Chronic kidney disease (CKD) is the leading cause of death in older cats, affecting up to 30% of cats over 15 years — making its recognition, staging, and management critical to feline welfare.
CKD cats experience progressive accumulation of uremic toxins causing nausea, weakness, and reduced quality of life as the disease advances. Without appropriate management, affected cats deteriorate through stages of uremia with associated suffering. With good management — appropriate diet, hydration support, blood pressure control, and regular monitoring — many CKD cats maintain good quality of life for months to years after diagnosis. The welfare challenge is ensuring early diagnosis before cats are symptomatic and implementing management before quality of life has declined significantly. End-of-life decisions require careful quality of life assessment using validated tools like the HHHHHMM scale to prevent both premature euthanasia and prolonging of unnecessary suffering.