Chronic kidney disease (CKD) occurs commonly in older dogs and cats and is the most
common renal disease occurring in elderly patients. It is defined as structural and/or
functional impairment of one or both kidneys that has been present for more than approximately
3 months. In most patients, there is loss of function and structure with CKD; however,
degree of functional impairment does not always mirror loss of structure. CKD implies
irreversible loss of renal function and/or structure that remains stable for some
period of time but is ultimately progressive. In some patients, CKD may be complicated
by concurrent prerenal and/or postrenal problems that may worsen the condition, but
if managed, they may improve the situation.
KEY POINTS
- •Chronic kidney disease occurs commonly in dogs and cats.
- •Chronic kidney disease is progressive; however, management utilizing dietary modification and pharmacologic agents may improve quality of life and survival.
- •Management of dogs and cats with chronic kidney disease is directed at minimizing the excesses and deficiencies that occur.
- •Specifically, management is directed at providing nutritional support, treating hypokalemia and metabolic acidosis, decreasing the degree of proteinuria, maintaining hydration, decreasing retention of wastes such as nitrogen containing compounds, avoiding other renal insults, improving anemia, minimizing renal secondary hyperparathyroidism and hyperphosphatemia, and decreasing blood pressure if systemic arterial hypertension is present.
- •Serial monitoring of dogs and cats with chronic kidney disease is essential because of the progressive nature of the disease.
Keywords
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References
- Chronic kidney disease.in: Bartges J. Polzin D.J. Nephrology and urology of small animals. Wiley-Blackwell, Ames (IA)2011: 433-471
- Clinicopathologic findings associated with chronic renal disease in cats: 74 cases (1973-1984).J Am Vet Med Assoc. 1987; 190: 1196-1202
- Feline renal failure: questions, answers, questions.Compen Contin Educ Pract Vet. 1992; 14: 127-152
- Feline chronic renal failure: clinical findings in 80 cases diagnosed between 1992 and 1995.J Small Anim Pract. 1998; 39: 78-85
- Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure.J Am Vet Med Assoc. 2005; 226: 393-400
- Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria.J Vet Intern Med. 2006; 20: 528-535
- Chronic kidney disease in small animals.Vet Clin North Am Small Anim Pract. 2011; 41: 15-30
- Assessment and management of proteinuria in dogs and cats: 2004 ACVIM Forum Consensus Statement (small animal).J Vet Intern Med. 2005; 19: 377-385
- Blood pressure determination.in: Bartges J.W. Polzin D.J. Nephrology and urology of small animals. Wiley-Blackwell, Ames (IA)2011: 86-90
- AAHA nutritional assessment guidelines for dogs and cats.J Am Anim Hosp Assoc. 2010; 46: 285-296
- Devlopment and validation of a body condition score system for dogs.Canine Pract. 1997; 22: 10-15
- Development and validation of a body condition score system for cats: a clinical tool.Feline Pract. 1997; 25: 13-18
- Weight loss to optimal body condition increases ground reactive force in dogs with osteoarthritis.Compen Cotin Educ Pract Vet. 2000; 23: 74
- Validation of a subjective muscle mass scoring system for cats.J Anim Physiol Anim Nutr (Berl). 2009; 93: 806
- Calculating a patient's nutritional requirements.Vet Med. 2004; 99: 632
- Evidence-based management of chronic kidney disease.in: Bonagura J.D. Twedt D.C. Kirk's current veterinary therapy XIV. Saunders Elsevier, St Louis (MO)2008: 872-879
- Histopathologic features of canine uremic gastropathy: a retrospective study.J Vet Intern Med. 2005; 19: 315-320
- Gastrin concentrations in plasma of cats with chronic renal failure.J Am Vet Med Assoc. 1998; 213: 826-828
- Plumb's veterinary drug handbook.6th edition. Blackwell, Ames (IA)2008
- The pharmacokinetics of mirtazapine in cats with chronic kidney disease and in age-matched control cats.J Vet Intern Med. 2011; 25: 985-989
- Comparison of ondansetron with metoclopramide in the symptomatic relief of uremia-induced nausea and vomiting.Kidney Blood Press Res. 2002; 25: 61-64
- Nasoesophageal and nasogastric feeding tubes.Vet Med. 2004; 99: 590-594
- Gastrostomy feeding tubes: percutaneous endoscopic placement.Vet Med. 2004; 99: 612-617
- Gastrostomy feeding tubes: surgical placement.Vet Med. 2004; 99: 604-610
- Gastrostomy feeding tubes: percutaneous, nonsurgical, nonendoscopic placement.Vet Med. 2004; 99: 619-626
- Esophagostomy feeding tubes.Vet Med. 2004; 99: 596-600
- Complications and outcomes associated with use of gastrostomy tubes for nutritional management of dogs with renal failure: 56 cases (1994–1999).J Am Vet Med Assoc. 2000; 217: 1337-1342
- Owner experiences with home use of a gastrostomy tube in their dog or cat.J Am Vet Med Assoc. 1998; 212: 1576
- Dietary protein intake and the glomerular adaptations to partial nephrectomy in dogs.J Nutr. 1991; 121: S125-S127
- Single-nephron adaptations to partial renal ablation in cats.Am J Physiol. 1995; 269: R1002-R1008
- Does modifying dietary lipids influence the progression of renal failure?.Vet Clin North Am Small Anim Pract. 1996; 26: 1277-1285
- Effects of dietary polyunsaturated fatty acid supplementation in early renal insufficiency in dogs.J Lab Clin Med. 2000; 135: 275-286
- Is there a role for dietary polyunsaturated fatty acid supplementation in canine renal disease?.J Nutr. 1998; 128: 2765S-2767S
- Beneficial effects of chronic administration of dietary omega-3 polyunsaturated fatty acids in dogs with renal insufficiency.J Lab Clin Med. 1998; 131 (447-5)
- Blood vitamin levels in dogs with chronic kidney disease.Vet J. 2012; 192: 226-231
- Proinflammatory effects of oxidative stress in chronic kidney disease: role of additional angiotensin II blockade.Am J Physiol Renal Physiol. 2003; 284: F863-F869
- Oxidative stress and chronic kidney disease.Vet Clin North Am Small Anim Pract. 2008; 38 (vi): 157-166
- Dietary supplements of vitamins E and C and beta-carotene reduce oxidative stress in cats with renal insufficiency.Vet Res Commun. 2006; 30: 403-413
- Retrospective study of the survival of cats with acquired chronic renal insufficiency offered different commercial diets.Vet Rec. 2005; 157: 185-187
- [Experimental treatment of rhubarb on mesangio-proliferative glomerulonephritis in rats].Zhonghua Nei Ke Za Zhi. 1997; 36: 87-89
- Herbal treatment for renal diseases.Ann Acad Med Singapore. 2005; 34: 44-51
- The effects of rheum officinale on the progression of feline chronic kidney disease [thesis].in: 2011: 54 (Department of Clinical Sciences, Kansas State University)
- Management of hypokalaemia and hyperkalaemia.J Feline Med Surg. 2001; 3: 181-183
- Potassium depletion in cats: hypokalemic polymyopathy.J Am Vet Med Assoc. 1987; 191: 1563-1568
- Potassium depletion in cats: renal and dietary influences.J Am Vet Med Assoc. 1987; 191: 1569-1575
- Effects of dietary sodium chloride intake on renal function and blood pressure in cats with normal and reduced renal function.Am J Vet Res. 2004; 65: 620-627
- Muscle potassium content and potassium gluconate supplementation in normokalemic cats with naturally occurring chronic renal failure.J Vet Intern Med. 1997; 11: 212-217
- Potassium depletion in cats: Renal and dietary influences.J Am Vet Med Assoc. 1987; 191: 1569-1575
- Effects of dietary acidification and potassium depletion on acid-base balance, mineral metabolism and renal function in adult cats.J Nutr. 1990; 120: 569-578
- Correlation of urine protein/creatinine ratio and twenty-four-hour urinary protein excretion in normal cats and cats with surgically induced chronic renal failure.J Vet Intern Med. 1992; 6: 36-40
- Development of chronic renal disease in cats fed a commercial diet.J Am Vet Med Assoc. 1993; 202: 744-751
- Chronic kidney disease.in: Hand M.S. Thatcher C.D. Remillard R.L. Small animal clinical nutrition. 5th edition. Mark Morris Institute, Topeka (KS)2010: 765-810
- Salt intake and progression of chronic kidney disease: an overlooked modifiable exposure?.Am J Kidney Dis. 2005; 45: 176-188
- Effects of sodium chloride on selected parameters in cats.Vet Ther. 2006; 7: 333-346
- Effects of dietary sodium chloride on health parameters in mature cats.J Feline Med Surg. 2009; 11: 435-441
- Assessment of acid-base status of cats with naturally occurring chronic renal failure.J Small Anim Pract. 2003; 44: 65-70
- Acid-base balance of cats with chronic renal failure: effect of deterioration in renal function.J Small Anim Pract. 2003; 44: 261-268
- Bicarbonate supplementation slows progression of CKD and improves nutritional status.J Am Soc Nephrol. 2009; 20: 2075-2084
- Serum bicarbonate and mortality in stage 3 and stage 4 chronic kidney disease.Clin J Am Soc Nephrol. 2011; 6: 2395-2402
- Progression of chronic renal disease in the dog.J Vet Intern Med. 1999; 13: 516-528
- Proteinuria in chronic kidney disease in cats–prognostic marker or therapeutic target?.J Vet Intern Med. 2006; 20: 1052-1053
- Tolerability and efficacy of benazepril in cats with chronic kidney disease.J Vet Intern Med. 2006; 20: 1054-1064
- Effects of enalapril versus placebo as a treatment for canine idiopathic glomerulonephritis.J Vet Intern Med. 2000; 14: 526-533
- Treatment of X-linked hereditary nephritis in Samoyed dogs with angiotensin converting enzyme (ACE) inhibitor.J Comp Pathol. 1997; 117: 209-225
- Reappraisal of proteinuria and estimated GFR to predict progression to ESRD or death for hospitalized chronic kidney disease patients.Ren Fail. 2011; 33: 31-39
- Pathophysiology and management of progressive chronic renal failure.in: Greenberg A. Primer on kidney diseases. 3rd ed. National Kidney Foundation, San Diego (CA)2001: 385-396
- Diet modulates proteinuria in heterozygous female dogs with X-linked hereditary nephropathy.J Vet Intern Med. 2004; 18: 165-175
- Fluid therapy for acute and chronic renal failure.Vet Clin North Am Small Anim Pract. 1989; 19: 343-359
- Protein and calorie effects on progression of induced chronic renal failure in cats.Am J Vet Res. 1998; 59: 575-582
- Effect of phosphate and protein restriction on progression of chronic renal failure in cats [abstract].J Vet Intern Med. 1998; 12: 221
- Effects of dietary protein and calorie restriction in clinically normal cats and in cats with surgically induced chronic renal failure.Am J Vet Res. 1993; 54: 1653-1662
- Effect of modified protein diets in dogs and cats with chronic renal failure: current status.J Nutr. 1991; 121: S140-S144
- Low protein diets are mainstay for management of chronic kidney disease.Front Biosci (Schol Ed). 2011; 3: 1432-1442
- Survival of cats with naturally occurring chronic renal failure: effect of dietary management.J Small Anim Pract. 2000; 41: 235-242
- Dietary management of naturally occurring chronic renal failure in cats.J Nutr. 1994; 124: 2660S-2662S
- Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats.J Am Vet Med Assoc. 2006; 229: 949-957
- Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs.J Am Vet Med Assoc. 2002; 220: 1163-1170
- Azodyl, a synbiotic, fails to alter azotemia in cats with chronic kidney disease when sprinkled onto food.J Feline Med Surg. 2011; 13: 405-409
- Feline chronic renal failure: calcium homeostasis in 80 cases diagnosed between 1992 and 1995.J Small Anim Pract. 1998; 39: 108-116
- Effect of dietary phosphate restriction on renal secondary hyperparathyroidism in the cat.J Small Anim Pract. 1999; 40: 62-70
- Renal secondary hyperparathyroidism in a cat.J Am Anim Hosp Assoc. 1993; 29: 345-350
- Calcium, phosphorus and vitamin D disorders in uremia.Contrib Nephrol. 2005; 149: 261-271
- Serum concentrations of 1,25-dihydroxycholecalciferol and 25-hydroxycholecalciferol in clinically normal dogs and dogs with acute and chronic renal failure.Am J Vet Res. 2003; 64: 1161-1166
- Renal dysplasia with secondary hyperparathyroidism and loose teeth in a young dog.J Vet Dent. 1995; 12: 143-146
- Effects of a dietary chitosan and calcium supplement on Ca and P metabolism in cats.Berl Munch Tierarztl Wochenschr. 2004; 117: 310-315
- Benefits of calcitriol therapy and serum phosphorus control in dogs and cats with chronic renal failure.Vet Clin North Am Small Anim Pract. 1996; 26: 1293-1330
- Vitamin D in chronic kidney disease: a systemic role for selective vitamin D receptor activation.Kidney Int. 2006; 69: 33-43
- Expanding targets of vitamin D receptor activation: downregulation of several RAS components in the kidney.Kidney Int. 2008; 74: 1371-1373
- Suppression of renin-angiotensin gene expression in the kidney by paricalcitol.Kidney Int. 2008; 74: 1394-1402
- Association of oral calcitriol with improved survival in nondialyzed CKD.J Am Soc Nephrol. 2008; 19: 1613-1619
- Comparison of the effects of daily and intermittent-dose calcitriol on serum parathyroid hormone and ionized calcium concentrations in normal cats and cats with chronic renal failure.J Vet Intern Med. 2006; 20: 1307-1313
- Pathophysiology and management of anemia in chronic progressive renal failure.Semin Vet Med Surg (Small Anim). 1992; 7: 175-182
- Anemia of chronic renal failure in dogs.J Vet Intern Med. 1992; 6: 264-270
- A health policy model of CKD: 1.Am J Kidney Dis. 2010; 55: 452-462
- [Economic impact of Losartan use in type 2 diabetic patients with nephropathy].Rev Med Chil. 2009; 137: 634-640
- [Gastrin and the kidneys].Klin Med (Mosk). 1984; 62: 14-17
- Anemia of renal disease: what it is, what to do and what's new.J Feline Med Surg. 2011; 13: 629-640
- Use of recombinant human erythropoietin for management of anemia in dogs and cats with renal failure.J Am Vet Med Assoc. 1998; 212: 521-528
- Human recombinant erythropoietin used to treat a cat with anemia caused by chronic renal failure.Can Vet J. 1994; 35: 375
- The use of erythropoietin.Vet Clin North Am Small Anim Pract. 2003; 33: 1245-1260
- Anemia predicts progression of chronic kidney disease in newly diagnosed azotemic cats.J Vet Intern Med. 2010; 24: 677
- Hypertension and renal disease.Vet Clin North Am Small Anim Pract. 1996; 26: 1331-1345
- Effects of the calcium channel antagonist amlodipine in cats with surgically induced hypertensive renal insufficiency.Am J Vet Res. 2002; 63: 833-839
- Evaluation of the effects of inhibition of angiotensin converting enzyme with enalapril in dogs with induced chronic renal insufficiency.Am J Vet Res. 2003; 64: 321-327
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Published online: May 21, 2012
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© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
