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 |
|Diastolic blood pressure |
|Risk of future target organ |
|150 - 159||95 - 99||Mild||AP1||Borderline hypertension|
|160 - 179||100 - 119||Moderate||AP2||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 2021
The IRIS 2019 meeting was held in Phoenix to coincide with ACVIM conference. Discussions focused on introducing SDMA to the IRIS guidelines for the diagnosis and staging of CKD. Updated diagnostic and staging guidelines were created and added to the website, along with continuing education articles providing an overview of the staging system, a discussion on risk factors for CKD and an update on the early diagnosis of CKD.
IRIS board meetings were held online through 2020-2021 necessitating a careful co-ordination of multiple international time zones.
IRIS Osborne Award
The 2019 IRIS Osborne award was awarded to Dr Stephen P. DiBartola in recognition of his substantial contribution to veterinary nephrology. Previous recipients of the IRIS award include Carl Osborne (1999), Delmar Finco (2000), Kenneth Bovee (2002), Donald Low (2004) and George Lees (2011).
Dr DiBartola's contributions to veterinary medicine and nephrology are extensive and include editorship of the Journal of Veterinary Internal Medicine and for the reference textbook "Fluid, Electrolyte, and Acid Base Disorders in Small Animal Practice" and over 105 peer reviewed publications. His outstanding contributions to veterinary nephrology have increased our understanding of polycystic kidney disease in Persian cats, muscle potassium content in cats with CKD, renal amyloidosis in Chinese Shar-pei dogs and Abyssinian cats, dietary-induced CKD in dogs and cats, juvenile renal disease in standard Poodles and Doberman pinscher dogs, as well as renal tubular acidosis.
Dr DiBartola contributed an important continuing education article to the IRIS website titled "What pet owners should know about kidney function and the diagnosis and management of chronic kidney disease in dogs and cats"
IRIS Renal week
Unfortunately, IRIS week 2020 was cancelled with short notice due to the international Covid-19 coronavirus pandemic and the idea of keeping the same program but holding the meeting 12 months later has not proved possible. Plans are underway for a future IRIS renal week conference, most likely in 2023. Some of the many benefits of the IRIS week program include the opportunity for informal collaboration and the advanced laboratory sessions both of which require in person attendance. However, to plan a safe, large international conference is challenging in the current circumstances and the IRIS week organising committee is currently assessing the best options for future conferences.
In 2020, IRIS the 3-year sponsorship agreement with Elanco Animal Health Ltd. finished. The IRIS Board thanks Elanco Animal Health and specifically Ms Stephanie Kirsch and Nichola Archer for their help over recent years in co-ordinating and facilitating IRIS board meetings and updates to the IRIS website. The financial support of first Novartis Animal Health and latterly Elanco Animal Health Ltd. have been critical to the success of IRIS enabling it to develop and disseminate it staging and grading system and treatment guidelines and plan a high-quality biennial conference and training event. All activities that fulfil IRIS's objectives as an educational charity. Future sponsorship of IRIS renal week will be sought to ensure costs for attendees are as low as possible.
IRIS Board members
Professor Scott Brown retired from the IRIS board in 2020. Professor Brown's contribution to veterinary nephrology is difficult to overstate. The original research he undertook on the dog and cat was fundamental in determining the importance of protein and phosphorous restriction, the role of omega 3:6 fatty acids, the relevance of glomerular and systemic hypertension and more recently, the likely role of hypoxia in causing tubule-interstitial pathology. His findings provide the underpinning evidence for many of the treatments we recommend for use today. Specifically, Professor Brown made a huge contribution to the IRIS Board, leading the development of the IRIS CKD Staging system and communicating many of the concepts in a very accessible way by authoring IRIS education articles on himself and providing valuable feedback to improve those written by others. His knowledge and experience will be greatly missed by the IRIS Board.
Drs Watanabe, Lefebvre and Hüttig also retired from the board throughout 2019-2020. Dr Lefebvre, a past president of IRIS, contributed continuing education articles educating practitioners about the interpretation and limitations of creatinine as well as the measurement of glomerular filtration rate in general practice. The different perspectives and experiences of Drs Watanabe and Hüttig enriched the discussion at the IRIS Board which encapsulates the ethos of IRIS – we learn a tremendous amount through listening to the different approaches developed and adopted throughout the world. The IRIS board appreciates their contributions to veterinary nephrology in general and the IRIS board specifically the awards, website, and projects committees respectively, during their membership.
Dr Joanna White joined the IRIS Board in 2019, replacing Dr David Watson who retired in 2018. Joanna is currently employed at Small Animal Specialist Hospital, Sydney, Australia where her responsibilities include clinical work, resident training, and clinical research. Joanna completed her Bachelor of Veterinary Science at Sydney University, Australia. After working in general practice, she completed a PhD evaluating the contribution of bacterial infection, FIV infection and familial disease to the development of chronic kidney disease in cats. Joanna subsequently completed a residency in small animal veterinary medicine and a Master of Veterinary Science in Epidemiology (investigating subclinical bacteriuria in cats). Joanna's current research focuses on kidney disease in cats, specifically the relative contribution of infection and hydration. Joanna is a registered specialist in small animal medicine, a member of the Australian and New Zealand College of Veterinary Science (feline chapter) and a Diplomate of the American College of Veterinary Internal Medicine. She is also an examiner for the Australian and New Zealand College of Veterinary Scientists in both internal medicine and feline medicine. A substantial amount of Joanna's clinical work involves the diagnosis and treatment of kidney diseases in cats and dogs and regular, direct contact with clients and veterinarians advising on the management of patients with kidney disease.
In 2014, Drs Larry Cowgill (IRIS), Cathy Langston, Carrie Palm, Sheri Ross, Mary Labato, Gilad Segev (IRIS), Thierry Francey, and JD Foster established the Hemodialysis Academy (HA) to provide formal instruction in the foundation of extracorporeal therapies to veterinarians worldwide. In 2020-2021, HA was formerly incorporated an important part of IRIS. The Hemodialysis Academy extends the international, educational mission of IRIS and members of the HA will contribute to development of the IRIS Extracorporeal Best Practices Guidelines Initiative.