Dealing With End Stage Kidney Failure

[macoduck]

Tell me your experience in dealing with end stage kidney failure or disease. Not so much all the treatments you did for your dog, but your dog's behavior near the end.

 

Harold is 13.5 years old. He had a very hard life filled with neglect before he came to us as his 4th owners 16 months ago.

 

It's been one year since he was diagnosed with failing kidneys. He has been doing well on Rx Royal Canin LP kibble, enalapril, aspirin and fish oil.

His incontinence went from mild drips while awake to full bladder emptying in his sleep. He tolerates a belly band when we're not home but hates to wear it at night. All his beds have a whelping pad on them covered by a crib pad.

 

This week he has become more anxious in the afternoons and evenings. Panting. I've given him some Tramadol for any pain, left over from his recent limping spell.

 

He just looked so unhappy last night.

 

He hasn't wanted to eat his food, even doctored up with extra good stuff. He has never been a picky eater so this is a big change.

 

He teeth are bad due to his neglectful previous owners, who left him to chew on crate bars for hours.

 

His mouth is not sensitive. He will accept a slice of bread and some crunchy cookies. With his medical history he is not a candidate for a cleaning.

 

Normally he's wanted to go out and pee at every opportunity that the door is open. Today barely at all. Water consumption is steady.

 

I guess my question for you is, near the very end of kidney failure, did your dog refused food, urinate more or less frequently, show any signs of pain, and did you see the light beginning to fade from their eyes? Was there a sudden shutdown in all functions?

 

Although we are experienced in losing seniors, we've been fortunate to sense when we thought it was time to say goodbye. Harold has been harder to get a read on. At 13.5 he's no spring chicken. We'll see how this week goes and how much we can get him to eat. We'll spoil him and see how things are in a few days.

 

[Riverhound]

Ok. I haven't been through this with a dog, but with a cat when I was very, very young. I can remember the cat refusing regular food, and my mother desperately trying to get him to eat baby food and that high calorie goop in a tube. I remember the cat just laying in a box, when usually he was the center of all things. I remember him not perking up when we came by to pet him, and how sad he looked. I don't remember water consumption or potty habits -- but he did smell pretty bad.

 

I'm sorry you're through this with Harold. It's a rough thing for them, and for us.

[TheFullHouse]

Oh Ducky, I have absolutely no experience with this but just want you to know that you all are in my prayers and special prayers for Harold.

[Rickiesmom]

Likewise I have no experience with chronic kidney failure, but I can tell you that when Jaynie was acute (before we knew what was wrong because she was initially mis-diagnosed) her behaviour was similar - drank a lot, no appetite, very little energy. She did go out to potty with some help so we didn't have incontinence problems. She also developed muscle spasms.

 

I am so, so sorry you are going through this. Harold is very lucky to have you caring for him.

[MaryJane]

Does the breath have an ammonia smell? That usually indicates that waste products are building up the blood because the kidneys cannot excrete them.

[Neighsayer]

I got Meeka when she was 11. She had been diagnosed several years before. She made it to 12 years 10 months. She became very picky about eating. I ended up feeding her several small meals with good stuff mixed in. She would not refuse a meal, but ate very little. She was skin and bones, but the light stayed in her eyes and she looked happy. She went out with the others, and sometimes played...tried to chase Mickey.

She was very unsteady on her feet and had minimal vision. When she slept, it was such a deep sleep that I often checked to see if she was still breathing. She slept on my bed so I checked a lot. There were times I hoped that she would just go in her sleep.

 

Her breath was bad. She was treated for a mouth infection (bleeding gums and a lump), but the smell came back in a few days. It got very bad at the end because the kidneys were not working. She drank tons of water. She would pee in her sleep, and the liquid had no smell at all. The vet said that we were at the "water in/water out" stage. The kidneys processed nothing.

 

There was no sudden shut down of functions, but she wouldn't eat enough to sustain her.

It was one of those hard/terrible decisions to make. Each day, i looked at that happy dog, and realized that I wasn't going to get a sign this time. Her spirit wanted to stay, but her body just wore out.

I'm crying as I write this. I'm so sorry that you are going through this. I lost two twelve year olds this year, and have two more turning thirteen before the end of the year.

[NancyB]

I'm so sorry this is happening to your boy. I have been through this with Ruby last year, she passed away at home from kidney failure on August 28, the morning after hurricane Irene. I have a notebook that I wrote everything in and I will tell you what happened in her last week.

8-22-11

Ruby threw up her breakfast and water

8-23-11

Ruby threw up a couple of times during the day, four times during the night and was panting a lot.

8-24-11

Ruby went to the vet for subq fluids and got a shot of Cerenia for nausea. Vet gave me Reglan for her to take with meals. Didn't eat any dinner, Peed in the kitchen after 2:30 am. Has been panting and lays down slowly, likes she's uncomfortable.

8-25-11

Didn't eat any breakfast. The vet told me to start syringe feeding her Hills A/D canned.

8-26-11

Still not eating on her own, had to syringe feed her which she hates. She walked very slow, with her head hanging down and always panting.

8-27-11

Still walking slowly, can't lift her head, panting. Vet told me to give her half of a Tramadol. This was the day of hurricane Irene, she kept going outside trying to dig a hole in the sandbox. I kept bringing her in and she kept wanting to be outside. She did not sleep at all that night, she was panting and every once in a while she made a whimper sound, she also had some think drool hanging out of her mouth. She was in and out all night and we were both soaked but she didn't care, she was in a daze. She stopped drinking.

8-28-11 Sunday

Ruby went out at 6 am, she fell when she tried to come back into the house and I helped her in. I brought her to a dog bed and laid with her so she would finally go to sleep. She fell asleep about 7:45, she was sleeping soundly and I kept checking on her. John came downstairs and I told him how she was during the night. Then I started to fall asleep on the couch and I heard her making some movement, I asked him to check on her and he said "She's dying" and in the two seconds it took me to get into the next room she was gone.

 

Shortly after we lost Ruby we found out Kassie also has kidney disease. she is now at the point where she's been going for fluids twice a week for a few months. I know when Kassie stops eating I won't force feed her. Ruby hated it but the vet wanted to see if she would come around, she didn't and I wish I had sent her to the bridge. Everything was worse because of hurricane Irene, I wouldn't have tried to get her through the weekend. I hope what I wrote will help in some way.

 

I'm sending you and your boy a big hug.

[Remolacha]

Sugar's kidney failure was not chronic, but in her last week, she refused all food, to the point of getting up and moving if I tried to bring it to her bed. No real physical changes, except she started to get weak after a week of not eating, and she hated to be helped. I could see in her eyes that she was ready, so I let her go while she still had her dignity.

 

[Guest saltwaterron]

no experience but so sorry you are having to deal with this. not easy watching a beloved pet struggle. my riley has heart failure and i dread the day that's coming. my thoughts are with you.

[greyhounds1234]

Our Storm died of kidney failure.

 

We had been giving her rounds of sub-q fluids daily to keep her kidneys flushed out but we knew we were just buying us a little more time.

 

We struggled to get her to eat anything at all....and we truly did try everything imaginable to tease her appetite. Sardines, lobster, canned tuna. She's nibble at some of it but I think she was tired and worn out.

 

She went through the incontinent issues and she'd pee in her sleep. I could tell by her eyes that the light had gone out and she was ready to be free of this world.

 

Basically, her kidneys just gave out and we chose to let her go.

 

About a year before she died, our vet thought she had a tumor in her chest. (She had been having rounds of coughing) Our vet recommended an ultra-sound from a different vet (sort of a second opinion) and the tumor showed up there and we sent copies of the x-rays to OSU and they thought they also saw the tumor.

When she died, we had a necropsy done to see this mysterious tumor and what it was exactly. The tumor didn't exist, her heart and lungs were fine....but her kidneys were shot.

 

I'm so sorry you are having to go through this.

[galgrey]

I've no advice as I'm in the same situation. My senior galgo (age unknown) is also in kidney failure and I have all the same questions. I thought about a month ago that Cruz had given up and it was time to let him go. But on the morning of the dreaded appointment he rallied and told me quite clearly that it wasn't time. He's taking an appetite stimulant. I'm doing fluids at home now and I'm cooking for him as he stopped eating dog food months ago. So far he's maintaining his weight pretty well. He's incontinent and wears a belly band with a heavy duty incontinence pad all the time now. Fortunately he doesn't mind it at all. I've been told, however, that things can go downhill quickly without much warning. It's helpful to hear from people who've been through this. Just taking it one day at a time here too. for you and Harold. And that face of his! I hope he has some more quality time.

Edited September 8, 2012 by galgrey

[macoduck]

Prior to Harold's situation, my only experience with kidney problems was with Thane. Completely fine one day, peeing blood the next. Horrible experience with the out of town vet who did the ultrasound. I begged to start the scan over Thane's left kidney but he refused, started at the bladder and did the left kidney last. It was consumed with cancer and I had Thane put down immediately.

 

Harold's problems are so different than Thane's.

 

Thank you all for sharing your stories. You have given me much insight to what may lay ahead.

[JohnF]

>I guess my question for you is, near the very end of kidney failure, did your dog refused food, urinate more or less frequently, show any signs of pain, and did you see the light beginning to fade from their eyes? Was there a sudden shutdown in all functions?>

 

Yes, I've been there 3 times over the years and even though it's hard I'll share with you.

 

Firstly, every dog experiences end-stage renal failure differently, some decline rapidly, others more gently.

Let's take Angel, my last one who had CRF for about 18months:

First inklings were polydipsia, polyruria, getting picky over food, lethargy and grouchiness. The pickyness over food became more of a problem 4 months before the end. Her situation was exacerbated by having to balance pain meds for a long term shoulder injury with quality of life. We decided to go for quality of life and allow the Metacam to hasten renal failure (a side effect). At 13 this was a no-brainer actually and we tried various other pain relief drugs to no beneficial effect. Tramadol didn't work because the CRF concentrated in her system and brought on severe heart arrhythmias (this had only beein listed in human medicine previously).

So the end stage: Refusing to eat her regular dinner at the end of November 09. Tried virtually everything and she only really picked at it eating about 1/3rd of what she ought to have. By the third week of December she would tip her dish over and push it awway. Remember, she was a heart dog and actually loved us, so doing that must have been seriously awful for her to do. As the new year turned she refused to eat anything but still drank water. (Expereince told me we had about 4 weeks before quality of life crossed the line and seizures commenced.). It is horrible having a dog like that when you know they have eaten their last meal ever and yet you still tempt them with bread and manuka honey, cat food, baby food, anything. In the final weeks Angel was treasured, taken to all her own haunts even though she couldn't walk far.

Vomiting and stomach soreness was under control with Omeprazole and Sucralfate. She also lost her urinary continence and continued to lose weight. We were taking it a day at a time and hoping tomorrow would not be the day. January 23rd turned out to be that day, she had her first seizure and was very, very worried about it. Called the vet, who had told me her time was very short just a week before, tool her in and sent her gently to the Bridge. Massive sadness with a heart dog leaving. The right thing to do because you just have to.

So BTDTGTTS twice before but it doesn't even help. Advice: Let them go one day too soon rather than a day of misery too late.

 

This place offered me some amazing support.

http://pets.groups.y...roup/K9KIDNEYS/

Edited September 8, 2012 by JohnF

[tbhounds]

First I would repeat bloods and check urine. Depending on the results would be how I approached further care. Have you started giving antacids like Prilosec, Pepcid?

[Guest IrskasMom]

Ducky , I am really sorry , for Harold and you to go through this. I have no Advice . I thank you for giving him a great Life after what he has been through.

[Houndtime]

I am really sorry to read this. Harold looks like such a sweet boy.

[FiveRoooooers]

Ducky, I'm sorry. I can't offer any more than hugs and wishes for as much quality time together with Harold as possible.

[greytpups]

Ducky, I'm so sorry you are facing this. I don't have any advice, just sending big hugs across the border

[cleptogrey]

velcro who had addison's disease for 10 years(yup- i kept him going for some time) ended up w/ kidney failure. my vet did inform me that it was a really painful way to go, toxins building up in the system. when he showed stress from the malfunction we decided that is was his time. remember most addisonians never make it past 5 or 7. the urine he was producing has no gravity- it was basically distilled water. no need for blood work, your vet should be able to visably see how his #s are w/ a simple dip stick test and the tool used to view specific gravitiy. with velcro, who was a real chow hound the sure sign was his refusal to eat, we knew it was time. it's really difficult to out living your beloved dogs.

[Guest alannamac]

velcro who had addison's disease for 10 years(yup- i kept him going for some time) ended up w/ kidney failure. my vet did inform me that it was a really painful way to go, toxins building up in the system. when he showed stress from the malfunction we decided that is was his time. remember most addisonians never make it past 5 or 7. the urine he was producing has no gravity- it was basically distilled water. no need for blood work, your vet should be able to visably see how his #s are w/ a simple dip stick test and the tool used to view specific gravitiy. with velcro, who was a real chow hound the sure sign was his refusal to eat, we knew it was time. it's really difficult to out living your beloved dogs.

 

 

I don't know if this will help but did want to reinforce that yes this is a very painful way to go especially towards the end.

My grandmother passed of renal failure and she was in terrible pain towards the end.

I can't imagine that it would be any different for a dog. So very sorry you are going through this . Harold looks like

such a sweetheart.

Edited September 8, 2012 by alannamac

[Pippin]

Jessie, my lovable nuisance, had kidney failure. I can't tell you about her last week, because I was on a business trip. But for us, it went like this...

 

Aug 7, I dropped her off at Doc's for a routine dental. Doc called me around 10am and said we weren't doing a dental, cause her kidney values were poor. Jessie had been on enalapril and prednisone since before I'd gotten her 2 years earlier. Some kind of liver problem - hepatitis, I think? It's been 8+ years ago now, so I don't remember. Anyway, Doc said we'll put her on this kidney food, and check her again in a month. I was on the road most of that month, and I had 2 dreams about Jessie -- in one, she was lost and Angie, Casey & I were walking country roads/small town streets looking for her. It was dusk, cloudy, and a storm clearly on the way, so I was worried for her. We found her standing next to a hedge on the side of the road, staring through a hole in it to the view beyond. When I looked to see what she was looking at, the other side of the hedge was sunshine and blue skies, green grass as far as you could see... To this day, I"m convinced she was looking at the other side of the rainbow bridge. The next dream was a week or so later, after I was back on the road. This time, Jessie wasn't in the house, and we weren't worried about her, like we had been the first time. We didn't need to go looking for her. (dang, 6 years later this memory still brings tears).

 

A week later, she was due for her blood re-check. Dee took her in, cause I was still on the road, but was heading home that day (driving home from TX). Doc called me about 530 that night, when I was in central MS. I pulled off the road so we could talk, and she told me that Jessie's numbers had gotten worse, not better. I asked her what was the next step, and her reply was that kidney failure is a very painful way to go, and the kindest thing to do was to let my lovable nuisance go before she was constantly suffering. Also, I was scheduled to be traveling for most of the next 6 weeks, and Doc couldn't give me any kind of reliable time-frame. I asked Doc "what would you do if she was your dog?" and Doc said "I'd let her go."

 

This was Thurs night. She had an appt available Sat afternoon, so we scheduled that. Sat a.m. I took Jessie out to breakfast with me, to a local restaurant that had an outdoor patio with dogs allowed. Some strangers at a nearby table gave her their leftover bacon, which she gobbled up. A couple hours later, she threw up the undigested bacon on my livingroom floor. I had been second-guessing myself on my decision, but that showed me I was actually making the right choice.

 

 

What does your heart tell you, Ducky? What do Harold's eyes tell you?

 

 

I wish I lived closer and could give you a hug.

[Guest 2dogs4cats]

I am so sorry. It's tough and I have been through it with Ella. I was able to keep her comfortable with a homemade diet and Chinese meds. My experience was she was in no pain as long as I kept the toxins down. Sometimes she ate, sometimes not. She lost some weight, but not as much as others I have heard. She was not in any pain, but she was often very cold and tired. Also her back end weakened, not painful like arthritis, just very weak. I often carried her into the house. I think the problem you are having is that they have good days and bad days, so it is confusing. I did struggle with the decision as well. It was made for me when one day, her back end gave out entirely and she couldn't walk. I don't think it was related to the kidney disease, but just that she was ready to go. I think without the Chinese meds, it would have been different. I had started giving them when she started having accidents and she no longer had them, they kept her from having the shivers and gave her a bit of an appetite. I did struggle though to keep weight on her. I would describe it as a very slow deterioration, not a sudden shutdown, although I think there are others that would say it was quick. I think it varies. I know some people have had success with IV fluids, but I never went that route. Ella passed one month shy of 15. Hugs and hugs and hugs to you. It is heartbreaking.

[GreyPoopon]

Jessie, who is 13 3/4, has kidney disease. She's on even more meds than Harold, plus fluids every second day.

 

After she had a bad patch in July, I talked to my vet about how I would make the decision. I'm watching for three bad days in a row (she rallied after 2 1/2 in July), total loss of appetite (I've jumped through all the food hoops), or vomiting (they can develop ulcers in their stomachs similar to the ones Jessie had in her mouth before we increased the frequency of fluids). So far, she's always had the light in her eyes; if she loses it, that will be enough as well. At the moment, she's doing well thanks to the anabolic steroids we have her on for her appetite (they've also improved the strength in her back end). She pants a lot, her eyes water, her nose and mouth drip, her urine is almost colourless, her breath is awful (teeth are OK), and she's a bit wobbly. But she's always happy to go for a walk (shorter and slower than they were), loves her trips to the vet, is currently eating fairly well, loves any and all attention, and is quite a happy camper.

 

I hope Harold has some good time left, and that he gives you a clear sign.

 

[greyhndz]

Ducky, I'm sorry to hear that Harold's renal disease has progressed to this point. Lexi was my first renal failure girl. It was an insidious decline, complicated by her polyarthritis and immunomodulators. But all the signs you describe I saw in Lexi as well and this was the point at which I decided to make her last days good ones. Because she didn't want to eat, I brought in pizzas every few days, which she loved. When she stopped eating that, I found an organic beef chew that she seemed to like. When she turned away from the beef chews, I could see in her eyes that she was tired.

 

The fact that he's drinking but not peeing suggests to me that either he's very dry or that his kidney function dramatically detetiorated. Labs and a urinalysis will be able to give you the answers.

 

Many people have seen improvement with daily subQ fluids and maybe you should ask your vet about this (you can do it yourself at home). I brought Lexi home many nights after hospitalization during the day -- and continued her IV fluids for as long as the IV continued to work. SubQ fluids were so traumatic for her that I made the decision to not traumatize her any further. I know my decisions probably shortened her life, but it was more important to me that her time be happy for her, not stressful.

 

I don't know that pain is an issue as renal failure escalates. It's more a matter of increasing lethargy, depression, inappetance, vomiting, dehydration. Invariably,they will find a way to show you that they're ready to go to a better place.

 

Hugs to sweet Harold and to you, Ducky!

[GeorgeofNE]

This is a very personal thing--but in my family, once a dog has lost the ability to control their body functions, it's usually time to day goodbye.

 

Harold sounds like he's uncomfortable.

 

Would you want to live like that, I guess that's what I'd be asking myself if I were in your position.

 

Hugs from George and me.