A Holistic Decision-Making Tool for Canine Chronic Kidney Disease: Navigating Palliative Care and Euthanasia

Managing end-of-life decisions in canine chronic kidney disease (CKD) remains one of the most significant challenges in veterinary nephrology, requiring a delicate balance between clinical data and ethical considerations.

This study introduces a novel decision-making algorithm designed to guide clinicians and owners through the complexities of end-of-life care, focusing on the assessment of Quality of Life (QoL) and disease progression.

The tool integrates IRIS staging with a multi-parameter QoL checklist, categorizing patients into three distinct clinical pathways: Tier A (Active Palliative Care), Tier B (Intensive Monitoring/Ambiguous Zone), and Tier C (Compassionate Euthanasia).

The algorithm defines Tier A as a proactive palliative pathway grounded in systematic clinical evaluation and continuous QoL assessment, aimed at preserving patient comfort and dignity. Across all tiers, QoL functions as a dynamic and central parameter, guiding transitions between clinical pathways in conjunction with objective indicators of disease progression. Tier C delineates the threshold of therapeutic futility, where declining QoL and biological resilience converge, and euthanasia is framed as an ethically appropriate option to prevent refractory suffering.

By providing methodological transparency and clear clinical thresholds, this tool facilitates communication between veterinarians and owners. It ensures that palliation is approached with high-standard medical rigor while safeguarding the animal's dignity when biological resilience is exhausted.