Animals : an open access journal from MDPI · 2026
A Holistic Decision-Making Tool for Canine Chronic Kidney Disease: Navigating Palliative Care and Euthanasia.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Sicuso Diego Antonio, Biondi Vito, Gambadauro Pietro, Pugliese Michela, Peli Angelo, Passantino Annamaria
Аннотация
BACKGROUND: 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.
OBJECTIVE: 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.
METHODS: 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).
RESULTS AND DISCUSSION: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
METHODS: 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).
RESULTS AND DISCUSSION: 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.
CONCLUSIONS: 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.