Evidence-based step-wise approach to managing chronic kidney disease in dogs and cats

Objective: To provide a framework for successfully managing chronic kidney disease (CKD) over an extended period of time with the goal of optimizing clinical outcomes by fostering a veterinarian-client relationship that facilitates successful application of evidence-based treatment. Etiology: Ultimately, CKD results from loss of functional nephrons; however, the specific disease process responsible for this loss usually cannot be determined due to development of chronic changes (eg, fibrosis) and compensatory adaptations that have occurred in the kidneys of patients with CKD. Earlier diagnosis may foster a better understanding of the etiologies of CKD. Diagnosis: Diagnosis of CKD is based on establishing loss of kidney function(s) due to primary kidney disease that have been present for an extended time (typically 3 months or longer). Therapy: The goals of therapy are to: (1) slow progressive loss of kidney function, (2) ameliorate clinical and biochemical consequences of CKD, and (3) maintain adequate nutrition. These goals are achieved by: (1) managing adaptive processes that promote progression of CKD, (2) controlling intake of water, nutrients, minerals and electrolytes, and (3) correcting hormonal deficiencies. Prognosis: The short-term prognosis for dogs with CKD varies from good to poor, while the long-term prognosis for dogs with CKD is generally guarded to poor depending on the International Renal Interest Society (IRIS) CKD stage of the patient. Both short-term and long-term prognosis for cats with CKD may vary from good to poor depending on the IRIS CKD stage. However, prognosis is more variable and unpredictable in cats.