Diagnosing, Monitoring, & Managing Chronic Kidney Disease

Chronic kidney disease (CKD) has an overall prevalence of 25% to 50% in older dogs and cats. Management focuses on slowing disease progression through early detection, staging, and therapeutic intervention. Although CKD is progressive and irreversible, early detection as well as avoidance of insults (eg, NSAIDs, hypotension, hypertension) can slow progress. 

Early signs include loss of urine-concentrating ability and muscle loss. Azotemia may be an insensitive CKD marker. Blood symmetric dimethylarginine is considered a more sensitive marker and can be used in conjunction with serum creatinine to assess CKD severity; however, it should not be used to monitor trends. 

CKD management should take into account owner goals and home care abilities. Therapeutic interventions focus on improving body and muscle condition, minimizing proteinuria and hypertension, reducing renal secondary hyperparathyroidism, stimulating RBC mass, and maintaining hydration.

Moderate protein restriction may be achieved with therapeutic renal diets, which also restrict dietary phosphorus and sodium and provide omega-3 fatty acids, B vitamins, and antioxidants. Antiemetics, appetite stimulants, and feeding tubes should be used to maintain weight in patients that are unable to maintain caloric needs. 

Proteinuria and hypertension should be controlled with amlodipine and ACE inhibitors as well as angiotensin-receptor blockers. Hyperphosphatemia can be controlled by ensuring adequate hydration, feeding a therapeutic renal diet, and administering a phosphorus binding agent. Darbepoetin along with parenteral iron can be effective for treating anemia.