IRIS guidelines for Chronic Kidney Disease (CKD) in cats

Chronic Kidney Disease (CKD) in cats is a common, progressive disease, especially in older
cats. The **International Renal Interest Society (IRIS)** provides widely accepted guidelines to
stage, diagnose, and manage CKD to optimize patient outcomes.
—
IRIS Staging of CKD in Cats
IRIS stages are based primarily on **plasma creatinine levels** and are updated annually. The
stages help guide treatment and prognosis.

| **Stage** | **Creatinine (mg/dL)** | **Additional criteria** | **Notes**

| **Stage 1** | <1.6 | Normal or mildly abnormal bloodwork | Usually
asymptomatic; early detection essential |
| **Stage 2** | 1.6 – 2.8 | Slight increase; can have other minor signs| Usually still
asymptomatic; monitor closely |
| **Stage 3** | 2.9 – 5.0 | Moderate increase, clinical signs often evident | Symptoms like
weight loss, poor coat, increased thirst/urination |
| **Stage 4** | >5.0 | Severe kidney failure; often symptomatic | Usually requires
intensive management; poor prognosis |
*Note:* Additional parameters like SDMA, urine specific gravity, proteinuria, and blood pressure
are used for staging and management.

Key Diagnostic Tests for IRIS Staging
– Serum creatinine**
– Urinalysis:** urine specific gravity (USG), protein levels
– Blood pressure**
– Serum phosphorus and potassium
-Urine protein:creatinine ratio (UPC)
—
Management Principles Based on IRIS Stages
Stage 1 & 2 (Early CKD):
– Regular monitoring (bloodwork, urine testing)

– Diet: renal-specific diet low in phosphorus and protein, high in omega-3 fatty acids
– Ensure adequate hydration
– Control hypertension if present
– Minimize stress and toxins
Stage 3 & 4 (Advanced CKD):*
– More aggressive treatment to delay progression
– Fluid therapy (subcutaneous fluids) to maintain hydration
– Phosphate binders and potassium supplementation if needed
– Antihypertensive medications (ACE inhibitors)
– Manage anemia and secondary complications
– Consider palliative care and quality-of-life measures
Monitoring and Follow-up
– Recheck bloodwork and urine every 3-6 months in early stages
– In advanced stages, more frequent monitoring
– Adjust treatment based on progression and clinical signs
Prognosis
– Early detection and management can prolong quality of life
– Advanced CKD has a guarded to poor prognosis, but supportive care can improve comfort
In summary, IRIS guidelines provide a structured approach to staging, diagnosing, and
managing CKD in cats, emphasizing early detection, tailored therapy, and regular monitoring.