Clinical
Understanding Feline Chronic Kidney Disease: Staging and Management Updates
Prevalence
Chronic kidney disease (CKD) is one of the most common conditions in aging cats. Studies estimate that 30–40% of cats over age 10 are affected.
IRIS Staging
The International Renal Interest Society (IRIS) staging system:
- Stage 1: Creatinine <1.6 mg/dL, SDMA <18 — Non-azotemic, CKD confirmed by other findings
- Stage 2: Creatinine 1.6–2.8, SDMA 18–25 — Mild azotemia, usually mild signs
- Stage 3: Creatinine 2.9–5.0, SDMA 26–38 — Moderate azotemia, various clinical signs
- Stage 4: Creatinine >5.0, SDMA >38 — Severe azotemia, significant clinical signs
IRIS further sub-stages based on proteinuria (UPC ratio) and blood pressure.
Early Detection with SDMA
SDMA can detect reduced GFR when as little as 25% of kidney function is lost, compared to creatinine which may not elevate until 75% is compromised.
Management by Stage
- Stage 2: Renal diet (restricted phosphorus/protein), phosphate binders if needed
- Stage 3: Add subcutaneous fluids, anti-nausea medications, potassium supplementation
- Stage 4: Intensive supportive care, quality of life assessment
Practice Tips
- Screen every cat over 7 with SDMA/creatinine in wellness panels
- Use consistent IRIS staging in medical records
- Set up automated rechecks based on stage-appropriate intervals
Sources: IRIS CKD Staging Guidelines 2023; ISFM CKD Guidelines.
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