Chronic Kidney Disease in Dogs: Catch It Early, Manage It Well

In brief

There are five things you should know about chronic kidney disease. First, and this explains almost everything: the classic kidney values rise late. Creatinine often only becomes abnormal once function loss is well advanced—so “but his values were always fine” does not contradict the diagnosis. Second: a newer marker called SDMA can become abnormal at an earlier stage of function loss. Third: among the most common early signs in everyday life are increased drinking and urination—and the urine often reveals more than the blood. Fourth: the disease is not curable, but its course can be influenced considerably. Fifth: the measure with the best evidence is not a pill but food—in a randomized study, a kidney diet reduced uremic crises and mortality.

Chronic kidney disease is one of the most common diseases of older dogs, and one in which the timing of the diagnosis matters a great deal. This article explains why it is noticed so late, what can tip you off earlier, and what actually changes the course of the disease.

Note: This article is general information and does not replace a veterinary examination. If a dog with kidney disease suddenly gets worse, with vomiting and loss of appetite, it needs to be seen right away.

👉 All about preventive care and health: dog health at a glance

1. What the kidneys do

The kidney is more than a filter. It is made up of hundreds of thousands of tiny functional units, the nephrons, and it takes care of several tasks at once.

It detoxifies by moving waste products from the blood into the urine. It regulates water balance by concentrating or diluting the urine. It controls blood pressure and mineral balance, above all phosphate and potassium. And it produces a hormone that stimulates the production of red blood cells—which is why anemia is one of the late consequences.

One property is decisive: in adult dogs, lost nephrons are not replaced to any meaningful extent. Individual cells do have some capacity for repair, but it is not enough to bring lost functional units back—in practical terms, what is destroyed stays destroyed. The remaining units take on more work and compensate for the loss for a long time—until they can't anymore.

This very capacity to compensate is both a blessing and a curse. It keeps the dog free of symptoms for a long time. And it means that by the time the first abnormal value appears, a great deal has already been lost.

2. Why the values rise so late

This is the point that puzzles owners most—and it explains why the diagnosis so often seems to come out of nowhere.

The classic kidney value, creatinine, comes from muscle metabolism and is excreted by the kidneys. It only rises above the reference range once a substantial part of kidney function has already been lost—the figure usually given is roughly three quarters. Until then, the remaining nephrons manage to keep the value within the normal range.

That figure, however, is a rough guide, not something to calculate with. The relationship between function loss and the rise in creatinine is not linear: at first the value barely moves, then it climbs all the more steeply as loss continues. On top of that come the influences described in the next paragraphs—muscle mass, hydration, feeding. The robust statement is therefore simply this: creatinine only becomes abnormal once kidney function is clearly reduced.

In other words: a normal kidney value does not mean the kidney is healthy. It means the kidney is still compensating.

Two things make matters more difficult.

Creatinine depends on muscle mass. An old, thin dog with little muscle produces less creatinine—its value can look normal even though the kidney is working poorly. Conversely, a very muscular dog can have a value at the upper limit without being sick.

The value fluctuates with hydration. A dehydrated dog has higher values without the kidney itself having gotten worse. That's why interpretation assumes a stable, adequately hydrated dog—and as a rule, the value is measured twice.

The step forward is called SDMA. This value rises considerably earlier—the figure given as a guide is a function loss of about 40 percent. It also does not depend on muscle mass, which makes it particularly valuable in old dogs that have lost condition. It does not replace creatinine but complements it—and it is the reason a kidney panel at a senior checkup includes more today than it used to.

And the urine is often faster than the blood. The ability to concentrate urine is lost earlier than the capacity to clear waste. A dog that passes large amounts of dilute, almost water-clear urine while its blood values are still normal is exactly the case you are looking for.

The key measurement for this is called urine specific gravity, often listed as USG on the lab report. It measures how strongly the kidney concentrates the urine. A healthy dog that can concentrate usually has a value above 1.030. If the value drops persistently into the range of about 1.008 to 1.012, the urine has practically the same density as blood plasma—the kidney is then no longer concentrating at all, it is just letting fluid through.

A urinalysis is therefore essential—bloodwork alone is not enough.

2.1 What else is on the lab report

If you keep your results, as recommended in Section 7, you'll find more there than creatinine and SDMA. Three values are worth a look because they often get lost in the conversation.

Urea (BUN). Like creatinine, it rises as waste clearance declines, but it is considerably less reliable: a protein-rich meal, bleeding in the gastrointestinal tract, or dehydration raise it too. An elevated urea with normal creatinine is therefore not a kidney finding, but a reason to look for something else.

Phosphate. It rises later than creatinine, but it is the value that a central part of treatment is guided by—the cycle described in Section 8. Whether it is under control has a say in how the disease progresses.

Potassium. In kidney disease, it can go off track in either direction. A value that is too low causes muscle weakness and loss of appetite; one that is too high is dangerous for the heart.

Then there are the red blood cells: because the kidney produces the hormone that drives their formation, anemia is one of the late consequences—and it explains part of the tiredness that is otherwise put down to age.

The practical value of this list is not that you interpret the results yourself. It is that you can ask the right question in the conversation: how does the phosphate look, and does something need to be done about it?

3. How to recognize it

The early signs are quiet, the late ones nonspecific.

Early:

• Increased drinking and urination, often with needing to go out at night
• Larger amounts of urine, pale and with little smell
• Slight, gradual weight loss

Later:

• Declining appetite, pickiness about food
• Vomiting, nausea, bad breath
• Lethargy, dull coat
• Pale mucous membranes due to anemia
• Ulcers in the mouth, bad breath
• High blood pressure with possible effects on the eyes

Important for putting this in context: increased thirst has many causes. The three most common in older dogs are kidney disease, diabetes, and Cushing's disease—and they can be told apart with a few tests.

👉 Telling them apart by thirst and weight: diabetes in dogs

👉 And the third possibility: Cushing's disease in dogs

4. Acute or chronic: an important difference

Not every kidney disease is chronic, and the distinction changes everything.

Acute kidney injury develops within hours to days. Causes include poisoning—grapes and raisins, antifreeze, certain human pain medications—severe circulatory collapse, leptospirosis, and urinary outflow obstruction. The dog is suddenly seriously ill, vomits, doesn't eat, and often passes noticeably little urine.

That is an emergency—and at the same time the form that, unlike the chronic one, is in principle reversible if it is treated early and intensively.

Chronic kidney disease, by contrast, develops over months to years, and the damage remains.

The two forms are not separate worlds, though. Acute kidney injury that a dog survives can destroy nephrons permanently—the dog recovers, seems healthy again, and years later a chronic disease appears whose starting point was that episode. That's why a dog that has once had acute kidney injury should continue to be checked regularly afterward, even if its values have returned completely to normal.

One special case deserves mention: in a dog whose kidneys are already chronically damaged, an additional stress—dehydration, anesthesia, a medication—can tip the situation into an acute crisis. That's why known kidney disease must always be raised before any anesthesia.

👉 Why this matters before anesthesia: anesthesia in dogs

👉 Why grapes are so dangerous: foods that are toxic to dogs

5. Which dogs are affected and where it comes from

Chronic kidney disease is primarily a disease of older dogs—its frequency rises markedly with age. But it occurs at any age, and in a young dog with abnormal kidney values, a congenital malformation or an infection ranks higher on the list.

Common pathways:

Age-related nephron loss, by far the most common situation, and usually without any single identifiable cause.

Previous acute damage—a poisoning the dog survived, a circulatory collapse, or leptospirosis can leave permanent damage that leads to chronic disease years later.

Hereditary kidney diseases, described in individual breeds, including the Cocker Spaniel, Bull Terrier, Shar-Pei, and Bernese Mountain Dog. They typically affect young dogs.

Diseases with protein loss through the kidneys, triggered, for example, by chronic infections or immune processes. In dogs from the Mediterranean region, leishmaniasis belongs on this list.

Dental and other chronic inflammation is discussed as a contributing factor—an association has been shown, but a proven cause-and-effect chain in dogs has not.

👉 Why the teeth play a role here: dental health in dogs

The most important point from this: in a young dog with abnormal kidney values, the search looks different than in an old one—there it is about a treatable cause, here mostly about managing a course.

6. How it is staged

The internationally used classification comes from the International Renal Interest Society, IRIS for short. It divides the disease into four stages—and that is more than bureaucracy, because treatment is guided by it. The current version of the staging guidelines was revised in 2026.

Staging is based on creatinine, SDMA, or preferably both, measured in a stable, adequately hydrated dog on at least two occasions, after other causes have been ruled out. A single value on a bad day does not make a stage.

Next, it is substaged in two directions:

By protein in the urine. What is measured is the urine protein-to-creatinine ratio.

By blood pressure. High blood pressure is common in kidney disease and damages the eyes, the heart, and the kidney itself.

These two additional details are not a fine point: in studies of dogs with kidney disease, both increased protein loss and elevated blood pressure were associated with a higher risk of crises and of death. Both are also treatable—unlike the nephron loss itself.

In addition, there is ultrasound and, depending on the case, further tests; in chronic disease, imaging typically shows smaller, brighter kidneys with a blurred internal structure.

6.1 What the stages mean for you

At first glance, staging looks like paperwork. For you, it is above all one thing: the answer to the question of how much time is probably left and which measures are due now.

In the early stages, the dog has no symptoms or at most increased thirst. Two things matter here: eliminating the factors that cause additional harm—dental inflammation, medications that strain the kidneys, high blood pressure—and starting phosphate control. This is precisely the phase in which the benefit of the diet is best documented, and precisely the phase in which it is most often put off, because the dog seems perfectly fine.

In the middle stages, symptoms appear and treatment becomes more extensive: nausea, blood pressure, protein loss, phosphate binders if needed. This is where it is decided how long quality of life stays high.

In the late stages, relief comes first—nausea, hydration, appetite. The question is then no longer how to slow the disease, but how to make the remaining time good.

What you should take from the staging: ask about the stage and about the two additional details on protein and blood pressure. Both are treatable, both were associated with a higher risk—and both are only found if they are measured.

7. Early detection: what you can contribute yourself

Section 2 leads to the most uncomfortable sentence of the whole topic: by the time the value is abnormal, a lot has been lost. But it also leads to something useful—there are two things that show up earlier than the blood, and both cost nothing.

7.1 Measure how much your dog drinks

Increased drinking is among the most common early signs in everyday life—not every dog shows it, but those that do usually show it first. And “he's drinking more” is worthless as information, because the impression is deceptive. A number is not.

In the morning, fill a measured amount into the bowl, measure over 24 hours how much you top up, and at the end measure what is left. Do this for three to five days and calculate the average. As a rough guide, an intake of more than about 100 milliliters per kilogram per day, measured repeatedly, counts as abnormal.

The key word is repeatedly: a hot day, salty food, or a long walk fully explain a single high value.

And even more meaningful than the cutoff is your dog's own baseline. If you know it while your dog is healthy, you'll see a change before any cutoff is reached—and with this disease, that is exactly the head start that counts.

7.2 Urine belongs in the senior checkup

This is the point where corners are most often cut in practice. The ability to concentrate urine is lost earlier than the capacity to clear waste—so bloodwork alone can be unremarkable while the urine already holds the answer.

In practical terms: at the preventive care appointment for an older dog, the question “should I bring a urine sample?” is a sensible one to ask. Collect the first morning urine at home, in a clean container with no traces of dish soap, and take it to the clinic promptly.

The value that matters here is called urine specific gravity. It is inexpensive, quick to measure, and answers a question that the blood cannot yet answer at this stage.

7.3 From what age, and how often

A preventive panel with blood and urine tests makes sense for a healthy dog from senior age onward, and earlier in breeds with a known hereditary predisposition. Your veterinary clinic sets the interval.

The real benefit lies less in any single result than in the trend. A creatinine value that has risen from 0.9 to 1.3 mg/dL over three years is information—even if both values are within the normal range. If you only measure once, you don't have that information.

That's why it pays to keep your results instead of filing them away after the appointment. A folder with the lab reports from recent years is worth more with this disease than any single test.

8. What actually works: the food

This is the best news in the article, and it is unusually well supported.

For the kidney diet, there is a randomized, double-blind, controlled trial in dogs—a rarity in veterinary medicine. Thirty-eight dogs with chronic kidney disease were fed either a standard maintenance food or a kidney diet for up to 24 months. The result: in dogs with mild and moderate disease, the kidney diet reduced uremic crises and mortality, and kidney function declined more slowly (Jacob et al. 2002).

The difference between the foods was substantial: the kidney diet contained about half the protein and roughly a quarter of the phosphate of the maintenance food.

Kidney diets are typically phosphate-restricted, adjusted in protein content while keeping protein quality high, sodium-reduced, buffered against acidosis, and enriched with omega-3 fatty acids.

According to current understanding, the single most important lever is phosphate—and it is worth understanding why.

When the kidney can no longer excrete enough phosphate, the level in the blood rises. The body responds by releasing more parathyroid hormone from the parathyroid glands, which is meant to increase phosphate excretion through the kidneys. In a damaged kidney, this works only to a limited extent, and the hormone at the same time releases calcium and phosphate from the bones—with two undesirable consequences: the bone becomes weaker, and calcium and phosphate are deposited in soft tissues and in the kidney itself. This calcification can further damage the remaining nephrons.

Phosphate control is therefore not fine-tuning, but an attempt to break a self-reinforcing cycle.

With protein, on the other hand, the stage matters, and this is where too much is often done too early. In the early stages, phosphate control comes first; a marked reduction in protein is indicated mainly when there are uremic symptoms, when a lot of protein is lost in the urine, or when the disease is advanced. The reason for the restraint: old dogs lose muscle anyway, and protein restriction that is too early and too strict accelerates exactly that—with consequences for mobility, immune status, and quality of life. That's why muscle condition should be assessed regularly in every kidney patient, not just the lab value.

Two practical points determine success.

Switching takes patience. Kidney patients are often picky, and an abrupt change frequently fails. Mix the foods over one to two weeks, warm the food, and offer several small portions.

Eating beats perfection. A dog that refuses the kidney diet and therefore eats nothing at all is worse off than one that eats something else. Weight loss and muscle wasting are a problem in their own right in kidney patients—so when in doubt, securing calorie intake comes first, and the composition is worked on afterward.

9. The other building blocks

In addition to food, further measures are added depending on the stage and findings. The IRIS treatment recommendations emphasize that all treatment of chronic kidney disease needs to be tailored to the individual patient (IRIS, 2026).

Water, always and everywhere. A dog with kidney disease can no longer concentrate its urine and therefore loses more fluid. Several bowls, always water on hand when you're out, and never restrict how much your dog drinks—not even if it means someone has to get up at night.

Phosphate binders, if diet alone does not lower phosphate enough.

Blood pressure treatment when high blood pressure has been confirmed.

Treatment of protein loss through the urine.

Anti-nausea medication and stomach protection for the corresponding symptoms—this often improves quality of life more than anything else.

Fluid therapy, in advanced stages sometimes also given under the skin at home, which many owners manage well after instruction.

And what to avoid: certain medications put additional strain on the kidneys, above all anti-inflammatory pain medications. In a dog with kidney disease, any pain treatment should be reassessed—and medications from your own medicine cabinet are particularly dangerous here.

👉 Why this can be life-threatening: never give your dog medications from your own medicine cabinet

9.1 Fluids at home—what that means

Subcutaneous fluids appear in the previous section as a keyword, and the idea scares off many owners. Because in advanced stages they make one of the biggest differences to quality of life, they deserve an explanation.

The idea behind them is simple: a dog that can no longer concentrate its urine permanently loses more fluid than it takes in by drinking. The result is gradual dehydration, which worsens nausea, appetite, and general well-being—and makes exactly the crises described in the next section more likely.

In practice, a volume of fluid is given under the skin between the shoulder blades, where it forms a reservoir and is absorbed over several hours. The dog notices less of it than most people expect—the skin there is loose and not very sensitive, and the needle is relatively thin.

What it takes is thorough instruction at the clinic and a willingness to practice. Many owners who at first thought it was out of the question do it routinely after two weeks—and spare their dog regular trips to the clinic.

Two things belong to an honest picture. Not every dog tolerates it, and not every person can bring themselves to do it; both are fine, and veterinary teams see it the same way. And it is a measure for advanced stages, not prevention—a dog in an early stage does not need it.

One note that goes with it: if your dog pants, becomes restless, or its breathing changes during the fluid administration, stop and inform the clinic. Too much fluid is a problem of its own in dogs with heart involvement.

10. When things tip over: the uremic crisis

A dog with chronic kidney disease can remain stable for years—and then deteriorate within days.

Signs of this:

• Vomiting, often repeatedly
• Complete refusal of food
• Marked lethargy, trembling
• Dehydration, bad breath, ulcers in the mouth
• Noticeably less urine than usual

This is a case for the clinic. Often an additional trigger is behind it—an infection, dehydration, a new medication—and when that is treated, the dog often recovers to its previous level.

That's why: don't wait. A crisis that is caught early often does not mean the end of the disease, but an episode within it.

11. Everyday life with a kidney patient

In a favorable case, years lie between the diagnosis and the uremic crisis. How that time goes depends to a considerable extent on things decided at home.

11.1 The struggle over eating

This is the most common burden, and it is underestimated. Kidney patients are picky because they are often nauseous—not because they are stubborn. If you keep those two apart, you handle it differently.

Nausea should be treated, not sat out. Medications against it often improve quality of life in these dogs more than any other measure—and they are the prerequisite for the diet being accepted at all. Raise appetite problems with your veterinarian instead of treating them as a side issue.

Warming helps. Food at body temperature smells more intense, and for these dogs smell matters more than taste.

Small portions, more often. A large bowl overwhelms a nauseous dog visually before it even starts.

Don't build up pressure. Coaxing, standing by, and offering food every minute can become linked with tension. Put the bowl down, leave it for ten minutes, take it away, offer it again later.

And the point that stands above everything else, already touched on in Section 8: a dog that refuses the diet and therefore eats nothing at all is worse off than one that eats something else. When in doubt, securing calorie intake comes first.

11.2 Exercise and exertion

Dogs with kidney disease should keep moving—muscle wasting is a problem in its own right for them, and exercise is one of the most important tools against it. What goes are the peaks: long walks in the heat, sustained running, exertion without access to water.

Heat is especially important. A dog that cannot concentrate its urine dehydrates faster—and dehydration is one of the most common triggers of a crisis. In summer, that means: go out earlier, keep it shorter, always bring water.

11.3 What should be discussed in advance

Three situations arise sooner or later for almost every kidney patient, and they can be clarified in advance rather than in the moment.

Anesthesia. The known kidney disease has to be raised, and before the appointment is scheduled—it changes the choice of drugs and the fluid plan.

Pain treatment. Anti-inflammatory pain medications, as commonly used for osteoarthritis, put strain on the kidneys. In a dog that has both conditions, this is a genuine trade-off—and one that is made together, not by simply leaving something out.

Care while you're away. Whoever looks after your dog needs to know: water always available, which medications when, and how to recognize a crisis.

12. What you can do at home

Measure water intake over several calm days and write it down. If it rises, that can be an early sign of deterioration—often weeks before the next bloodwork.

Weigh your dog regularly. In kidney patients, weight loss is associated with a less favorable course and is easy to overlook.

Note appetite and vomiting. Two lines a week are enough.

Make sure there is water everywhere and take it along on every walk.

Use the senior checkup. From about seven to eight years of age, bloodwork and a urinalysis belong in the annual checkup—the urine is the part that is most often left out and shows the most early on.

Ask for SDMA with the bloodwork if it isn't already included.

Report every new medication—including anything prescribed for a different problem.

👉 What else changes with age: caring for a senior dog

13. Prognosis

An honest answer is: it varies a great deal.

The deciding factors are the stage at diagnosis, the speed of progression, the extent of protein loss, and blood pressure. Dogs that are diagnosed early and managed consistently often live for years with good quality of life. Dogs that are only noticed at an advanced stage have a considerably shorter outlook.

What cannot be stated responsibly is a number for the individual dog. Reported survival times vary, even within a single stage, from a few months to several years.

More important than any prognosis, then, is the question of how the dog is doing today—and there, as a rule, a lot can be done.

13.1 What the prognosis means in practice

Survival figures are particularly hard to interpret with this disease, and it is worth knowing why.

The timing of the diagnosis shifts every statistic. A dog whose early finding shows up in a senior panel starts the count years before a dog that is only brought in with vomiting and loss of appetite—even if both have the same disease and live equally long. An earlier diagnosis lengthens the measured survival time simply because the count starts earlier—even without a single day actually being gained.

In addition: most of these dogs are old. A twelve-year-old with early chronic kidney disease, statistically, often dies of something else.

More meaningful than any general figure are therefore three individual factors: the stage at diagnosis, whether protein loss and high blood pressure are present and being treated—and how the course looks over the first months. A dog whose values remain stable for a year has a different outlook than one in whom they keep moving within three months.

For everyday life, that means: the useful question to ask your veterinarian is not “how much longer,” but “how is the course developing compared with last time.” That question has an answer.

14. Limits of the evidence

The figures for the degree of function loss at which creatinine and SDMA rise are rough guides drawn from various studies, not exact thresholds. They reliably describe the direction—that creatinine responds late and SDMA earlier—but not the exact percentage.

The feeding study cited included 38 dogs. By veterinary standards, that is a good study with a clean design; compared with human medicine, it is a small one. The effect was also shown in mild and moderate disease; for advanced stages, the data are thinner.

The IRIS staging system is a consensus instrument that is revised regularly—cutoffs have shifted over the years and will continue to do so. This article follows the version revised in 2026.

And the prognostic figures come from observational studies of selected patient groups, mostly from referral clinics. They can only be applied to the average patient in general practice to a limited extent.

On the structure of the evidence: the diet study is the most robust single finding in this article—randomized, double-blind, controlled. But it includes only 38 dogs and dates from 2002; the diet tested does not necessarily correspond to every product available today. The statements on SDMA, on the stages, and on the cutoffs, by contrast, come from guidelines and review articles—that is, from expert consensus. The orders of magnitude are well supported; individual numbers are rough guides.

👉 Family veterinarian, specialist, or referral clinic: When does my dog need to see a specialist?

15. Conclusion

Chronic kidney disease is so treacherous because the kidney conceals its own decline for a long time: by the time the creatinine value is abnormal for the first time, function loss is usually already far advanced. That is exactly what makes the urine and the earlier-responding SDMA value so valuable—and it makes the senior checkup with a urinalysis one of the most effective tools for early detection. The disease cannot be cured, but it can be influenced: the measure with the best evidence is not a pill but food. And the best early-warning value for home is the same as with the other diseases of old age—water intake, measured instead of estimated.

👉 What matters when choosing: what makes a good veterinarian

If you take away only one thing: at your older dog's preventive care appointment, have the urine tested too, and keep the results. Both cost next to nothing—and both provide exactly the information that bloodwork cannot yet provide at the stage when the course of the disease can best be influenced.

Key takeaways on kidney disease in dogs

A normal kidney value does not mean the kidney is healthy. Creatinine only becomes abnormal once function is clearly reduced—the rough figure usually given is about three quarters, and the rise is not linear. Until then, the remaining nephrons compensate.

Lost nephrons are not replaced to any meaningful extent. That's why the chronic form is not curable—but its course can be influenced considerably.

Creatinine depends on muscle mass. An old, thin dog can have a value that looks normal even though the kidney is working poorly. SDMA does not have this dependence and rises earlier.

The urine is often faster than the blood. The ability to concentrate is lost earlier than the capacity to clear waste—so bloodwork alone is not enough.

The measure with the best evidence is food. In a randomized, double-blind study of 38 dogs, a kidney diet reduced uremic crises and mortality over up to 24 months (Jacob et al., 2002)—a rarity in veterinary medicine.

According to current understanding, the most important lever within it is phosphate, not protein. Controlling it is meant to break a self-reinforcing cycle of parathyroid hormone, bone loss, and calcification of the remaining nephrons.

With protein, too much is often done too early. Restriction that is too strict accelerates the muscle loss that is already under way in old dogs—so muscle condition should be assessed too, not just the lab value.

Eating beats perfection. A dog that refuses the diet and eats nothing at all is worse off than one that eats something else.

A crisis is often an episode, not an end point. Often an additional trigger is behind it—if it is treated, the dog often recovers to its previous level. So: don't wait.

References

• Jacob, F., Polzin, D. J., Osborne, C. A., Allen, T. A., Kirk, C. A., Neaton, J. D., Lekcharoensuk, C. & Swanson, L. L. (2002): Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs. Journal of the American Veterinary Medical Association 220(8): 1163–1170. https://doi.org/10.2460/javma.2002.220.1163 (double-blind, randomized controlled trial in 38 dogs over up to 24 months; kidney diet compared with maintenance food, with a favorable effect on uremic crises and mortality in mild and moderate disease and slower loss of function; kidney diet with about half the protein and roughly a quarter of the phosphate content)
• Jacob, F., Polzin, D. J., Osborne, C. A., Neaton, J. D., Lekcharoensuk, C., Allen, T. A., Kirk, C. A. & Swanson, L. L. (2003): Association between initial systolic blood pressure and risk of developing a uremic crisis or of dying in dogs with chronic renal failure. Journal of the American Veterinary Medical Association 222(3): 322–329. https://doi.org/10.2460/javma.2003.222.322
• Jacob, F., Polzin, D. J., Osborne, C. A., Neaton, J. D., Lekcharoensuk, C., Allen, T. A., Kirk, C. A. & Swanson, L. L. (2005): Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure. Journal of the American Veterinary Medical Association 226(3): 393–400. https://doi.org/10.2460/javma.2005.226.393
• International Renal Interest Society (IRIS) (2026): IRIS Staging of Chronic Kidney Disease (modified 2026). https://www.iris-kidney.com/iris-guidelines-1 (staging after a diagnosis of chronic kidney disease, based on fasting blood creatinine, SDMA, or preferably both, assessed on at least two occasions in a hydrated, stable patient; substaging by urine protein-to-creatinine ratio and systolic blood pressure)
• International Renal Interest Society (IRIS) (2026): IRIS Treatment Recommendations for CKD in Dogs. https://www.iris-kidney.com/s/IRIS-DOG-Treatment_Recommendations_may-2026.pdf (overview page: https://www.iris-kidney.com/iris-guidelines-1) (cited here for the principle that all treatment of chronic kidney disease needs to be tailored to the individual patient)
• Treatment Guidelines for Chronic Kidney Disease in Dogs and Cats. Today's Veterinary Practice. https://todaysveterinarypractice.com/urology-renal-medicine/treatment-chronic-kidney-disease-dogs-cats/ (creatinine as a comparatively insensitive marker; always interpret in light of muscle mass, urine concentration, and clinical findings; SDMA as a complement for earlier detection)

Frequently asked questions about kidney disease in dogs

The questions asked most often in the exam room