To provide optimal treatment for dogs and cats with chronic kidney disease, you'll need to thoroughly evaluate the animal and diligently monitor the natural course of the disease as well as the patient's response to intervention.1 With conservative medical management of chronic kidney disease, you're trying to attain these four general goals:
1. Provide adequate and appropriate nutritional support.
2. Correct fluid deficits and excesses, acid-base imbalance, and electrolyte abnormalities.
3. Ameliorate clinical signs of chronic kidney disease.
4. Slow the disease's progression with renoprotective therapy.
The following 11 guidelines provide a framework for achieving these treatment goals in concert with the International Renal Interest Society (IRIS) staging system for chronic kidney disease. These guidelines are for the conservative medical management of chronic kidney disease and are not intended to be provided without due consideration for identifying and specifically treating any active renal disease present, especially in patients with stages 1 and 2 chronic kidney disease in which identification and treatment of active renal disease may markedly alter the long-term outcome. See Tables 1-3 for a summary of the IRIS staging system. Because the IRIS staging system categorizes specific disease markers as they relate to kidney function, the system will help you recognize kidney disease earlier and better monitor a patient's condition. Table 4 provides an overview of the 11 guidelines.
TABLE 1: A Summary of the IRIS Staging System of Chronic Kidney Disease*
PROVIDE ADEQUATE AND APPROPRIATE NUTRITION
In many or most dogs and cats with chronic kidney disease, death or euthanasia results directly or indirectly from starvation. This devastating deterioration results from progressive hyporexia and anorexia and their associated adverse nutritional effects. It is essential that hyporexia and anorexia are recognized and responded to early in the course of chronic kidney disease. Thus, always evaluate whether the patient is maintaining a stable body weight at an acceptable nutritional status (usually measured as a body condition score and assessment of activity and strength).
TABLE 2: A Summary of Chronic Kidney Disease Substage Based on the Urine Protein/Creatinine Ratio*
#1 Recommend feeding a renal diet. Strong evidence (evidence-based medicine grade 1; see sidebar titled "The evidence-based medicine hierarchy") supports feeding a diet formulated to address the specific nutritional needs of animals with chronic kidney disease (a renal diet) to dogs and cats with serum creatinine concentrations in excess of 2 mg/dl (chronic kidney disease stages 3 and 4 in dogs and stages 2 through 4 in cats).2-4 Dietary therapy in dogs and cats slows the progression of chronic kidney disease and prevents or delays the onset of uremia and premature death due to complications of the disease. Renal diets have been shown to maintain or improve nutrition compared with maintenance diets.2-4 Patient and owner acceptance of the diets used in these studies was excellent, perhaps in large part because of gradual diet introduction over several weeks.
TABLE 3: A Summary of Chronic Kidney Disease Substage Based on Results of Blood Pressure Measurement and Signs of End-Organ Damage or Complications*