Options for end stage renal failure

Hello, I have been told today my cat has only days, or could potentially have up to a month more if her blood is cleaned for 8 hours at the vet's tomorrow. She is currently not eating and clearly not herself, but otherwise peaceful and responsive, and occasionally alert and mobile. My questions are: 1. I've seen that in these cases, the blood cleansing should be 1-4 days. I think these were all US sites, I'd like to know whether the shorter duration is standard in the UK, or simply because the vet is only staffed in the daytime. I've tried one local vet hospital but they won't answer questions without a referral. 2. There are multiple factors that could have cause the sudden onset of illness,   the vet will only say that it's just because she's old (just turned 15). She was mostly in good shape though. As I understand it, prognosis is different depending on what caused the renal failure. Is it worth pushing for a more refined diagnosis? Possibly from another vet, as some of the factors are possibly excessive vaccination and / or NSAIDs? 3. I am reluctant to put my cat through a traumatic day at the vets without me when she could die there, vs being peaceful at home. I don't want to lose her, but I'll trade the possibility of one more month for the certainty of a more tranquil death here in her home with me. The only thing that could make me more inclined to go with the treatment would be any chance at all of her having more than a month of good quality life. Any stories or statistics on this? Thank you for any input. This all may all sound very detached but she is everything to me.

Hello and Im sorry that you are facing tough decisions for your old cat.  To my understanding, what is sometimes called 'blood cleansing' in the states refers to putting cats on intravenous fluids, in order to support hydration and the kidneys.   I will try to answer your questions.  

1) Most of the time, cats are put on iv fluids to rehydrate the animal and the speed at which that happens, usually reflects how quickly the fluid is administered.  If there hypovolaemia / low blood volume / dehydration, circulation can actually be restored very quickly - within, say half an hour.  However, when the fluids are stopped, if the kidneys are still not doing their job, then dehydration begins to recurr.  I suspect that in the 'cleansing' you describe, the idea is to keep the patient on fluids until kidney perameters toxins etc are at a normal level, which I suppose would be different for every cat.  However, if the kidneys remain leaky, the dehydration is likely to slowly recurr from the moment the drip is stopped;  if I have understood this correctly (please ask your vet), then it is not widely practised in the UK, except perhaps to allow owners time to say goodbye during end-stage renal failure.  The time taken to recurr would depend how 'leaky' the kidneys are.  2) the causes of kidney disease in cats are many and complex, from the acute (rapid eg drinking toxins) to the more common slow-onset kidney failure of cats.  Some NSAIDS can certainly have an impact on the kidneys (although they can have a lovely impact on cats experience of chronic pain, for example, and one can be used to justify the other in low risk cases) but vaccines, to my knowledge, do not.

3.  Kidney failure, I'm afraid, involves dehydration and likely nausea / sickness as toxins build up in the body.  In my opinion, this can be an unecessarily slow death for some cats, although some cats do not experience it that way.  There are advantages and disadvantages to every method and cat, but my personal preferance for my own animals has always been to fit them with a cannula (just like putting them on fluids) so that they dont feel the injection and have them pass away in their owners arms, the drug being passed down a drip.  This is one to talk through with your vet, who will be keen to tailor treatment to match their patient.

If you search both 'put to sleep' (the old Uk words) and 'euthanasia' in the blog, I hope that you will find some interesting reading.   My best to you both, whatever happens next.

Finally, my apologies for vague, general answers;  cats and their illnesses are as individual as people and their illnesses;  you and your vet are in the best position to work out what is right for your cat - your vet for their medical knowledge and you for your person understanding of your pet and their situation.  There is no 'right' way to pass away;  this will always be a hard decision, whenever and whyever you make it.  We hope that omething in these ramblings has helped - see also the Ralph (we-)site, which was started by a fabulous vet, to help people facing the prospect of saying goodbye to their loved ones (Ralph was his cat).