pets to feel nauseous and they may not want to eat like they used to, and have vomitting.
Your veterinarian may use the terms “Azotemia” and “Uremia” to describe these changes seen on lab work. “Azotemia” occurs when nitrogen builds up in the blood; “Uremia” is a build up of urine in the blood. BUN (blood urea nitrogen) and creatinine are two markers of nitrogen accumulation. Symmetric dimethylarginine (SDMA) can also be measured on lab work, this increases earlier than creatinine in dogs with CKD.
Healthy kidneys produce erythropoietin (EPO), which stimulates red blood cells production that carry oxygen in the body. CKD causes decreased EPO, thus fewer red blood cells are made, causing anemia. Pets with CKD may feel weak, have decreased energy, become wobbly and sleep more.
The parathyroid glands secrete parathyroid hormone (PTH), important for maintaining normal calcium levels in the body. These glands can produce too much PTH in pets with CKD, altering the normal calcium levels. Affected pets may tissue mineralization, bladder stones, neuropathy, and other secondary issues.
What changes may I notice if my pet has CKD?
Common Signs of CKD in pets:
Increased drinking and urination
Decreased appetite to no appetite at all; You may notice your pet sniffs food as though he/she wants to eat but doesn’t actually eat
Decreased energy
Nausea and vomitting; Lip licking can be a sign of nausea
Weight loss and loss of muscle (seen especially along the spine and hips)
Hair coat changes: Decreased grooming & changes in the quality of the coat are common, becoming more dull and unkempt
Constipation or Diarrhea
The gums and skin coloration in may appear more pale in color
Bad breath
Urinary tract infections (UTI’s)
Less Common Signs of CKD in pets:
GI bleeding: You may notice a change in the coloration of the stools to a more tarry appearance
Impaired ability to regulate body temperature- your pet may seem more cold in general
Heart murmur
Retinal detachment causing sudden blindness
Ventral neck flexion: Your pet may not be able to lift their neck normally and they may appear to constantly be looking down or in front (not up)
Muscle tremors
Seizures
Generalized bone and muscle soreness
Is CKD painful?
In most situations CKD is not outright painful. People with CKD often describe feeling up and down: Good at times and not themselves at other times. As CKD progresses, you will likely notice more changes in your pet’s behavior and routine, indicating your pet is not feeling well.
Even though CKD may not be thought of as a painful condition, some secondary complications of CKD are painful, such as muscle and bone soreness. Cancer affecting the kidneys causes changes to the structure of the kidney, which is a painful condition.
How can a Hospice Veterinarian help your pet and family?
Hospice veterinarians are specially trained to help with comfort care for pets at the end of life. Your hospice veterinarian will make an individualized plan for your pet based upon your pet’s condition and goals as pet parents. Hospice care for your pet when focused on symptomatic and supportive care can help your pet feel better, improve secondary sequelae of CKD, slow disease progression and have a good quality of life!
Ways a hospice veterinarian can help your pet and family:
Education on disease progression and what to expect: Having an experienced & compassionate vet who will take the time to discuss disease progression and signs to watch for is critical in helping your pet. Monitoring for changes and knowing what to watch for can greatly help your pet and your family.
Quality of life assessing: Monitoring your pet’s quality of life on a regular basis can help you identify changes to your pet’s overall quality of life. Assessing quality of life also helps decipher when its time to consider compassionate euthanasia
Hydration Support: This is a mainstay of helping pets with CKD as their kidneys cannot concentrate urine like normal. Your hospice veterinarian will guide you when to consider hydration support, options available, amount and frequency. Some pets with CKD also struggle with constipation, hydration support will often help relieve this issue.
Comfort Care: Keeping your pet as comfortable as possible, recognizing signs of pain and distress, and setting up your home so it is safe and comfortable for your pet to perform normal functions is very important in your pet’s quality of life and yours.
Pets with CKD often have muscle loss & may have muscle aches, affecting mobility. Pain control may be needed as CKD progresses, however not pain medications are not safe for pets with CKD. Your hospice veterinarian will discuss best pain relief options for your pet.
Pets with CKD have difficulty thermoregulating their body temperature: Heating pads for cats and heating pads for dogs are often a welcome comfort for them.
Keeping food & water bowls accessible and having easy access to bathroom needs is essential.
Elevated bowls are often easier for your pet to eat from
Water fountains providing fresh, filtered water may encourage more drinking and flushing of kidney toxins
Easily accessible low rimmed litter boxes on all levels of the home make it easier for your cat to use the litter box
Ramps may help you safely move about and get to their favorite spots
Kidney Support Supplements may help slow down the progression of CKD. Your hospice veterinarian will guide the best options for your pet. Below are some commonly used kidney support supplements.
Omega-3 fatty acids high in eicosapentaenoic acid (EPA) are beneficial for kidney health and helpful for cats & dogs with CKD
Azodyl is a probiotic for dogs and cats, which adds nitrogen consuming bacteria to the intestines. These bacteria break down the increased waste products resulting from the kidney’s impaired ability to eliminate them.
Epakitin is a supplement that utilizes chitosan, a natural ingredient that limits absorption of phosphorus from the intestines.
GI support is important as vomitting, nausea, and decreased, picky or lack of appetite are common in pets with CKD. Probiotics are a good way to help support the GI tract. Preliminary studies show probiotics may decrease azotemia and provide intestinal immune support: Fortiflora cats & Fortiflora dogs. There may be other ways to support your pet’s GI tract, your hospice veterinarian will discuss the best options.
Blood pressure support: Blood pressure abnormalities are common in pets with kidney disease, if left untreated, they can progress to other issues such as retinal detachment causing sudden blindness.
Monitoring & Treating blood abnormalities such as: Anemia, serum calcium levels, electrolyte imbalances, etc is important to help your pet feel better and slow progression of CKD.
Find a Veterinary Hospice Provider
A diagnosis of CKD can be disheartening, however hospice care veterinarians will compassionately guide you and your pet during this difficult time. Symptomatic and supportive care can help your pet feel better, improve secondary sequelae of CKD, slow disease progression and have a good quality of life! Palliative care veterinarians are a compassionate group of veterinarians that will help you and your family navigate the intricacies of aging gracefully, so you and your pet make the most of each day!