IRIS staging can assist with development of empirical recommendations regarding appropriate, logical treatment for each CKD stage (see Resources). Predictions based on clinical experience might be made about the likely response to treatment.
Management strategies may include:
- Discontinuing all potentially nephrotoxic drugs, if possible
- Identifying and treating any pre- or postrenal abnormalities
- Ruling out any treatable conditions (eg, pyelonephritis, renal urolithiasis)
- Correcting dehydration
- Reducing proteinuria (eg, low-protein diet, ACE inhibitors, angiotensin-receptor blockers)
- Addressing systemic hypertension (eg, calcium channel blockers, ACE inhibitors)
- Reducing dietary intake and GI absorption of phosphate
- Correcting metabolic acidosis (usually only encountered in advanced Stage 3 and Stage 4)
- Treating anemia (usually only encountered in advanced Stage 3 and Stage 4)
Reduced phosphate intake4 and reduction of proteinuria5-9 are the most important treatment strategies for reducing CKD progression. Patients in Stage 1 represent the best opportunity for intervention with these strategies to prevent or ameliorate CKD’s rate of progression.5-10 Correction of systemic hypertension, if present, is also important.11-14
Dogs and cats in Stages 1 through 3 often respond to appropriate management with improved longevity and slowing of progression,15 whereas those in Stage 4 tend to be fragile and much more prone to repeated episodes of uremic crises that require IV fluid support and renal replacement therapy (ie, dialysis) for restabilization.