Cat dying of kidney failure -- what to expect?

As someone who has had cats die at home and die with veterinary assistance, I can't overstate how much worse a 'natural' death can be for a sick cat. I totally understand and sympathize with not wanting your cat to die in a strange place, but I would strongly encourage you to reach out to vets in your area who might perform housecalls for a peaceful euthanasia. You don't want to see your cat go out in an hour-long fit of seizures. I'm really sorry you have to deal with any of this.

OK, my experience with this was not like the folks above. The vet wanted me to put my old (19 years) cat in the "hospital". I asked if she had renal failure, the vet said yes, and I asked what good would it do to put her in a hospital when she was going to die no matter what? Sheepish grin returned, I guess it would make money for the vet. They skin-popped her with a bunch of fluids, and we went home. She was wobbly, yes. She loved to lay on my chest in bed, I'd finally realized this was for warmth because of her kidney failure. (She had always liked being cuddled, even to the point of being held like a baby and her tummy rubbed.) We went to bed abut 10, I put her on my chest and stroked her gently. Sometime around 2 or 3 I felt her pass, a couple small jerks. At home, in her favorite place in the world, on top of her person. Would not have had it any other way.

You sound like a brave and loving friend to your dear old cat. Please remember that many vets make house calls for euthanization, and that you and your sweet derpy kitty don't have to go through this the hard way.

OK, I will inquire about in-home euthanasia options tomorrow morning when the vets are open. I don't want him to suffer or be scared and if they can do it at home then that would be acceptable. In case he deteriorates rapidly before I can get a vet over here, what can I expect as we near the end? How can I best comfort him?

Brief update: He continues to get better. I found a new vet who set me up to give him subcutaneous fluids at home and those seem to be helping him stay hydrated and thus feel a lot better. He's also back on the antibiotic that seemed to kick off his recovery after the emergency weekend vet gave it to him a week ago. He's semi-active now: walking around, giving affectionate head bumps, purring, etc., which are all things he wasn't doing a week ago. The only worrying symptom remaining is that his appetite is poor and he's lost a lot of weight so I'm temporarily supplementing his food intake by syringe-feeding him a slurry of kidney-supportive canned food mixed with omega 3 fish oil (for the caloric density) to put some weight back on him and hopefully jump-start his appetite again (cats get into a downward spiral where not eating leads to no appetite which leads to not eating...). The felinecrf.org website has been my guide through all this and is a literal lifesaver.

I'd also appreciate any suggestions for how to make him as comfortable and happy as possible. Call your vet and see if you can arrange a house call for euthanasia. This is the last, best and most loving gift we can give our beloved companions.

I am very sorry for what you and your cat are going through. As a fellow living thing, though: if I were in the position your cat is in, I would very strongly prefer that my life be promptly ended by intravenous injection of barbiturates, which is how cats are euthanized by veterinarians. The procedure for euthanizing feline companions is very, very different from the lethal injection protocol used in ending the lives of condemned humans. It is much gentler, more humane, and guaranteed not to be painful once underway. It will almost certainly not be easy for you, but it will likely be the kindest thing you can do for your cat. In the mean time, are you able (if your vet recommended) to administer subcutaneous fluids to your cat? It is my understanding that doing so can help cats with kidney disease feel better, at least temporarily.

One thing you might remember is cats don't really look at the future the way we do. We think of holding onto life as one more opportunity to see a sunrise, one more opportunity to visit our favorite park, one more opportunity to see our nephews and nieces and laugh at the funny faces they make. Animals don't make plans. They live utterly in the moment. It's not just about whether they're still able to do their favorite things, but also whether they're having more bad moments than good moments. One of my parents cats they let go too long. She was blind and deaf and confined to the partly-finished basement because she would fall down stairs. But she still liked to eat and get skritches so my dad held onto her. But one night they came back from dinner to find her on her side in a litterbox, paralyzed and half-unconscious from a stroke. Were the moments she had up until then worth that panic and pain? I don't think cats think about it like that--I think for her, she was just stroked-out, lying in her poop, alone. It would have been kinder to let her go. Remember it is sometimes hard to tell if cats are in pain. If he is hunched up a lot, curled up very tight, or holds himself in awkward positions that can be a sign he is really hurting. I am so sorry you're going through this. It is the hardest thing about owning pets.

Could you make a very comfortable box for your cat at home, and then (after a few days) transport the cat in that box to the vet's office so the cat not only doesn't have to move but is nestled comfortably into its comfy spot when it is time to euthanize? You might also try calling the vet who retired recently. Couldn't hurt.