Quality ofLife
Before attempting to assess the long-term prognosis, one must ensure that the disease is irreversible and that the apparent kidney function tests represent a steady state rather than prerenal or postrenal complications, or acute decompensation (which may be reversible).
In this regard, it is important to remember that compensatory hypertrophy and recovery after acute kidney insult might last up to 3 months.Not all dogs and cats diagnosed with CKD will die from the disease (especially when diagnosed in Stage I or II). Particularly in cats, the progression rate might be very slow. For example, in one study of 211 cats with CKD and a sCr> 2.3mg∕dL, the overall median survival time was 771 days (Boyd et al. 2008). Cats with Stage III and IV CKD median survival time was 679 and 35 days, respectively. When communicating to owners about prognosis, however, clinicians should exercise realistic expectations and must always emphasize that there is a great deal of variability between animals and between circumstances.
A quality-of-life questionnaire has not been validated for veterinary CKD patients but a general quality-of-life assessment might be used (Lavan 2013), to improve the communication between clinicians and pet owners, to document changes in quality of life over time, to assess the response to treatment, and even to help guiding decisions regarding euthanasia.
Before electing euthanasia, owners need to consider the following questions:
• Does the pet have a poor quality of life?
• Is the current quality of life directly related to the presence of CKD, or do other reversible comorbidities contribute to the clinical signs, keeping in mind that CKD is typically well controlled until Stage IV, and in most patients until a certain (individual) point within stage IV?
• Is the current kidney function reversible (consider acute on chronic disease)
• What are the realistically available therapeutic options, and have they all been exhausted?
Weight loss and low body-condition score are markers of poor outcome (Elliott et al. 2003; Parker and Freeman 2011). When these are present, clinical signs cannot be controlled despite appropriate treatment, the disease is confirmed to be irreversible, and therapeutic options have been exhausted, euthanasia should indeed be considered.