What dietary changes should be considered (and when) for a patient diagnosed with chronic kidney disease (CKD) based on blood, urine, and symmetric dimethylarginine (SDMA) results?  


The advent of the SDMA biomarker ( has enabled earlier diagnosis of CKD in cats and dogs when performed with serum creatinine, blood urea nitrogen, and urinalysis.1,2 The International Renal Interest Society (IRIS) offers peer-reviewed resources that allow for specific and practical classification of a patient’s CKD stage.3 These guidelines use serum creatinine values and recently updated modifications if SDMA values are known for early CKD stages. Based on IRIS staging of CKD, recommendations for additional diagnostics, therapy (nutrition and drug), and prognosis are provided for each stage. Although it is unclear which therapeutic interventions are most impactful in the early IRIS stages of CKD, there is sufficient evidence that appropriate changes to a patient’s diet can reduce morbidity and may increase longevity.4-6 

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