Chronic kidney disease (CKD) is among the most common conditions in older dogs, causing a progressive decline that requires careful welfare management and ultimately, end-of-life decision-making.
CKD creates a welfare challenge because its progression is gradual and its symptoms are often mild until late stages. Dogs in early and mid-stage CKD may appear relatively comfortable while experiencing the metabolic consequences of reduced kidney function - nausea from uremic toxin accumulation, anemia-related fatigue, and hypertension-related headaches that they cannot communicate. Late-stage CKD causes uremia - a state of profound systemic toxicity - with nausea, lethargy, oral ulcers, and neurological effects that severely compromise quality of life. End-of-life decisions in CKD are particularly difficult because decline can be slow and punctuated by periods of relative stability, making the optimal timing of euthanasia challenging to determine.