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"Oh! I have slipped the surly bonds of earth and danced the skies on laughter-silvered wings..."

John Gillespie Magee



End Stage Renal Disease

Possible Signs That the End Might Be Near

Accepting the Time Has Come

Home Hospice

A Natural Death


Resting Places



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Home > Saying Goodbye > The Final Hours



  • We all want to give our cats every chance of life; yet at the same time we do not want them to suffer, particularly if the end is near and inevitable.

  • Unfortunately, it can be very hard to know when a CKD cat is really reaching his or her final hours. With CKD, many cats can be literally at death's door, or to use the analogy from the first page of this site, at the edge of the precipice; yet with treatment they may be pulled back to safety and go on to enjoy many more days, weeks, months or years of happy quality life. 

  • This page discusses the signs you may see towards the end, the factors to consider when deciding whether to euthanise and what to expect if you do choose euthanasia.

End Stage Renal Disease (ESRD)


Eventually, since CKD is terminal, your cat is going to move into End Stage Renal Disease (ESRD), which ultimately leads to death. However, even in ESRD, death may not be imminent. As discussed on the How Bad Is It? page, there is no precise definition of what ESRD is, and many cats can manage to live relatively long and happy lives even with high bloodwork values and very little kidney function remaining — see Success Stories for some examples. 


Nevertheless, once people learn their cat is in ESRD, they often start to wonder what to expect as their cat's health deteriorates. This is perfectly understandable, and if you can bear it, it can often help to think about it in advance, before you are faced with this scenario at a time when you cannot think straight, and when you will quite possibly not wish to accept that your cat is dying.


This page is an attempt to make this horrible experience a little more bearable.


Possible Signs That The End Might Be Near


The following is a list of possible signs that the end might be approaching. If your cat really is in the final stages of this disease, you will see more than one of these symptoms, though you will not necessarily see all of them:



You will notice that many of these symptoms are identical to those seen throughout the course of the disease.


These symptoms in themselves do not mean the end is near.


If you haven't already tried treatment — if your cat has just been diagnosed and is on an intravenous fluids drip at the vet's, for example — you should definitely consider trying the various treatments available for a reasonable length of time before making the irrevocable decision to euthanise your cat. 


This applies in particular if your cat has high BUN/urea and creatinine, but has only just been diagnosed. In such a case, these values may be reflecting an acute situation such as a kidney infection (commonly undetectable) or severe dehydration. In many cases the values will reduce dramatically with treatment. 


I therefore usually recommend treating a newly diagnosed cat for at least two weeks before making any irrevocable decisions. Please check the Index of Symptoms and Treatments page to find more information on possible treatable causes of the various symptoms.


The primary differences between the symptoms of treatable CKD and symptoms of the final hours are the severity of the symptoms and the fact that they no longer seem to respond well or at all to treatment.


With those very important provisos, here are the main signs that are commonly seen when a cat is close to dying from CKD. Please, please do not take them as gospel, as incontrovertible evidence that your cat's time has come. This is your cat, you know him or her best, and if you are not sure if the time has come for your cat to cross, and your vet is confident that your cat is not in pain (CKD is not normally painful), then it is better to wait until you feel more comfortable with your decision.


Of course, it may be that you are deluding yourself because you simply cannot face the thought of losing your cat, which is understandable. This is why your vet's opinion can be helpful: ask your vet what he or she would do if this was his or her own cat, and factor this response into your decision, but do not base your decision wholly on your vet's opinion.


Generally speaking, with a CKD cat, little or no harm is done through waiting a day or so before deciding on euthanasia, and you will probably feel more at peace with helping your cat to cross if you have time to say goodbye, and time to come to terms with the fact that this is most probably inevitable.


Very High BUN (Urea) and Creatinine Levels

These are not in themselves a reason for euthanasia because many cats who are newly diagnosed, or cats who crash, have very high levels but pull through.


If the end is near, it is quite likely that creatinine is over 7.0 mg/dl or 650 µmol/l and BUN over 150 mg/dl or 55 mmol/l and — this is a key point — these levels do not fall after treatment. If your cat has just been diagnosed, high levels such as this are by no means unusual and it is also not unusual for them not to fall immediately (in fact, sometimes they get worse, see Intravenous Fluids).


Generally speaking, urea and creatinine will continue to rise inexorably in ESRD. If your cat suddenly experiences a hike in blood values, as opposed to a gradual worsening, it may mean an infection of some kind is present, and it would be worth trying treatment to see if this helps. 


A sudden increase or an increase for no apparent reason may also be a sign of high blood pressure, in which case I would get your cat's blood pressure measured and try medication if appropriate before choosing euthanasia.


If your cat has been receiving sub-Qs but bloodwork is worsening, you may wish to consider trying intravenous fluids (IV) for a few days, in case it helps to reduce the values to a level manageable with sub-Qs once again. If you have not yet tried treatments such as IV fluids or sub-Qs at all, as is sometimes the case with cats who are only diagnosed when they crash, you should give your cat a reasonable shot at these treatments.


When Thomas was first diagnosed, his numbers were off the scale (his BUN level was 241 mg/dl) and he was on IV for four solid days and nights, yet his numbers did not improve; but nevertheless, after treating his anaemia and using sub-Qs for a few weeks, he improved greatly. However, in humans giving IV to a truly end stage person can be risky, because it may cause pulmonary oedema, and the same may apply to cats. And really high BUN levels can cause inflammation of the brain and seizures (though this is not inevitable).


Thomas recovered from his crashes and had six months of normal life before his bloodwork climbed again. Even then, he enjoyed a few weeks of good quality life (including eating well and going for walks) with his creatinine level over 7 mg/dl, and he is by no means the only CKD cat to do this. Treat the cat, not the numbers.


Just to confuse matters, in end stage CKD, creatinine levels may fall (although this is pretty rare). This occurs because creatinine is a by-product of muscle, and towards the end CKD cats may lose a lot of muscle, and therefore cannot produce as much creatinine. There is more information about this on the Diagnosis page.


High Phosphorus Levels

High levels of phosphorus may accelerate the progression of CKD and may also make the cat feel poorly. It is usually relatively simple to control phosphorus levels, and you should see a difference a week or two after taking steps to do so. Towards the end though, you may find that, despite feeding a low phosphorus food and giving large amounts of phosphorus binder, your cat's phosphorus levels just keep on rising. Your cat will probably become weaker as a result, and may have diarrhoea.


Please read up on the importance of phosphorus control here.


High Potassium Levels

Although many CKD cats have low levels of potassium, in advanced cases the potassium levels often increase as the kidneys' ability to excrete potassium decreases.


If potassium levels become really elevated, the cat can suffer seizures and occasionally even a heart attack. You can read more about high potassium levels here.


Reduced Urination (Oliguria) and Inability to Urinate (Anuria)

Most CKD cats urinate profusely. In ESRD, however, the cat may produce less and less urine, and in the worst case may eventually be unable to urinate at all. Although this is relatively uncommon, because apart from anything else most people have their cats euthanised before this stage is reached, both Tanya and Thomas became unable to urinate and this came on very quickly indeed.


CKD cats are prone to kidney and urinary tract infections, which may result in the cat visiting the litter tray and producing little or no urine. Occasionally, an inability to urinate may be caused by a blockage or kidney stones. Therefore do not assume the end is near simply because you see this symptom, have your cat checked by the vet.


If the problems with urination have no obvious cause, it is sometimes possible to "kick start" the kidneys with a diuretic such as furosemide (Lasix or Salix), but in both Tanya's and Thomas's cases we felt, based on our vet's advice, that this was pointless. It was this inability to urinate that made us decide for each of them that the time had come for them to cross, since being unable to urinate is extremely uncomfortable, and things were simply not going to get better. However, since this is a relatively uncommon symptom, it is not a common reason for people to choose euthanasia, based on what I have seen over the years.


Pet Place has some information about anuria in cats.



Just to confuse matters, some ESRD cats develop the opposite problem and become completely incontinent, urinating wherever they are lying. Often this happens in cats who do not have the strength to move so they end up lying in their own urine or faeces or both, which can be very distressing to the cat, since cats are usually very fastidious.


Do have your vet check to exclude the possibility of a urinary tract, kidney or bowel infection, which might respond to treatment. 


Very Strong Bad Breath

The distinctive CKD bad breath smell may appear or worsen as your cat gradually deteriorates. We got Thomas's breath under control after he first crashed, but over the last two weeks of his life his breath got worse and worse, despite his sub-Qs and other treatments, as toxin levels increased in his body.


Bad breath may also be caused by dental problems such as an abscessed tooth or gum disease, or by dehydration, so be sure your vet checks for these.


Body Odour

The same smell as seen in the breath may also seem to emanate from the cat's body; this is because the toxins are no longer being excreted properly, so are building up in the body.


Body odour may also be caused by dehydration, which is usually treatable.


Severe Oral Ulcers

These may develop when a cat first crashes, and can often be brought under control once treatment is commenced.


Cats with metabolic acidosis may also develop mouth ulcers.


With ESRD, however, very severe ulcers, often covering the entire mouth and even the throat, may develop, often quite suddenly, and be unresponsive to slippery elm bark powder, although sucralfate may bring some relief.


Uncontrollable Vomiting

Most CKD cats suffer from vomiting at least occasionally and it can usually be managed.


Towards the end, however, you may find that the vomiting worsens to the point where you are unable to control it well enough, and the cat's quality of life is severely compromised as a result. In Thomas's case, this came on extremely suddenly, he hardly ever vomited but the day before he died, he suddenly began projectile vomiting, which simply did not respond to treatment. 


Loss of Appetite/Refusal to Eat or Drink

If a cat is truly dying, the digestive process will cease to function and the cat will not need food. Perhaps because of this, vets often seem to tell people that if their cat will not eat, it is time to say goodbye.


Unfortunately, almost all CKD cats will stop eating or drinking at some point, and it can therefore be very hard to know when this symptom takes on a more sinister meaning. If you haven't tried to treat this symptom, please do so before fearing that the end is near — food is an essential part of the treatment plan, and a cat can improve dramatically after taking in some nourishment. This is particularly true of cats who have been hospitalised, where they are often too stressed to eat.


There are various causes of inappetence in CKD cats, so you need to be sure you've looked into any of those which are present and treated them as appropriate (see Index of Symptoms and Treatments, loss of appetite). Cats who don't drink are often dehydrated, so look into correcting that too. Even when imbalances are under control, cats may have got out of the habit of eating, so read Persuading Your Cat To Eat for more information on ways to get food into your cat.


With Thomas, a refusal to eat was a very dramatic symptom since he ate almost the whole time during his illness, even when his creatinine level was over 7 mg/dl, until the day before he died, when it was simply impossible for him to eat — if we had forced him, he would have vomited it right up. This was because his digestive system was shutting down.


However, our Indie had very little appetite for several weeks after a dental, yet she made a full recovery. So it is important not to look at this symptom in isolation. 


Inability to Walk and General Weakness

These symptoms are often caused by low potassium levels, high phosphorus levels, anaemia or metabolic acidosis, all of which are treatable in principle; and, more rarely, by a blood clot to the leg (arterial thromboembolism), for which the prognosis is less favourable, though some cats do pull through. If your cat has had a stroke, s/he might not be able to walk.


If you haven't already done so, do try some treatments, but in ESRD, these conditions may simply no longer respond to treatment. 


Meatloaf Position

Symptoms has a full description of the meatloaf position. Many CKD cats sit in this position when they are crashing, but may recover with treatment, so this symptom alone is not reason to panic. However, if the cat assumes this position despite treatment, or in conjunction with other signs discussed here, it may be cause for concern.  



These can be caused by very high levels of BUN/urea (which may in turn be due to dehydration), high potassium levels, high blood pressure or  calcium imbalances.


If you are able to treat the condition causing the seizures successfully, the seizures may not return. Most of the cases I hear about are caused by high blood pressure, and virtually all of them resolve once the hypertension is under control with daily medication.


If your cat does have seizures towards the end, it may comfort you to know that people who have experienced seizures report that they often are not aware at the time of the seizure.



This is usually caused by high blood pressure causing the retinas to detach. In about 50% of cases, treating the high blood pressure can mean the retinas successfully re-attach, so try treating it first.


Blindness alone is not a reason for euthanasia in my opinion: cats navigate by smell rather than by sight, and are simply not as psychologically affected by blindness as humans are. Blindness in conjunction with some of the other symptoms described on this page, however, may be grounds for saying goodbye.


Dull, Sunken Eyes

Many people take this as a sign from their cat that it is time to let him or her go. This can certainly be a useful sign, particularly if you and your cat have a very close bond, but be careful not to read too much into it, certainly not without trying treatments first — dull, sunken eyes are often a symptom of dehydration.


I personally did feel that I could see in Tanya's eyes that she had had enough; but then I saw the same look in Thomas's eyes when he first crashed, and he pulled through, which has left me wondering what more aggressive treatments might have achieved for Tanya.


If you get this sign after trying many treatments, it is obviously more reliable than if you have tried none. 



Many CKD cats prefer to be in a quiet place, such as in a closet or high up on a shelf, so again, this alone is not always a reliable sign that the end is nigh. Often as the cat improves, s/he will hide much less. In conjunction with other signs described here though, this may be significant.


Restlessness and Pacing

Some cats seem to be unable to get comfortable, and keep moving from place to place, never staying in one for long. Tanya exhibited this symptom on her last day.


Restlessness may also be a sign of pain, hyperthyroidism, hypertension, or a side effect of certain medications. All of these are manageable. See Index of Symptoms and Treatments for more information.


Sudden, Severe Weight and/or Muscle Loss

If your cat seems to have lost weight, this may indicate dehydration or not eating enough.


By his last couple of days, it seemed like Thomas was losing weight and muscle tone virtually by the hour, despite still eating several times a day. We did notice this ourselves of course, but it was really brought home to us by the vet. She had not seen him for a few days, and when I took him in the day before he died because of his sudden terrible vomiting, she was really shocked by how thin he had become. This had happened despite the fact that Thomas always continued to eat fairly well: he simply did not have any reserves left to draw on. By the time Tanya died, she weighed three pounds (her healthy weight was six pounds), and like Thomas, she lost a lot of the weight very suddenly.


Sudden Weight Gain

Many people are delighted when their CKD cat gains weight, but if this happens quickly it may mean fluid is building up because the cat's body is no longer able to regulate body fluids. In many cases, this can eventually lead to congestive heart failure


This may also be a sign of overhydration, which is usually treatable.


Difficult to Rouse and Falling Temperature

The cat may start to spend more and more time sleeping (which tends to be common in older cats anyway) and may sometimes take time to respond and be difficult to rouse.


The cat's temperature may fall as the cat's body shuts down. Other possible causes for a low temperature are high calcium levels, anaemia and heart disease, which may be treatable.


Eventually in some cases — if the end is near — the cat may slip into a coma.


Mental Confusion

The cat may become confused and seem to not really "be there". This can be a result of the toxins in the bloodstream, which may be treatable, especially if the cat is dehydrated. It may also indicate cognitive dysfunction.



This may be caused by toxins in the body or by high potassium levels. Thomas began to twitch on his last day.


Of course, you should first try to treat any possible causes of twitching as outlined in the Index of Symptoms and Treatments.


Congestive Heart Failure (CHF)

Heart problems are relatively common in CKD cats, as discussed on the Heart Disease page. These can often be managed with medication, but the treatment for the heart condition tends to put additional strain on the kidneys, and vice versa. In the worst case, the cat may develop congestive heart failure (CHF), whereby fluids in the cat's body leak out of veins and build up in the lungs (pulmonary oedema), around the lungs (pleural effusion) or in the abdomen (ascites).


It is possible to remove this fluid, either through the use of diuretics or physically ("tapping"), but once congestive heart failure has developed, the outlook can be relatively poor. Some people have managed to keep a cat with congestive heart failure going for several months, but this is unusual and for most cats the prognosis is usually only a few weeks. It partly depends on how often the cat needs to have the fluid tapped: obviously a need for tapping every two days is wholly different to a need for tapping every two weeks or once every month. A cat in CHF is usually not able to absorb sub-Q fluids well, if at all, which means the kidney values tend to worsen; it is basically a vicious circle. In severe CHF, if the fluids are not drained off, the cat effectively drowns from the fluid in the lungs, so it is important to keep a close eye on the cat in case of distress.


Low Blood Pressure

Blood pressure tends to fall as death approaches, though you will probably not be able to tell that this is happening.



Anaemia in CKD cats is usually non-regenerative anaemia caused by the failing kidneys not producing a hormone called erythropoietin. Generally speaking, this does not kick in until the CKD is relatively advanced.


Mild anaemia is unlikely to cause major problems, and even with severe anaemia caused by the CKD, you may be able to treat it very successfully with erythropoiesis stimulating agents (ESAs) such as darbepoetin (Aranesp), epoetin alfa (Europe: Eprex; USA: Epogen or Procrit) or epoetin beta (NeoRecormon). Blood transfusions may also give you a breathing space, though in some cases treatment may be started too late for it to help.


In general, there is no reason why a CKD cat should die of CKD-related anaemia, but it is critical to keep an eye on PCV and treat anaemia proactively if it appears.


There is more information on the Anaemia page and the ESAs page.


Sudden Improvement Before a Crash (Rallying)

Some cats seem to suddenly improve just because their final crash and act better than they have in weeks. This phenomenon is also sometimes seen in humans. It is also known as rallying.


Tanya kept herself to herself the last couple of weeks, hardly ate anything and generally looked very delicate. The, on the night before she died, she suddenly appeared in the kitchen and ate a massive bowl of her favourite food of her own accord, having refused to eat without a lot of encouragement for weeks, and even then she had only nibbled. She then proceeded to spend the evening with us for the first time in weeks.


Of course, when she crashed the next day, this made it all the harder to accept because she had been doing so well only the day before; but my vet reassured us that this does sometimes happen.


At any rate, once we were over the shock, we were at least left with a nice memory of Tanya's final evening with the family. 


Running Away

It is natural for cats to hide when they do not feel well: it is a way to protect themselves from predators. Some cats near the end may take this a step further, and may actually run away from home and hide if they are allowed outdoors. Even an indoor cat who normally never has any interest in going outside may take the opportunity to escape if one presents itself. Unfortunately this may also mean that the cat's humans cannot find him/her, so the cat dies a lonely and perhaps uncomfortable death. For the cat who does survive and return home, the lack of food and fluids during the absence can make an already sick cat even sicker.


We experienced this with Thomas: he normally went out alone, but on his last morning we took him out on a lead to give him a last chance to smell his garden. He tried to run away, and would have succeeded if he hadn't been on the lead.


Since it is terribly distressing not knowing what has happened to your beloved cat, I recommend not allowing your cat out alone if you suspect the end is near. By all means take him/her outside on a lead, but please do not make the mistake of thinking your cat is too weak to move, you could get a very nasty surprise.


Accepting the Time Has Come


Even if every single one of the symptoms described above were present, you still might not feel ready to let your cat go. That is perfectly understandable: it is one of the hardest decisions you will ever have to make.


Also, if you have been devoting much of your time to helping your cat, it can be very hard to accept that you can no longer do anything to help him or her — the feeling of helplessness is an awful one, so we cling to the hope that we just need to find the one magic treatment that might help. I see this sometimes when people join my support group (perhaps when their cat is already in crisis) and see the success stories and keep trying to be one themselves.


Unfortunately not every cat can be a success story. Even for those who are, eventually the day is going to come when there is nothing left to try.


Even when there is nothing left to try, we do not always know that is the case. Before the end: prepare highly attached clients to face their-pet's death (2016) Wooten SJ Veterinary Medicine says "As the pet's proxy, the owner makes the decision for euthanasia based on uncertain anticipated events rather than what is known. Uncertainty makes the decision more difficult."


If you think you may decide to use euthanasia, please read below for more information on making the decision.


Home Hospice


Your cat may be near the end, but perhaps it is not quite time yet. You are probably familiar with the concept of hospice care for terminally ill human patients nearing the end of their lives, and hospice care for pets is also becoming more popular.


The American Association of Feline Practitioners Position Statement: Veterinary Hospice Care for Cats (2010) Thayer V, Monroe P, Smith R & Robertson S Journal of Feline Medicine and Surgery 12 pp729-730 says "The concept of hospice care is to provide an alternative to the premature euthanasia of a terminally ill cat – and not about heroic medical interventions."


This does not mean euthanasia is not an option; rather, the goal is to ensure that your cat's last hours or days are comfortable, so you do not have to act too soon. 2016 AAHA IAAHPC end-of-life care guidelines (2016) Bishop G, Cooney K, Cox S, Downing R, Mitchener K, Shanan A, Soares N, Stevens B & Wynn T Journal of the American Animal Hospital Association 52(6) pp341-356 explain more about this.


If you feel your cat is towards the end but not quite there yet, your goal changes from prolonging life to providing supportive care focused on your cat's comfort and quality of life. This would include the basics to keep your cat comfortable, such as sub-Qs to prevent dehydration, medications for nausea, treatment for mouth ulcers, painkillers etc. However, other treatments such as vitamins or phosphorus binders would probably not be given. You might want to give your cat treats, this is normally acceptable but check with your vet if you are not sure.


If the end is truly nigh, the cat will probably not want to eat, so do not assist feed, but keep food and water available. If there is a food your cat loves and will still eat, such as tuna, by all means give it.


Undertaking hospice can also help you come to terms with the harsh reality of your situation. 2016 AAHA IAAHPC end-of-life care guidelines (2016) Bishop G, Cooney K, Cox S, Downing R, Mitchener K, Shanan A, Soares N, Stevens B & Wynn T Journal of the American Animal Hospital Association 52(6) pp341-356 explain more about hospice, and mention that care of the human caregiver (i.e. you) is also an important part of the feline hospice programme.


The American Association of Feline Practitioners Position Statement: Veterinary Hospice Care for Cats (2010) Thayer V, Monroe P, Smith R & Robertson S Journal of Feline Medicine and Surgery 12 pp729-730 explains more about hospice care, including information on the criteria to consider in relation to quality of life issues, and where to find pet hospice services in the USA.


The International Association for Animal Hospice and Palliative Care offers information and support.


Saying Goodbye


You need to make some difficult decisions about your cat's death. i.e. whether you wish to let them die naturally or whether you will use euthanasia when the time arrives.


We probably all wish our cats would die naturally and peacefully in their sleep, but there is no guarantee that a natural death will be peaceful (the same might be said for some euthanasias, though fortunately not many).


A Natural Death


Some people decide to let their cat cross unaided for religious reasons. Other people feel they do not have the right to choose death for their cat, or it may be that they simply cannot face making the decision. Occasionally the decision is taken out of your hands, e.g. there is a storm and you cannot seek veterinary help.


I used to be terrified by the idea of a natural death. My opinion changed when my kitten, Lily, began to die naturally at home (she had FIP but not CKD). She fell asleep on the sofa and her body temperature began to fall. She was so deeply asleep and breathing so shallowly that for a moment I thought she had already crossed. So what did idiot I do? I'd never lost a cat naturally before, so I panicked and called the vet and asked her to meet me at her premises (it was 9.30 at night). I was so distraught (I wasn't expecting Lily to suddenly die) that I didn't even think to ask the vet to come to my home, which she would have done.


Unfortunately Lily woke up in the car en route to the vet's and was upset. I felt and still feel terrible for taking her to the vet when she was so scared there. I should have let her die peacefully at home on my lap.


Nevertheless, I do still worry about the idea of a natural death for a CKD cat, because sometimes a natural death can be unpleasant for such cats.


If you decide to allow your cat to die a natural death, I would read the information above about hospice.

What Happens During a Natural Death

If possible, allow your cat to be in a comfortable place of his/her choosing. With CKD cats who cross naturally, you may still see some of the signs outlined above, such as strong body odour; reduction in body temperature and possibly coma; hiding; incontinence; and twitching and possibly seizures.


Some cats will simply gradually fall into a coma, become unresponsive, and die a gentle death (as was happening with Lily above). However, other CKD cats may have seizures and a heart attack. Dying may be swift and painless, or it may be drawn-out and uncomfortable; it may even be painful, particularly if your cat has congestive heart failure, when s/he will basically drown from the fluids in the lungs.


Unfortunately, it is impossible to predict which cats will die in which way. Therefore please ensure that you are able to contact a vet at any time should your cat appear to be in discomfort and you decide that you want medical intervention after all. This should not be too difficult in the UK, where vets are obliged to provide a 24/7 service, so you should be able to contact a vet at any time, day or night. People in other countries may have to find an emergency clinic if they need help out of office hours.


Below are two experiences, one of a cat who crossed peacefully and one of a cat who did not. If you have already definitely decided on euthanasia, do yourself a favour and do not read the unpleasant death story.


Sometimes people who allow their cats to die at home find that their cats hang on while they are in the room, and only die when their caregiver leaves the room.


If you allow your cat to die a natural death, be careful about permitting outside access, because some cats will run away to die (see above).


Natural Death (Unpleasant)

"My cat died of CKD in my arms, without benefit of euthanasia. Not because I made a deliberate choice to have it that way but because the vet didn't make it in time to ease his passing.


"My cat's last hours were not pretty to witness. His deterioration was extremely rapid. He went from being weak but functional, to being almost completely helpless, in a matter of hours. At one point he managed to get himself up on a cat perch to sleep, but woke up later needing to urinate. I had been in the room with him keeping an eye on him, but sadly I wasn't in the room at that moment; I heard a crash and ran back in to find that he'd tried to get off the perch to make it to his litterbox but had been too weak, and he fell, hard, about four feet to the floor. I found him lying there, stunned, leaking urine and unable to get up. This was about two hours before he died. I left frantic messages for my vet, who was scheduled to come the next day to euthanize him, but she didn't get the messages in time to be of any help. I put my cat on my sofa and sat next to him. He lay there for two hours, too weak to do anything but breathe, until he was overtaken with convulsions. He kept convulsing in my arms for nearly thirty minutes (while my neighbor was driving us to an emergency vet) until he finally took his final breath and left me. I talked to him the entire time, telling him that I loved him and was there with him, but I know he didn't hear me or even know that I was there. 


"There was nothing peaceful about his death, nothing to make me come away feeling like we'd shared anything noble or beautiful. I would have far, far rather been able to hold him in my arms while the vet helped him to a truly peaceful passing, before matters deteriorated to the point they did. I would have rather spared him what he had to endure on the last day of his life." 


Natural Death (Pleasant)

"Roady slipped peacefully away at 3:03 a.m. California time this morning.


"About 8:00 last evening he came to me and wanted to be with me on the couch. My wife went to bed about 11. She brought us a big fluffy towel and the heating pad in case we got cold. I wrapped him loosely in the towel and held him in my arms. We stayed that way, until he passed. He gave a little crackling meow, his bladder let loose and he was gone. There was no pain.


"Mine and Roady's final time together was the best and most private. Something we would not have had, had I opted to take him somewhere to be put to sleep.


"I knew Roady, knew his wishes, knew in my heart that his crossing would be without pain and it was."




Euthanasia, literally translated, means a good death (which is what we all want). Unfortunately opting for euthanasia means the pain and uncertainty of making a decision to use it.

Euthanasia: Whether to Use

If you feel you would consider euthanasia when the time comes, it can be helpful to decide in advance, perhaps in conjunction with your vet, the criteria which will lead you personally to seriously contemplate euthanasia. This is not easy because different cats have different tolerance levels (and so do their humans); and many of the symptoms of CKD, which might lead some people who are unaware of the latest treatment options to consider euthanasia, can in fact be successfully controlled. 


How will I know? Assessing quality of life and making difficult decisions for your pet (2019) Ohio State University Veterinary Medical Center explains more about euthanasia and making the decision.


Euthanasia: When to Use

If you have decided to have your cat put to sleep when the time arrives, this does not necessarily mean you will know when to act. In fact, it can often be quite difficult to know.


"You Will Just Know"

Some well-meaning people may tell you that that your cat will let you know when it is time to leave, that you will look in his/her eyes and "just know".


Although it is comforting to think that your cat may effectively take the decision out of your hands in this way, you have to accept that it is just as likely that this will not happen. It might possibly be easier with a CKD cat to look in his or her eyes and "know" that it is time, in that you are probably giving your cat so much care and attention that you will know when something is wrong; but that doesn't translate as always knowing when it is time. 


I looked into Tanya's eyes and felt it was time; but then later on I saw that exact same look in Thomas's eyes — and he pulled through. So I know from personal experience that "looking into your cat's eyes" is an unreliable indicator. I have also heard from people who have been told they will "just know" and who are so worried about looking into their cat's eyes for "the signs" that they neglect to enjoy their time with their cat.


So by all means, hope for a sign; but do not count on receiving one.  


How To Decide

There is sometimes a tipping point, where you realise things are not going to improve. However, this does not always happen, and even if it does, you still may not want to accept that death will follow.


We cannot know the best time exactly. I have heard from many people over the years, and the consensus seems to be that they would prefer to have acted a day too soon rather than to have left it a moment too late. However, some people need to know they have tried everything they can and that things are completely hopeless before they act. I personally tend towards the latter approach, simply because I'm very bad at giving up. Have a think about this, and consider whether you would feel worse afterwards if you think you acted too late or too soon.


I would definitely talk to your vet about whether it is time. Vets deal with death regularly, plus they have more emotional detachment than you. Coping With Your Loss has links to pet loss support helplines at veterinary schools, and many of these are also happy to talk to you before your loss, when you are trying to decide whether the time has come.


At the same time, always remember that nobody knows your cat like you do: if you feel pressurised into making the irrevocable decision, perhaps by your vet or family, this may distress you afterwards; so again, try to decide in advance what are the criteria you personally would use for making the decision.


Talk to your cat. Your cat is an adult, and should be treated as such. Cats do not fear death as we do, they live in the moment. On the day before Ollie died, he was not eating much and seemed a little restless. In the afternoon he sat on a chair opposite me. I gave him a cuddle and I told him that we loved him very much, that we were so glad he had come to live with us and we hoped to have much longer together, but we knew things were tough for him and that we would understand if he had to leave us soon and he mustn't fight on our account. Two hours later he collapsed and I rushed him to the vet, where treatment overnight didn't work so we said goodbye. I often wonder if our little chat gave him permission to go.


I would suggest an approach something along the lines of:

  • if your cat is in pain, or about to be in pain, which cannot be treated; 

  • if your cat has very little quality of life, however you personally define that. Is your cat living or just existing? Has s/he lost dignity? Areas for consideration might include whether your cat is incontinent; whether your cat is able to rest comfortably; whether your cat still enjoys interacting with your family. Obviously treatment might resolve some of these issues, so what also matters is: 

  • if there is in your and your vet's opinion very little or no chance of curing or improving the situation and regaining quality of life;

then consider euthanasia. 


Quality of life scale (2004) Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, Villalobos A Blackwell Publishing, Table 10.1, released 2007 can be helpful in determining whether it is time to say goodbye.


Quality of life scale for pets Hilst K Journeys Home Pet Euthanasia has a quality of life scale and an online calculator you can use to gauge your cat's situation.


Even after reading the foregoing, you may feel unsure about what to do. If you are not yet sure, in most cases waiting a few more hours or occasionally days does not condemn a CKD cat to agony, but can at least help you to get used to the idea and to know that you have done all you could.


I brought Thomas home to spend his last night with his family before he was put to sleep the next day. He had become sick really fast, so this gave me time to get over the shock and to be sure it was hopeless and to accept that there was nothing to be gained for him from making him stick around. But having that time together did help me, and I like to think he was not too uncomfortable whilst we said our goodbyes.


However, if you look at the list of symptoms you may see towards the end (see above),  you will see that some of them are more tolerable than others. I would not recommend waiting too long if a cat is suffering from congestive heart failure, has problems breathing, cases of PKD in which the cysts have ruptured (this is rare), or seizures where you cannot find and treat the cause. If your cat can no longer urinate, you should act quickly. If you are at all unsure, call your vet. Saying goodbye a few hours earlier than you planned may be easier for you to cope with afterwards than worrying that your cat might have suffered even for a moment.


You should consider visiting the Other People's Losses page, which contains some personal histories bravely provided by several people who describe what happened during their cat's final hours, and in most cases why they then decided to use euthanasia. These histories are very hard to read, but offer a unique insight.


Pet MD has a very sensitively written section about euthanasia.


How I Make the Decision

When Tanya was ill, I felt that I would never be able to bear having her put to sleep. I had never had to make this decision before, and it absolutely terrified me. I felt like I would be murdering her, and couldn't comprehend the idea of killing somebody you love (well, I can't comprehend the idea of killing anybody, but especially not somebody I love).


The only way I was able to do it when the time came was when I finally accepted that neither Tanya nor Thomas was ever going to get any better than they were at that moment; that we had tried everything in our arsenal but our weapons were no longer working; and that waiting any longer would therefore ultimately be for my sake, not for theirs.


How much more could I ask of them? Ultimately you cannot avoid death; but often it is possible to avoid suffering. Once I began to look at it from the perspective of what was right for them and what would spare them pain, it was still by no means an easy decision, but I did at least feel it was inevitable, because I simply could not stand by and watch them suffer when it was within my power to prevent that. 


By not acting, I would not be prolonging their lives, I would be prolonging their deaths.


I have put the previous sentence in bold because many people tell me this single sentence is the thing that has helped them most on this page.


A friend sent me a quotation shortly after Thomas died. It said that a good death was not about when or how; it was about knowing love. This comforted me greatly, because, for all my mistakes, my cats did know love. Cats don't know how old they are, or wish to live longer, they live in the moment. All that matters to them, however long they live, is that they are loved and cherished.


Place of Euthanasia

Most cats are put to sleep at the vet's office, however, it is sometimes possible to have euthanasia performed at home.


Euthanasia at the Vet's

If you have to go to the vet's, let the receptionist know why you are coming. Many vets make special arrangements in such cases, e.g. my vet uses one particular room so you can leave without having to walk back through the waiting room.


Aim to get the last appointment of the session if possible so you do not feel rushed and fewer people will be in the waiting room when you arrive and leave.


Try to arrange for somebody you trust to drive you there and back. You will probably not be in a fit emotional state to drive, and if somebody else drives, you can hold your cat during the journey.


Euthanasia at Home

I think this is the best option by far, especially in the time of Covid-19. I recommend arranging in advance that your vet will come to your home if possible when the time arrives, even though you will not necessarily know when this will be. At home euthanasia is usually much less stressful for your cat and usually for you, though some people think they will be haunted by the experience if their cat crosses at home and therefore prefer to go to the vet's office.


Most UK vets are prepared to come to your home, usually with a vet nurse to assist, though you may have to wait until they have finished their day's consultations, and you will probably have to pay more. Our UK vet kindly came to our home at 9.30 p.m. on a Sunday evening to euthanise Tanya — it was a terrible experience, but that act of kindness made it a little easier to bear. Thomas was also put to sleep at home. This meant I could sob in private, and also that I did not have to drive home; I really don't think it would have been safe for me to drive in my state of grief.


I have heard that euthanasia at home is not permitted in France.


It can be much harder to find a vet who makes house calls in the USA. My vet did not offer this service, but put me in touch with an ER vet who came to our home.


Lap of Love may be able to provide at home euthanasia, depending upon where you are located within the USA. They also offer hospice care and will let you know if they think the time has come or whether you can wait a while. The reports I have had on Lap of Love have been universally positive.


Pet Loss at Home may also be able to assist.


The In Home Pet Euthanasia Directory may also be able to help you find a vet who can assist.


Vet Locator helps you find housecall vets, most of whom should be able to perform at home euthanasia.


Westoba Canadian Business Directory has details of house call vets in Alberta, Canada.


Euthanasia: Whether to be Present

Try to decide in advance whether you wish to be with your cat when s/he is put to sleep. Again, this is a very personal decision. Some people feel they owe it to their cat to be present; others simply cannot bear the idea. Both of these approaches are perfectly valid. 


Personally, I have always felt I had to be there because I felt the presence of somebody they knew and loved would comfort and reassure my cats.


What Happens During Euthanasia

Many people are very scared by the thought of euthanasia. Quite apart from the emotional trauma associated with the procedure, there can also be a fear of the unknown in terms of what to expect from a practical perspective: how is euthanasia performed, what exactly happens to the cat etc. 


The basic aim of euthanasia is to stop the cat's heart in a painless way. In order to achieve this, an overdose of an anaesthetic (pentobarbital sodium or pentobarbitone sodium) is given by injection. If you have ever had a general anaesthetic, I would imagine that the sensation of dropping off to sleep is similar for the cat, since an anaesthetic is used in both cases.


The injection must be given directly into a vein, and most vets will inject into the front leg. The vet usually has to shave or trim the cat's leg in order to see the vein clearly.


Some vets insert a catheter, a tube through which they will feed the anaesthetic but other vets simply insert the fine needle with the anaesthetic directly, which I preferred.


Some vets (particularly in the USA) give the cat a sedative first, which is a single injection under the skin. If you have a cat who hates vet visits, you may wish to ask your vet to do this. The sedative should relax the cat, and often the vet will then give you some quiet time together, perhaps twenty minutes or so, to say goodbye to your cat. Your cat may be relaxed but awake following a sedative, but some cats may become very sleepy and not particularly responsive to you. My British vet does not use sedatives because she says they can sting. I have had euthanasia performed both with and without sedatives, and I do not think the sedative bothered Harpsie, but nor do I think putting my other cats to sleep without sedatives caused any problems. 


Some cats actually pass before the final injection is given, especially if you can hear slightly gasping breaths (known as pre-agonal breathing) beforehand, but the vet will always give the final injection, just to make sure.


Occasionally a vet may inject the cat directly in the heart (intracardiac euthanasia), which I personally would find very distressing. I would suggest that you should not agree to this unless all other methods have failed; it should certainly not be the method of first choice, but may on rare occasions be necessary if the cat has very low blood pressure (which makes it virtually impossible to find a vein to use). This type of euthanasia should never be performed on a conscious cat (US law only permits it on animals who are heavily sedated, anaesthetized or comatose).


Once the final injection has been given, usually the cat will look as if s/he is falling asleep, and then s/he will gradually breathe more and more lightly until eventually the breathing stops completely: this only takes a few seconds.


Most cats cross peacefully, though unfortunately some cats may struggle a little or cry out, especially if they haven't been sedated first. However, this is uncommon. I have now had seven cats put to sleep in my presence and it has always been very gentle and gradual, and we didn't find it scary.


The vet checks the cat's eyes and heart and pronounces the cat dead. You may notice a few little sighs even after your vet has pronounced your cat dead; this is known as agonal breathing. This is just a physiological effect of the muscles relaxing, not proper breathing, but it can be extremely upsetting if you are not expecting it. Fortunately our vet had warned us about this possibility, which we saw with both Tanya and Thomas. Very occasionally your cat may suffer what appears to be a nosebleed — this is also caused by agonal breathing, and simply means that some capillaries or other larger blood vessels in the lungs have ruptured. This does not hurt the cat because it happens after death. Tanya also began pulling tongues, it was really just her tongue relaxing, and we actually found it rather cute since she often pulled tongues when she was alive. 


We were stroking both Tanya and Thomas the whole time as they crossed. You need to be aware that, just as there can be involuntary breathing movements after death caused by muscles relaxing, so other muscles may relax, including the bladder and the bowels. As a result a cat may empty his/her bladder and/or bowels after death. For this reason it is best to have a thick towel and/or incontinence pad on your knee if your cat crosses while on your knee.  


Unlike humans, cats' eyes stay open after death. They look empty though, compared to the depth in a cat's eyes before death.


It may help you to spend some time with your cat after he or she has crossed. To be honest, I found this essential in order to be absolutely sure that they had definitely crossed. It had been hard to groom Tanya for a while before her death because she was so thin, but I promised her she would be beautifully groomed after she had crossed. I kept that promise to her. If you have other animals, you may wish to let them view the body, because it may help them understand what has happened.


You may have a vet who cries along with you, or your vet may appear to remain detached. My vet never cries during euthanasia, because she wants to focus on her job of helping the cat to cross as peacefully as possible; but she told me that all her team do find it distressing and often need some emotional support from their colleagues afterwards. So if your vet doesn't cry, please don't assume he or she doesn't care; and please do not let this stop you crying yourself if that is what you want to do.


What's euthanasia like for a vet (2017) Barchas E Catster explains more about euthanasia from a vet's perspective.


The emotional cost of euthanasia Hoggan S is a video Ted Talk about how vets cope with euthanasia.


Resting Places


Ideally this is something which you should think about in advance if you can. Although we had previously decided to bury Tanya in our garden, we had not given any thought to a suitable container so we were faced with a real problem when she died. Also, she died in January, so the ground was very hard and difficult to dig.


One thing that I have found really helps me is to keep my cat's body at home for a while. If my cat has been put to sleep at home, this is easy to do. I often keep them overnight or for several hours during the day, then take them to the vet for storage until they are ready to go to their final resting place. I find it reassuring to be able to talk to them, look at them, hold them, gaze at their beautiful faces, be sure they are dead and basically delay the moment of truth. This way I am only dealing with the loss of life, but I still have their physical presence for a little while longer.


Paw Prints

Whichever resting place you choose, you may wish to clip a lock of hair as a memento. Some people have a cast made of their cat's paw, which can be very comforting. In the USA, vets often offer to do this, but you can do it yourself with moulding dough, available from toy shops.


See Coping With Your Loss for more options.


Resting Place Options

The options are:

  • to bury your cat in your garden

  • to bury your cat in a pet cemetery

  • to have your cat cremated and have the ashes returned to you

  • to have your cat cremated and not have the ashes returned to you

  • to have your cat freeze dried


If you wish to bury your cat, you need a suitable place to do so, such as your garden. If you do not have a suitable place to bury your cat, or if you do not expect to stay in your current home forever, you may prefer to pay to bury your cat in a pet cemetery.


If you are burying your cat privately, somebody needs to dig the grave. You need to dig down at least a foot. We buried Tanya in our garden, but digging her grave was a challenge since she died in January and the earth was very hard.


Thomas was also buried in the garden. Unfortunately, after we had buried him, I had a dreadful urge to dig him up again just to make sure he was definitely dead. I didn't, of course, but the urge was very strong, signalling my unwillingness to accept that he really had gone.


Many people choose to mark the grave in some way. We planted a rose bush on the graves of each of our cats, and placed brass memorials on the wall nearby. See below for suppliers.



Some people choose cremation because they prefer it to burial, while others choose it because they know they will move in the future and do not want to leave their cat behind when they do so, whereas ashes can travel with you. Some people choose cremation because they do not like the idea of their cat being outside in the cold ground.


If you choose to have your cat cremated, your vet will normally arrange for your cat to be collected from the vet's premises and taken to a special animal crematorium. Often the vet's premises will only be visited once or twice a week, so your cat may need to stay in your vet's freezer for a while, which some people find upsetting.


You need to be aware that quite often several cats will be cremated at once, so if you ask for the ashes back, you will be receiving either mixed ashes, or possibly none of your cat at all will be there.


If you wish, you can ask for an individual cremation instead (known as a separate retort), which usually costs more. I always opt for a private cremation. I not only do this, but I also always collect my cat's body from the vet and take the cat to the crematorium myself, but I collect a few hours in advance so we can spend a little more time together. Although the cat is frozen, I find it very comforting knowing after the death that I will see my cat again before the final goodbye.


Some places will allow you to attend private cremations if you wish. I have attended two of them, one in the USA and one in the UK. See below for my experiences.


If you do not visit the crematorium yourself, it can be upsetting receiving the call that your cat's ashes have been returned to the vet and are ready for you to collect. However, many people actually find it comforting to have their cat back home again, albeit in a different form.


If you choose to have your cat's ashes returned to you, they will usually be in a sealed plastic bag within a plain, simple container. Many people choose to buy a nicer urn or some other type of holder, either from the crematorium or from another supplier. I have always used those offered by the crematorium, for which I have usually paid a little extra.


Some people like to scatter the ashes, others like to keep them in their home. It is possible to have some of your cat's ashes made into jewellery if you prefer. You might also like to ask for your cat's ashes to be mixed with your own after you die, local laws permitting.


Cremation: Our Experiences

We have now had five of our cats cremated in two different countries. The first time we used cremation was in the USA, the four later cats were cremated in the UK.


We lost Harpsie in the USA, so since we lived in an apartment at the time, we had no choice but to have him cremated. I was dreading it. Many people had told me it would probably give me a sense of peace and completion, which I thought highly unlikely. I hated the thought of burning his lovely fur and beautiful face in particular, even though all the humans in my family opt for cremation.


We chose to attend the cremation, which I gather is unusual. But we are always present when we bury our cats, and we didn't want to do any less for Harpsie. Plus I wanted the reassurance of knowing they had got the right cat.


So we set off to the oldest pet cemetery in the USA, Hartsdale Pet Crematory (founded 1895). It was in a beautiful tree-filled setting, and there was torrential rain, which we didn't mind, it fitted our mood better.


Of course I sobbed my heart out but people were right, it was cathartic. We were given plenty of time in a private room for a personal goodbye with Harpsie. I'd been told that Harpsie might look a little different, but I'm pleased to say he looked exactly as he did when we took him up to the vet the day after he crossed. They placed him in a little casket for the viewing, with a little white satin pillow for his adorable little head, and a little cat-sized white satin blanket. We were able to hold and cuddle and stroke him, until we felt ready (after a fashion) to part with his little furry body. We placed two red roses in with him, and then watched as he was carried respectfully to the crematorium. We watched the man (who was very kind and considerate) place Harpsie in it, then we went inside the main building to choose an urn. We opted for a pale cream marble chest with a few pinkish-red swirls — the base colour is a similar colour to Harpsie. We felt this was very fitting because when Harpsie was a kitten, he loved sleeping with his head resting on the marble hearth.


We then went for a walk and the heavens opened, so we got soaked to the skin. We returned an hour later to collect Harpsie in his new form. It was curiously moving. We brought His Handsomeness home, and he now rests in his marble chest surrounded by the urns of our other deceased cats. And whilst we of course still wish that cute little face, body and personality were still with us, we do feel a sense of completion that he is home at last.


Although I found Harpsie's cremation in the USA comforting, the one I attended in the UK felt odd because it was more impersonal somehow thanks to the infamous British obsession with health and safety. I would return to Hartsdale in an instant, but for the last three cats I have had cremated in the UK, I have taken my cats personally to the crematorium, but have then visited a nearby garden centre during the cremation and purchased a memento of some kind, such as a vase or a rose bush.

In almost all cases I would suggest that burying your cat or having the ashes returned to you can give you some small form of comfort, as if your cat has come home to you.


Urns and Markers

Many people find it comforting to select a pretty urn to hold the ashes, or mark the grave in some way. The following companies sell urns and caskets, although I do not know anything about them unless stated (they are listed in alphabetical order):



Amazon sells a stone marker. Many other styles are also available.


Angel Ashes sells a variety of urns.


Casket Gallery sells wooden urns and photo-urns, and granite headstones.


Life Cycle Urns sell urns and charms, including some suitable for Pandora bracelets. Their products are available in the USA, Canada, UK, Australia, New Zealand and Singapore.


Paws 2 Heaven sells a variety of pet remembrance items, with 10% of purchase price going to a shelter or rescue group of your choice.


Perfect Memorials sells a wide selection of headstones and markers in the USA. I have had positive reports about this company.


Rainbow Bridge Urns sells a variety of urns.


Rays of Joy sells stained glass urns.


Freeze Drying

In the USA there are now a number of businesses that offer freeze drying. This is not the same thing as taxidermy (where the animal is stuffed). Instead, the cat is freeze dried in a position of your choice.


The advantages are that your cat's physical presence can remain in your home, and you can still hold your cat and stroke the soft fur.


Disadvantages include the fact that, if your cat has had any areas shaved for previous treatments or for euthanasia, these will remain visible. In addition, if your cat died of end stage CKD, s/he will not look as healthy as in their prime, and may be rather thin.


From what I can see and have heard, freeze drying costs around US$800-1000 for a 10 lb cat.


I have heard from several people who were considering this option, but I have not yet heard from anyone who has had it done.


Perpetual Pet is one company offering this service.




Please visit Coping with Your Loss for help with navigating your journey through grief, including a link to my free private online support group.






"They that love beyond the world cannot be separated from it.

Death cannot kill what never dies.

Nor can spirits ever be divided, that love and live in the same divine principle, the root and record of their friendship.

If absence be not death, neither is theirs.

Death is but crossing the world, as friends do the seas;

They live in one another still."


William Penn, More Fruits of Solitude





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This page last updated: 11 November 2020

Links on this page last checked: 01 September 2020







I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.


If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.



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