Managing quality of life for cats with advanced chronic kidney disease requires balancing life extension with comfort, using validated tools to make welfare-centered treatment intensity decisions.
Advanced CKD welfare management requires the most careful quality of life assessment in companion animal medicine because the trajectory is inevitably toward decline and the question is not whether but when treatment burden exceeds benefit. Uremic cats that are nauseous, weak, and mentally dull despite maximum supported treatment are experiencing poor welfare regardless of continued kidney function values. The welfare-centered approach uses validated quality of life tools to track the balance of good versus poor welfare experiences over time, making treatment intensity decisions based on this balance rather than on biochemical parameters alone. Subcutaneous fluid therapy at home can meaningfully extend good-quality life for many cats, but the decision to provide or continue this treatment should be grounded in observed quality of life rather than any biochemical target.