{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T11:21:17Z","timestamp":1771586477495,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Animals"],"abstract":"<jats:p>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\u2019s dignity when biological resilience is exhausted.<\/jats:p>","DOI":"10.3390\/ani16040669","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T10:32:37Z","timestamp":1771583557000},"page":"669","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Holistic Decision-Making Tool for Canine Chronic Kidney Disease: Navigating Palliative Care and Euthanasia"],"prefix":"10.3390","volume":"16","author":[{"given":"Diego Antonio","family":"Sicuso","sequence":"first","affiliation":[{"name":"Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vito","family":"Biondi","sequence":"additional","affiliation":[{"name":"Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pietro","family":"Gambadauro","sequence":"additional","affiliation":[{"name":"Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0440-5457","authenticated-orcid":false,"given":"Michela","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3488-2948","authenticated-orcid":false,"given":"Angelo","family":"Peli","sequence":"additional","affiliation":[{"name":"Department for Life Quality Studies, University of Bologna, 47291 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1701-3636","authenticated-orcid":false,"given":"Annamaria","family":"Passantino","sequence":"additional","affiliation":[{"name":"Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"ref_1","unstructured":"IRIS (2026, February 10). 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