Try it with human patients. Very similar experience. 
Sometimes you just have to let go.
Dialysis is no fun. If not for the hope of a kidney transplant I may have just given up and found a peaceful way to end it all. I have never had chemo but from what I hear the suffering is similar. The chills, vomiting, lack of energy and appetite, staying up all night from uncontrollable shivering…it’s no way to live. For a pet who can’t understand what is going on, I imagine it’s even worse. They don’t do kidney transplants for dogs; you are only delaying the inevitable by prolonging its misery. Let it go. Give your dog a death with calm peace instead of a prolonged painful one.
(And yes, I did eventually find a donor and am in good health currently.)
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In the end, we decided to go ahead with the operation to prepare him for dialysis and that will happen tonight. We decided we would rather he had some chance than no chance at all, and if things don’t work out well, we will deal with that situation as it comes. But they may also work out somewhat for the better.
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The previous doc just kept giving him drugs and said ‘take care of him’ even though the dog was in a vegetive state for god knows how long.
The next doc diagnosed him with cancer, and also kidney complications bought on by the cancer. BS vs non BS.
That happened with our cat too.
First guy: she’s just getting old.
Second : she has a huge tumor in her cheek .the suffering must be unimaginable.
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Gooooood luck.
Jesus, yea the first guy said the same thing: he is old. Genius.
Do you have any good links on the renal diet for cats?
The previous vet we used, in retrospect, was shockingly expensive, and we’re never going there again. There’s definitely quite some variation in quality in the veterinarian operations around Taipei at least.
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You mean the official one, or the one we ended up with? The latter was just pieced together from the textbooks the vet gave me. I was arguing with him about the wisdom of feeding a cat a high-carbohydrate, low-protein diet - that is, the expensive ‘renal diet’ kibble - which seemed to me (from first principles) to be all downside and no upside. It couldn’t possibly do any good, not even in theory. Exasperated, he said “here, go home and read the bit about chronic renal failure” and gave me two big thick textbooks about cats. So I did. The textbooks said exactly what I’d already been arguing with him about: cats have a (very high) minimum protein requirement and a rather rudimentary (compared to humans) metabolic pathway for carbohydrates. These are non-negotiable features of cat physiology, regardless of renal impairment. It’s not exactly that they can’t utilise carbohydrates (they can) but they’re not built to do so - and glucose toxicity (caused by repeated excursions outside of the normal physiologic range) is far more likely to negatively affect kidney function than anything else.
For some reason, vets seem to have picked up on that bizarre (human) claim that “protein is bad for your kidneys”. This is so utterly stupid it shouldn’t even need explaining: eating protein does not result in either proteinuria or hyperproteinemia, there is no known mechanism by which a high-protein diet might harm your kidneys (or a cat’s kidneys) … nor is there any empirical evidence that it actually does. Yet this meme refuses to die. And thus we end up with ‘low protein’ diets for cats with CKD. Since the resorption function of their kidneys is impaired - they are excreting amino acids and other things that shouldn’t be excreted - they probably need MORE protein than you might otherwise expect. This is, in part at least, why they end up losing muscle mass and wasting away (particularly if they’re being given a ‘renal diet’). Yes, there do seem to be certain amino acids that can exacerbate or delay the progression of chronic kidney disease, but nobody seems to know why this is, so I figured it wasn’t worth stressing over.
The upshot is that I fed him mostly with oily chicken meat (and similar), supplemented with potassium gluconate, a small amount of ‘low salt’ salt (NaCl and KCl mix), and calcium hydroxyapatite. It was pure guesswork and probably wasn’t optimal, but in the absence of a more well-established protocol, it seemed to be close enough. He had a good appetite, stopped throwing up his food, stayed alive and healthy for nearly two years, with no symptoms except being mildly underweight and a somewhat higher-than-usual urine output (matched by higher-than-usual drinking). IIRC his creatinine remained slightly elevated above the normal range but lower than it originally was, and blood markers were otherwise normal - at least until we stopped bothering to test. Eventually he just went suddenly downhill, at a ripe old age for a cat.
I’m glad I didn’t do that awful subcutaneous fluid thing more than a few times - apart from the unpleasantness of the procedure, it didn’t seem to make any difference to his blood results. Even malfunctioning kidneys, it seems, can still do a reasonable job for a good while, and I suspect one’s body can compensate to a certain extent for kidney dysfunction.
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Cheers for the explanation.
One of my cats is 19 sometime this week. She has been on an expensive renal diet for about 19 months after a blood test result. A vet in Taiwan mentioned her kidney function about 8 years ago and to be aware.
But I have always felt something not right about that diet. She ate raw meat and a little bit of wet cat food most of her life. I am going to start her on some fatty chicken from a blender.
They don’t get kibble but have done in the past.
I’ve always fed them small meals since they were kittens. One issue I have now is they want feeding every 2-3 hours at night (reason for the blood test, etc. - expensive at 300 qwid, vet saw no problem bar kidney issue).
Apparently cats frequently get progressive kidney failure towards the end of their lives - the fact that she’s made it to 19 suggests you’ve been doing something right, and IMO if it ain’t broke it’s best not to fix it. I honestly cannot understand why (apart from money) vets recommend the high-carb, low-protein diet, and our vet was unable to give me any reason for it other than “that’s the way we manage it” and “protein is bad for your kidneys”. Yes, a cat’s kidneys are obviously handling a large throughput of amino acids because of their unique biology. But they’re built that way.
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