About IRIS
The IRIS Board made three significant changes to CKD Guidelines during 2014 and 2015. A summary of these new recommendations is presented here. The full version of 2015 Guidelines will be uploaded during our website relaunch by the end of 2015.
Substaging by Arterial Blood Pressure
We recommend replacement of the existing abbreviations for blood pressure substages (AP0-AP1) with descriptive terms as follows:
| Systolic blood pressure (mm Hg) | Diastolic blood pressure (mm Hg) | Risk of future target organ damage | BP substage | |
|---|---|---|---|---|
| Original | New | |||
| <150 | <95 | Minimal | AP0 | Normotension |
| 150 - 159 | 95 - 99 | Mild | AP1 | Borderline hypertension |
| 160 - 179 | 100 - 119 | Moderate | AP2 | Hypertension |
| >180 | >120 | Severe | AP3 | Severe hypertension |
Treatment of Proteinuria
We recommend that IRIS CKD Stage 1 patients with persistent proteinuria (UPC ≥ 0.5 for dogs or 0.4 for cats) are not only monitored and thoroughly investigated but also receive standard treatment for proteinuria as currently recommended for IRIS CKD Stages 2 to 4. This parallels the IRIS consensus statement on standard treatment for glomerulonephritis (J Vet Intern Med 2013;27:S27–S43).
Interpreting Blood Concentrations of Symmetric Dimethylarginine (SDMA) in CKD
SDMA concentrations in blood (plasma or serum) may be a more sensitive biomarker of renal function than blood creatinine concentrations. A persistent increase in SDMA above 14 µg/dl suggests reduced renal function and may be a reason to consider a dog or cat with creatinine values <1.4 or <1.6 mg/dl, respectively, as IRIS CKD Stage 1.
In IRIS CKD Stage 2 patients with low body condition scores, SDMA ≥25 µg/dl may indicate the degree of renal dysfunction has been underestimated. Consider treatment recommendations listed under IRIS CKD Stage 3 for this patient.
In IRIS CKD Stage 3 patients with low body condition scores, SDMA ≥45 µg/dl may indicate the degree of renal dysfunction has been underestimated. Consider treatment recommendations listed under IRIS CKD Stage 4 for this patient.
These comments are preliminary and based on early data from the use of SDMA in veterinary patients. We expect them to be updated as the veterinary profession gains further experience using SDMA alongside creatinine, the long-established marker in diagnosis and monitoring of canine and feline CKD.
IRIS Newsletter 2014-2015
IRIS annual Board Meeting 2014
The IRIS Board's annual meeting for 2014 was held on September 1 and 2 in Mainz, Germany just before the 24th ECVIM Congress.
In attendance were Claudio Brovida, Scott Brown, Larry Cowgill, Astrid van Dongen, Jonathan Elliott, Pepa Fernandez del Palacio, Reidun Heiene, Alexander Huettig, David Polzin, Xavi Roura, Toshifumi Watanabe and David Watson. Apologies were recorded from Greg Grauer, Herve Lefevre and Jean-Louis Pouchelon.
Also present were Nicky Archer Thompson (representing Novartis Animal Health and introducing Elanco Animal Health) and Susanne Pauwels and Ilona Vermeeren (organisational and secretarial support from Pauwels Congress Organisers).
Attendees at the 2014 IRIS Board meeting in Mainz; from right to left: Xavi Roura, Toshifumi Watanabe, Reidun Heiene, Alexander Huettig, Larry Cowgill, David Watson, Claudio Brovida, Pepa Fernandez del Palacio, David Polzin, Scott Brown, Astrid van Dongen, Jonathan Elliott and Nichola Archer Thompson.
At the meeting the Board discussed progress since the previous meeting in Seattle, reviewed IRIS's current published guidelines and considered future actions.
Update of IRIS CKD Guidelines
Apart from minor textual revisions, the IRIS Board voted to replace the existing abbreviations for blood pressure substages (AP0-AP3) with descriptive terms as follows:
| Systolic blood pressure (mm Hg) | Diastolic blood pressure (mm Hg) | Risk of future target organ damage | BP substage | |
|---|---|---|---|---|
| Original | New | |||
| <150 | <95 | Minimal | AP0 | Normotensive |
| 150 - 159 | 95 - 99 | Mild | AP1 | Borderline hypertensive |
| 160 - 179 | 100 - 119 | Moderate | AP2 | Hypertensive |
| ≥180 | ≥120 | Severe | AP3 | Severely hypertensive |
Note: systolic blood pressures are used for IRIS CKD substaging (the diastolic values here are only informative)
These changes will be incorporated into the IRIS CKD Guidelines when they are next revised.
Interim IRIS Board Meeting on line, 2015
On February 12th 2015 an additional Board meeting was organised on line. Despite time zone difficulties, there was a quorum (Brovida, Brown, Cowgill, Heiene, van Dongen, Elliott, Polzin) and Nichola Archer represented Novartis Animal Health and Elanco Animal Health.
This provided information on the acquisition of Novartis Animal Health by Eli Lilly and Company through its Elanco Animal Health division, introduced by Paul Ghyoot as its new Category Director for Cardiology and Nephrology in Global Marketing, and affirmed Elanco’s continued financial support of IRIS, including for the scheduled 2015 Board meeting in Indianapolis.
Progress on execution of items on the action list was reviewed and rescheduled, clarifying agenda items for 2015 meeting. Delays in updating the website following the acquisition of Novartis Animal Health by Eli Lilly and Company through its Elanco Animal Health division, were recognized and discussed; these were thought likely to be overcome during the course of 2015.
IRIS Website
Several Educational Topics are being revised for the website and a new article on assessment of GFR in practice is being prepared. A new section, Emerging Themes, is planned, which will feature occasional articles on subjects currently being discussed in veterinary medicine but for which the future significance is still under investigation. The first two articles to be included will deal with Fibroblast Growth Factor 23 (FGF-23) and with Symmetric Dimethylarginine (SDMA).
The IRIS Award
The IRIS awardee for 2013, Nathalie Finch, presented her work at the 2014 ACVIM Forum. The next IRIS Award will be announced after the meeting in June 2015, the aim being to recruit candidates and select a winner to be presented during the ECVIM of 2016.
Projects
The outcome of the canine glomerular disease consensus, published as a supplement to the Journal of Veterinary Internal Medicine in November 2013, can now be freely accessed through the IRIS website.
The IRIS Board intends to seek further international collaborations and partnerships to stimulate advancement of knowledge of canine and feline kidney disease. Currently, the Board is seeking input on and endorsement of the Acute Kidney Injury guidelines from the American and European societies of Veterinary Nephrology and Urology. Other opportunities on the horizon are to analyse renal data on feline cardiac patients. Negotiations are also ongoing on development of a central database for continuous collection of clinical and histological data from renal patients at various centres.
IRIS Board Elections
Astrid van Dongen has assumed the role of IRIS President for the next two years (see below), Scott Brown, the immediate past President assumes the role of IRIS Treasurer in the financial advisory committee together with its chair Claudio Brovida, the newly-elected Vice-President. The membership of the various IRIS Committees was also revised as follows:
New IRIS Committees
| Executive | Finance (Financial advisory Committee) | Website | Awards | Projects |
|---|---|---|---|---|
| Astrid van Dongen | Claudio Brovida (chair) | David Watson (chair) | Reidun Heiene (chair) | Larry Cowgill (chair) |
| Claudio Brovida | Scott Brown | Jean-Louis Pouchelon | Toshifume Watanabe | Xavier Roura |
| Scott Brown | Larry Cowgill | Alexander Hüttig | Greg Grauer | Jonathan Elliott |
| David Watson | Astrid van Dongen | Scott Brown | Herve Lefebvre | Claudio Brovida |
| Larry Cowgill | Pepa Fernadez del Palacio | Astrid van Dongen | ||
| Reidun Heiene | David Polzin |
Introducing the IRIS Board President for 2015-2016
'The IRIS leadership may change but the goals remain the same with outcomes to be obtained through team effort.'
Astrid M. van Dongen received her veterinary degree from Utrecht University in the Netherlands some time ago, and remains affiliated with the Department of Clinical Sciences of Companion Animals there.
After working in private practice for several years, she completed an Internship and then a Residency in Internal Medicine of Companion animals to become an RNVA-registered specialist.
Working abroad did have its appeal and sparked an interest for international collaborations in and around the field of veterinary science. So, in her role as assistant professor in internal medicine, Astrid nowadays combines patient care, research and education with involvement in boards of international partnerships such as the European Society of Veterinary Nephrology and Urology, the WSAVA Renal Standardizations Group and IRIS with its growing group of supporting members and associate participants.
With a legacy of years of development by competent predecessors, the challenge now is to continue improving IRIS's established diagnostic and treatment guidelines while simultaneously keeping track of emerging themes and working to improve outcomes via consensus statements and cooperative studies to gather further evidence.
Acknowledgement of Support from Novartis
The IRIS Board wishes to thank Novartis Animal Health and its representatives for continuing to support IRIS since its inception, and looks forward to working with Elanco Animal Health to further the educational and scientific goals of IRIS.