Chronic kidney disease (CKD) is one of the most common serious illnesses in older dogs, causing progressive loss of kidney function and requiring long-term management to maintain quality of life.
CKD in dogs is a progressive condition that, if unmanaged, causes mounting discomfort including nausea, weakness, hypertension, and the systemic effects of uraemic toxin accumulation. The welfare burden is invisible in early stages but grows as disease progresses. With appropriate management — renal diet, blood pressure control, anti-nausea medication, phosphate binders, and subcutaneous fluids — quality of life can be maintained for extended periods even in advanced disease. End-of-life decisions are particularly challenging in CKD because decline is often gradual. Monitoring quality of life using structured tools (like the HHHHHMM scale) helps owners make euthanasia decisions based on welfare rather than emotion, preventing prolonged suffering in the final stages.