Managing Chronic Kidney Disease in Dogs: The Proactive Dog Owner’s Guide

Chronic kidney disease (CKD) is a common health issue that affects up to 1 in 10 dogs. The incidence climbs to 13% of dogs by age 13, and 42% of dogs ages 15+. As a proactive dog owner, it is essential to be aware of CKD and take steps to identify the condition and intervene as early as possible in to allow for the best opportunity to slow the progression and delay or minimize signs of illness that interfere with a good quality of life. In this blog post, we will delve into our management approach, which is based on recommendations of the International Renal Interest Society (IRIS) for different stages of CKD in dogs.

Understanding How Chronic Kidney Disease Can Affect Your Dog:

CKD is a progressive condition that impairs the kidneys’ ability to function properly. In the early stages (stage 1-2), there are often no visible symptoms–this is when we focus on slowing down the disease’s progression. As CKD advances to later stages (stage 3-4), symptoms become more frequent and severe, demanding greater emphasis on controlling these symptoms for an improved quality of life.

How We Detect Kidney Disease:

Ideally, CKD is detected in early stages on routine wellness profiles. We recommend annual screening blood work for young adults, with the addition of urinalysis for seniors or dogs at increased risk of CKD due to other factors like tick-borne infections.

IRIS Guidelines

Stage 1 – Early Kidney Disease:

At this early stage, dogs may have normal blood work results but show indications of kidney dysfunction, such as abnormalities on ultrasound or impaired ability to concentrate urine. The goals at this stage include discontinuing medications potentially harmful to the kidneys, ruling out treatable causes like kidney infection or obstruction, and screening for secondary high blood pressure or protein loss from the kidneys. To ensure proper hydration, constant access to fresh drinking water is crucial, and prompt correction of dehydration during other illnesses like diarrhea is necessary. In cases of high blood pressure or protein loss, appropriate medications and dietary adjustments are recommended.

Primary interventions:

-Ensuring adequate hydration
-Minimizing use of medications that may be harmful to kidneys
-Telmisartan and omega-3 fatty acid supplement if needed for protein loss from kidneys
-ACE-inhibitor (benazepril or enalapril) and sodium-restriction if needed for high blood pressure control
-Monitor every 6-12 months

Stage 2 – Managing Mild Chronic Kidney Disease:

As CKD progresses to stage 2, a kidney support diet is introduced along with the strategies used in stage 1. Dogs at this stage have a reduced ability to concentrate urine, making sufficient water intake and aggressive hydration management during other illnesses even more important. Controlling blood phosphorus levels through dietary adjustments and supplements becomes beneficial for slowing the progression of kidney disease. While symptoms are usually mild or not apparent in stage 2, it is essential to treat any suspected nausea episodes or reduced appetite with appropriate medications.

Primary interventions (in addition to those for Stage 1):

-Therapeutic kidney support diet, such as Hill’s k/d or Pro Plan NF
-Phosphorus-controlling supplement like Epakitin if needed
-Nausea/vomiting medications like Cerenia and omeprazole as needed
-Monitor every 3-6 months

Stage 3 – Managing Moderately Advanced CKD:

In stage 3, some dogs may still be free from symptoms and managed similarly to stage 1-2 patients to slow down disease progression. However, many dogs start experiencing symptoms affecting their quality of life, such as nausea, vomiting, dehydration, and anemia. Treatment goals shift to a focus on helping the dog feel their best, which may include routine subcutaneous fluid administration, nausea control, appetite stimulation, and addressing complications like high blood pressure and protein loss from the kidneys.

Primary interventions (in addition to those for Stages 1-2):

-SubQ fluid therapy
-Appetite stimulants like mirtazapine or Entyce
-Monitor every 1-3 months

Stage 4 – Enhancing Comfort in Advanced CKD:

At this advanced stage, dogs may experience frequent symptoms at home, making their comfort the primary goal of treatment. Special foods, supplements, medications, and fluid therapies are employed to manage symptoms such as vomiting, nausea, poor appetite, weight loss, dehydration, and systemic acid build-up. Maintaining adequate protein and calorie intake, hydration, and monitoring becomes even more critical. In some severe cases, kidney transplant could be considered, though ethical implications remain.

Primary interventions (in additoin to those for Stages 1-3):

-Hospitalization for in-patient management of “uremic crises” as needed
-Monitor at least monthly


Managing chronic kidney disease in dogs requires early detection and proactive measures to slow down disease progression and improve the dog’s quality of life. As responsible dog owners, being aware of the different stages of CKD and the recommended management strategies can significantly benefit our furry companions. By working closely with veterinarians and following IRIS guidelines, we can provide the best care possible for our beloved dogs, ensuring they live happy and healthy lives for as long as possible.

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Dr. Alison Barulich

Dr. Alison Barulich

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