Understanding End Stage Kidney Disease in Cats

End stage feline kidney disease sets in when one or more treatment methods fail. What does it mean for the cat and its owner?

End stage feline kidney disease sets in when one or more treatment methods fail. Dr. Derek Duva – in his Internet Vet Column — outlines that a diagnosis of kidney failure in cats requires a three-pronged treatment approach:

  1. Minimize system-wide presence of toxins that healthy kidneys would filter
  2. Control the intestinal buildup of phosphorus
  3. Prevent the formation of ulcers in the stomach

A mix of dietary changes, intravenous fluids and medication generally suffice to achieve all three goals. Sadly, managing the disease symptoms only buys the animal a few months or a couple of years. At that time, the cat lover is faced with the final stage of kidney disease in cats.

What is the End Stage?

Misericordia University divides the disease into four stages, with symptoms not becoming readily visible to the fancier until stage three, when physical damage is already severe. During the final stage, approximately 90 percent of the cat’s kidney has died off. This leads to an impossible to manage buildup of toxins. Although each animal is different, there are some general phases the pet goes through prior to death.

  • Anemia sets in. End-stage cats need just as much monitoring – if not more – as stage three animals. The cat lover should seek treatment for the anemia to enhance the pet’s quality of life.
  • Bodily toxins lead to noticeable smell. This smell is no longer reserved for bad breath alone; it now seems to come from each pore.
  • Loss of body control. The animal may lose its ability to control bladder functions and bowel movements. It may not be able to get up and walk; if it does move, it may be unsteady on its legs. The limbs may twitch at times.
  • Flight instinct heightens. Cats instinctively hide when they feel ill. This mechanism avoids detection by predators, when the animal is incapable of defending itself. A dying pet may suddenly follow this instinct as well; it is not unusual for a pet lover to see a dying cat dash out of an open door with a last ounce of strength.
  • Vomiting sets in. As the body continues to shut down, it will expel anything from within the stomach.
  • Dramatic weight loss. Diarrhea and vomiting prevent the body’s absorption of nutrients. Even a cat that is still eating will lose a lot of muscle mass that is rather noticeable.
  • “Miraculous” but short-lived recovery. Probably the saddest aspect of dealing with a cat that is near death due to kidney failure is the false hope of recovery. Cats — that just in the morning seemed at death’s door – suddenly act as if they are feeling well again. This ‘false’ recovery lasts for eight to 12 hours, before the animal once again displays all the signs of stage four kidney disease.

Euthanasia vs. Natural Death

Making the decision to euthanize the cat is an individual choice that no veterinarian, family member, friend or author can make for the cat lover. It is fair to say that a cat, which shows a number of the aforementioned signs, will likely face death in short order. That being said, consider euthanasia earlier if you choose to halt treatment of the animal by a vet. As death is unavoidable at that time, it stands to reason that suffering should be minimized.

On the other hand, if you are continuing treatment – including pain killers – and you have the time to spend with the animal, then you may not yet be ready to let it go. Even sick and weak, the animal still enjoys your company. If you can control its pain and keep stress low, even during treatment for end stage feline kidney disease, you may wish to wait for death to occur naturally.


The Internet Vet Column. “Feline Kidney Disease” (accessed December 16, 2011)

Misericordia University. “Renial [sic] Failure in Cats” (accessed December 16, 2011)

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User Comments
  1. sanataryal

    On December 16, 2011 at 8:17 pm

    Very scientific as well as useful article . Keep it up .

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