Feline CKD is staged using fasting serum creatinine and/or symmetric dimethylarginine (SDMA) concentrations measured on at least two occasions in a stable, well-hydrated patient, with substaging added for proteinuria (urine protein:creatinine ratio [UPC] on at least two samples ≥2 weeks apart) and systolic blood pressure (SBP).Journal of Feli…+1 The International Renal Interest Society (IRIS) framework drives both prognosis and treatment decisions at each stage.The Veterinary…+1

Dietary modification is the only intervention with robust evidence for improving survival and slowing progression in azotaemic CKD. A protein- and phosphorus-restricted renal diet is recommended from IRIS Stage 2 onward, with use recommended in all Stage 3 and 4 cats.The Veterinary…+1 Feeding a renal diet to Stage 2 and 3 cats reduces uremic episodes, lowers serum phosphate and fibroblast growth factor 23 (FGF23) concentrations, and increases survival time compared to a conventional diet.Journal of the… The primary barrier to dietary management is acceptance: 42% of cats in one prospective evaluation did not successfully transition because either the cat or owner was unwilling to make the change, and compliance is improved by gradual dietary transition.Journal of Feli…+1

For IRIS Stage 1, dietary intervention is currently advised only when FGF23 is elevated, indicating disruption of calcium-phosphorus homeostasis secondary to kidney disease.Journal of the… Weight loss and phosphorus dysregulation are present in non-azotaemic cats, and progression to azotaemic CKD can occur over time, making early detection clinically meaningful — but dietary protein and phosphorus restriction in pre-azotaemic cats has not yet demonstrated the same survival benefit as in azotaemic stages.The Veterinary…

Phosphate binders are added when serum phosphate is not controlled by diet alone, or when transition to a low-phosphorus diet has not been achieved. Whether phosphate binders confer the same survival benefit as renal diets is not established.Journal of Feli…+1

Proteinuria and hypertension substaging drives additional pharmacological intervention. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) are indicated for severe and sustained elevations in UPC and SBP.Journal of Feli…+1 Benazepril in proteinuric cats significantly improves appetite but has not been shown to improve survival.Journal of Feli… The evidence supporting proteinuria management on quality of life is graded as poor; evidence supporting hypertension management on quality of life is graded as good.Journal of Feli…

Fluid therapy — intravenous or subcutaneous — addresses dehydration and electrolyte and acid-base imbalances at any stage where these are present.Journal of Feli… Hypokalaemia requires potassium supplementation; interventions to control hypokalaemia are important to prevent serious complications.Journal of Feli…+1

Anaemia and metabolic acidosis management, including erythrocyte-stimulating agents, are generally reserved for Stage 3 and 4, when these complications are more likely and quality of life becomes the priority over disease-progression delay.Journal of Feli…+1 Antiemetics and appetite stimulants are used to relieve clinical signs of uraemic gastroenteritis as CKD advances.Journal of Feli…+1

CKD prevalence reaches up to 80% in cats aged 15 years and older, making routine screening of senior and geriatric cats — particularly those with concurrent hyperthyroidism, hypertension, ureterolithiasis, retrovirus infection, or cardiovascular disease — a core practice responsibility.Journal of Feli…+1 Diagnosis at early disease stages is associated with more prolonged survival times.Journal of Feli…

Would you like to go deeper on the specific UPC and SBP cutoffs that trigger pharmacological intervention at each substage?