# Chronic Renal Failure: when do you know "it's time"?



## Argelius (Jun 20, 2012)

Hello All,

This is a question for those who have had a dog with chronic renal failure (CRF). At this point I'm pretty well-versed in the usual things like treatment, diet recommendations, access to water, monitoring of creatinine and BUN to asses progress, etc.

Briefly, I have have a 13 year old Westie (Madision) who was initially diagnosed with CRF about a year and a half ago. He's done well, although over the past several months has lost a good deal of weight. Anyway, this past week (Wed-Sun), we were out of town and lift him (and his littermate) at a new boarder. When we picked them up, Madison was very listless and wasn't eating much.

Anyway, we took him to the vet and blood work showed markedly elevated BUN (122) and Creatinine (5.3). Vet said he was very dehydrated and kept him over night for IV fluids. Anyway, he's urine now is very clear and he remains listless and uninterested in food.

This rapid deterioration was clearly brought about by the stress of being at the new boarder and he may not have drunk as much water as he should have.

If anyone is still reading (!), what are the triggers for considering euthanasia in these situations? I know it's a personal decision and this is a discussion we need to have with our vet. But curious what folks here think. 

I love him to death, but I'm not interested in continuing to do things to keep him (barely chugging along) with things like home SQ fluids like some do. Given that the IVFs given at the vet overnight haven't changed his behavior/activity and his urine remains very clear and unconcentrated, I'm wondering if this is how it ends...

Thanks for your thoughts.


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## lil_fuzzy (Aug 16, 2010)

I haven't had to put an animal to sleep yet, which I guess is lucky. But we did get up this morning to find our 13 year old cat dead on the floor. It was horrible.

So we have decided that in the future if we think one of the cats might die, we will go to the vet and have it put to sleep. We don't ever want to wake up to a dead animal ever again. 

I don't know about your dog's condition, so I don't know if he would be likely to die during the night or anything like that, but if he was my dog and there was a possibility I could find him dead, and I knew he would never get better no matter what treatment, then I think I would choose to euthanise.

It's a very personal decision though.


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## georgiapeach (Mar 17, 2012)

I'm so sorry you have to make this difficult decision - it's never easy to lose a beloved family member! It sounds as though you know it's time, but you want verification. When his quality of life is gone, it's time. Have you talked to your vet to see what his/her opinion is? We had to make this hard decision last summer with our 14.5 year old lab, Chipper. His passing was very peaceful and painless, and now he's romping happily at the Rainbow Bridge.


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## PappyMom (Jun 5, 2009)

I had to make the decision with my sharpei. His kidneys had shut down, he was vomiting and having diarrhea which contained blood, and often his urine did. I looked into his eyes and my heart broke for him.. I was being selfish trying to hold on to him when he was ready to go. He was PTS that day. It's hard.


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## undervenued (Mar 26, 2011)

I've only had to make the decision fe my pet guinea pig, never a dog, so it might be different. 

But I think you just sort of know in your heart when it's time. 

You can sort of look into their eyes and know they have had enough.


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## Bordermom (Apr 28, 2010)

You have to decide for yourself. For me, it's when they have too many bad days in a row without perking up again. With one dog, he stopped eating, which wasn't out of the norm, but even bribe foods he didn't really go for. He wasn't uncomfortable, just slept a lot, would go out for a potty break then back in and back to bed. That was about four days. The last night, he wasn't comfortable enough to sleep, and sat and panted a lot. So I knew. Our other dog had good days and bad days, some really bad days but would always be back to herself the next day. I'd spend the day thinking 'this is it' then the next morning she'd be stealing food off the table again. She was having a really good day, we went out for dinner and came home and she was close to passing, not waking up and not able to move. I had enough time to get DH into the house to say goodbye and that was it. Had we been even 20 minutes later we would have found her gone.

It's not an easy choice, but you can always make arrangements and postpone. If he's not going to improve, it might be kinder to help him pass, you can talk to the vet about it. 

Personally I get the vet to come to my home, with our old dog I took my 3 year old son to a sitter's house, then closed the blinds, lit some candles and moved his bed to the front room. The cremation service came first and got his paperwork out of the way, spent a moment greeting my old guy, then went outside while the vet came in. It was just nicer to have the other dogs there and not be in a clinic for the whole thing, we've had friends who had no choice and found it to be a worse experience. But totally up to you and of course how your dog is doing, if he'd be able to come home for a few days with IV or something or whatever you feel is best for him.

You will make the right choice for your friend and while they are 'gone' they are still around in spirit.


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## 3doglady (Jul 31, 2011)

I am sorry you and Madison are going through this. Kidney failure can be so complicated. 

My 12 year old is in mid-stage kidney failure. She is quite happy, for some reason that my vet and I cannot figure out, so I know our turn is coming, to face the same decision you're facing now. I've often thought about the point where I'd have to make that decision and I still don't have a fixed answer in my mind. I have, however, decided that it will be when she is in obvious pain with no relief, when she stops enjoying life and loses that spark in her eye, or when her body is just unable to keep up with her. 

That said, I am hoping Madison's current condition improves with fluids and meds and perhaps it is just a temporary set-back. 

When it comes time to make the decision, he knows he was loved and cared for and had a great life. 

Keeping you in my prayers.


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## Pawzk9 (Jan 3, 2011)

Argelius said:


> I love him to death, but I'm not interested in continuing to do things to keep him (barely chugging along) with things like home SQ fluids like some do. Given that the IVFs given at the vet overnight haven't changed his behavior/activity and his urine remains very clear and unconcentrated, I'm wondering if this is how it ends...
> 
> Thanks for your thoughts.


This is how it ended for my old girl Cybill (at 14) Fluids would make her feel better in the short term, but there simply wasn't enough kidney function to maintain the improvement. I let her get some fluids, and then euthanized her while she was feeling "better" temporarily. I think it was the right decision, but I still second guessed myself on it. I also had a cat (also around 14 that we managed to maintain for close to a year with sub-q fluids. But then she developed a tumor at the base of her heart and was either drowning herself from that or dehydrated from treating it. So the timing of putting her down was less of a question. I recently had acute kidney failure (creatinine was, like, 7.) It was pretty awful. But in my case it was secondary to being dehydrated from nausea due to chemo. And I recovered. But if there wasn't recovery possible, it's not how I would want to live. I think you'll know when it is time. And I think after you do it, you will probably second guess yourself. But I think it is better to chose a little too soon than a little too late.


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## PatchesPet (May 24, 2007)

As you know I can not tell you when it is time or what you should do. I can say that I feel your pain. I cry as I write this as I had to make this same decision on May 28th. Only I never knew my little girl had Kidney Failure until just 10 days before. She was a very energetic Jack Russell who loved to play. One morning she was very tired and didnt want to move so I rushed her to the vet who says she was dehydrated and needed fluids. He kept her for 3 days, 1 day of fluids did not help her. He also administered other medications. She came home on a Friday and was her old self again until the following Tuesday and back to the vet. He then tells me that she had kidney failure and it was time. Her BUN # was unreadable. I was very angry so I took my dog to University of Florida and after a couple of days of dialysis and many dollars there was no more we could do. I stayed with Harvest and held her in my arms while the vet at UF administered the meds to help her pass. I would have spent any amount of money, I drove to the University of Florida over 2 hours from our home nearly every day for a week. If kidney transplants in dogs were an option we would have done it. 

I learned alot from this experience. Given the age of your dog and the length of time he has had the disease it is quite possibly that time. I learned that the numbers are important but the dogs reaction to the treatment is more important. If they do not respond then it is likely the time. My harvest had levels that were unreadable even by UF's testing. I also learned that dogs can live with CRF for about 2 years +/-. with special diets and treatment. Although IV fluids are good in some cases Dialysis is needed to get the dog back on track but it is expensive and may not work for an animal that is older and has had CRF for a long time already. I was told IF it worked she may at best case live for another 2 years or it may only be a couple of months then we would be in this very same situation. This disease is terrible and I hope and pray that they find a cure for this one day.

I do not know you but you seem to be a caring pet owner and I think you will make the right choice for you and your family. I do believe in not allowing the animals to suffer only for them to pass at a different hour or day. With the same breathe I believe it is our duty to care for them the best we can and to give them the best chance to also enjoy their time while they are here with us. Whatever you decide please know that you are not alone. I know this will not make the pain of losing your family pet go away. 

Good Luck and God Bless

Patti


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## Sassy Grace (Jun 29, 2012)

Looking for answers just like you. Happy your post is recent. I "inherited" my Shelty, Maggie, when I bought my house. The owners told me they were going to put her down because they didn't want to move her to NY with them. I couldn't believe that. I told them I would keep her and Oct 2010, Maggie let us move in to her house. She was 11 1/2 years old. I took her to the vet the next March and we did a blood test. Found out she was in renal failure. Previous owners had never done a test before. Have loved that puppy for 1 1/2 years but she's rapidly going down hill. I had her groomed Memorial Day weekend. A week and a half ago, she created a "hot spot" on her back (now I wonder if that is where her kidneys are). She chewed it up pretty good. Vet put her on antibiotics. The big surprise for me was that she had lost 5 pounds in just a few weeks. She was on the antibiotics for 9 days and just yesterday morning, she refused to eat anything. She has arthritis and really hasn't had much problem getting around. She loves to "herd" our neighbors as they walk by our house every evening. Yesterday, she couldn't stand up on her own without help. She threw up and couldn't even get up. I did get her to eat some IAMS ground lamb and rice this morning. Took her to the vet at 10 am and of course, she seemed a little more chipper. He gave her an injection to help her with the nausea. Did another blood test and I am waiting for the results right now. He said the antibiotics could have caused her GI distress. We brought her home and she pretty much collapsed on the garage floor where it is nice and cool. Just a little bit ago, she threw up again and peed herself. She didn't even bother to try to get up. I wish it weren't Friday. My vet doesn't have Saturday hours. I hate feeling pressured to make this decision NOW but I can't stand to see her suffer over the weekend until Monday morning. So I googled "how do you know when it's time when a dog has kidney failure." The dog I saw on Tuesday was just fine. The dog I am seeing today - I just don't know if she'll ever come back. I couldn't decide this morning if the antibiotics were causing her distress and I really want those blood test results, but after reading these posts, I'm pretty sure it is her kidneys shutting down. I have about two hours to decide.


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## Selah Cowgirl (Nov 14, 2009)

I would rather put a dog down a few months two early then a few days to late. When you stop seeing the spark in her eyes and a spring in her step it is time.


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## Abbylynn (Jul 7, 2011)

I just made this decision ... the light in Leeo's eyes had gone, he was in pain and distress, he could not be saved, he would never get better. He gave me so much love and joy in my life that it was the very least I could do for him ... give him a peaceful passing.

It is the hardest decision I have ever had to make. I did not want to let him go. But I loved him enough to do so.

I am sending sincere prayers your way(s) ... you will know when.


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## Sassy Grace (Jun 29, 2012)

About 5 minutes after my last post, I told my husband it was time. I called the vet back and said I was bringing her in. I had not yet read Abbylynn's post, but I came to the same conclusion. Maggie would never get better. It was the right thing to do for her. My grief is deep. I had her for 1 1/2 years but I feel I have had a lifetime of love because of her.


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## tom1989 (Apr 8, 2013)

lil_fuzzy said:


> I haven't had to put an animal to sleep yet, which I guess is lucky. But we did get up this morning to find our 13 year old cat dead on the floor. It was horrible.
> 
> So we have decided that in the future if we think one of the cats might die, we will go to the vet and have it put to sleep. We don't ever want to wake up to a dead animal ever again.
> 
> ...


I agree with you. His dog had an incurable disease, and it seems to me that it has entered into crisis. Death may be it is a relief. But even people sick, you want to live, we don't know it would not want to end his life.


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## Alynorah (Aug 2, 2015)

I have a 14 yr old bordie collie that has as of Friday gone into complete kidney failure per vet visit. They have her fluids on Friday and she is going back Monday. To look at her you wouldn't know she is sick.. Aside from her lack of appetite. On top of all that she is anemic, has a stone in her bladder per X-ray and they believe a tumor on her spleen or liver again per X-ray. She hasn't thrown up yet but has decided she won't eat her kidney food either wet or dry so she is now getting beneful wet food mixed in with chicken. She is still drinking water and going potty outside... Vet has her 3 meds... Something for vomiting, something for appetite to make her eat and then an antibiotic in case there is an infection. 

Other than that she seems happy but very very tired. :heart_eyes:. The decision of when to let her go is going to be difficult.


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## Kathyy (Jun 15, 2008)

This is the tough part. Hang in there, she will tell you when it is time. We discovered Sassy had kidney disease when she was 13.5 years old and she did well for 3 years with some scary bumps then the last 6 months were a definite decline. I learned a lot from dogaware.com's kidney disease pages. 

Sometimes the lack of appetite is temporary. I thought Sassy was finished first time she stopped eating but a simple antacid fixed that. Another time it was because the antibiotic she needed for a UTI killed her appetite. The appetite stimulant worked so well she ate well her very last day but she collapsed in her bed and we knew it was time.

Sassy didn't tolerated fat as she aged. You might try offering mushy white rice with white meat chicken to see if that helps as that is very low fat. Don't go crazy making lots as she may well eat it fine then refuse it for the following meal. Is she on phosphorus binders? One main reason kidney dogs don't eat is they get acid stomachs from more phosphorus than they can handle and once blood phosphorus levels reach a certain point they get ulcers and have trouble eating. Plain old calcium is a moderate phosphorus binder.

If you saw a change in her after the fluid treatment look into giving her daily subcutaneous fluids. Kidney dogs get really dehydrated trying to rid their bodies of wastes when the kidneys cannot filter the blood properly. I gave 1/2-1 liter daily to Sassy for her last year or it could be 2. Should have written this stuff down! Vet told me they didn't generally help with larger dogs but she responded beautifully to them. He told us a liter a week. She perked up the day of the fluids then started drooping again once they were absorbed. It was quite amazing and I was sold. Could take her in daily to see if it helps and get tutored on how to then do at home if it helps. 

If she is active and happy then try some of these little things. I know I would have said enough much sooner if I hadn't cooked for her or given her that antacid or learned how to give subQs.


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## doglovelost (Oct 12, 2016)

Just had to put my lovely Maltipoo to sleep because of Renal Failure he was 18 years 9 months old. At 18 he had lots of energy still and would run around a little. People would be surprised. He managed well only being able to see well with 1 eye and not hearing well but you wouldn't notice. He was very responsive still and we went for long walks. I love him so much and kissed him daily. 

It only gets worst and I wish I knew the signs sooner. When they stop eating on there own or lose weight it is time. When he can no longer enjoy life by going on walks it is time. I regret not doing it sooner because there is no cure just prolonging. I am very sad knowing he was in pain even though he didn't show it. He was very weak and his back legs where weak in the last 1-2 weeks of his life. He would still pee outside and looked like sometimes he was okay. He was still trying until the end. 2 weeks before he was walking fine. I gave him water and food with a oral syringe but it wasn't helping. He lost a lot of weight suddenly. I bought all different kinds of high quality foods and treats but he had no appetite. 

I didn't know he had kidney failure until it was too late. His BUN levels and creatine levels where too high. I put him on IV at the vet thinking that would help because he was dehydrated. It was painful for me seeing him like this and for him because he had a seizure a couple of hours before we put him to sleep with a at home vet. I would recommend euthanasia sooner then later after what I experienced. He didn't like being put on a iv in a cage at the vet twice and I wish he didn't have to go through it. My baby didn't enjoy life in his last week and was sleeping most of the time. Too weak the rest. I miss him so much and it was a very difficult decision but I feel relief that he is no longer in pain. Still very sad. Wish I walked him more and spent every second with him while he was around. Life was great with a loving dog around.


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## doglovelost (Oct 12, 2016)

I agree much sooner is better because I wish I put my dog to sleep sooner in hindsight to avoid unnecessary suffering. I didn't know about the symptoms and signs at the time until it was too late. Had to put him down 2 days after blood work showed he had very bad kidney failure. Was crying after I found out he had renal failure. I would have done anything to save him or paid anything but there is no cure only prolonging. I tried so much trying to help him but it just goes downhill fast. It only gets worse, don't let him go through anymore. But it is a extremely difficult decision to make at the time. After I felt relief he is no longer in pain but still very sad.


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## Kyllobernese (Feb 5, 2008)

I have just made the decision with Susie, my 12 and a half year old Bernese cross. She has been having trouble getting up and down but the past week she has really struggled. I looked over at her last night and she was lying on the floor, having tried several times to get up. She had her head resting on her bed and looked so sad and worn out with just trying to carry on, I knew it was time. For years she ran beside my horse when I went riding, went on lots of camping trips, competed in Agility when she was a lot younger but old age has caught up with her.

I had her into the Vet in the spring and put her on some medications which helped but now the weather is cold and damp it is not helping and she will not get any better. Dogs live in the moment so euthanizing them when they are in pain and cannot do the things they loved to do is the kindest thing you can do.


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## doglovelost (Oct 12, 2016)

My dog also had difficulties getting up but I thought it was old age at first because he was over 18.5 years old. Now I know it wasn't because of that but it was because of weakness due to Kidney failure. I agree euthanizing is definitely the right decision when they can no longer function properly, are in pain, or too weak and are not completely happy.


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