Chronic kidney disease (CKD) is the leading cause of death in older cats, affecting the majority of cats that reach senior age. Long-term welfare management of CKD requires balancing treatment efficacy, quality of life, and end-of-life decisions.
CKD creates a long-term welfare management challenge that evolves over months to years as the disease progresses through IRIS stages. In early stages (I-II), cats may show few outward signs yet be accumulating uraemic toxins that impair wellbeing subtly. Welfare improves with early detection through proactive screening (annual blood and urine testing from age 7+) and appropriate management. The welfare tension in CKD management often centres on diet: renal diets are medically beneficial but frequently refused, and the stress of food aversion, appetite stimulant administration, and subcutaneous fluid therapy — while medically indicated — impose their own welfare costs. Balancing the benefits of treatment against the burden of treatment is central to CKD welfare management. In late-stage CKD, uraemia causes nausea, mouth ulcers, neurological impairment, and profound weakness that substantially reduce quality of life. Regular quality-of-life assessment using structured tools guides end-of-life decisions and helps owners distinguish treatable deterioration from irreversible decline.