Enfermedad renal crónica (ERC) en perros

Qué podría notar

• Toma mucha más agua y pide salir a orinar con más frecuencia, incluso de noche: esto suele ser lo primero que nota la familia, y es motivo para darle MÁS agua, nunca menos
• La orina se ve casi transparente o casi no huele, o un perro que antes era limpio empieza a tener accidentes en la casa
• Baja de peso despacio aunque siga comiendo, o se vuelve cada vez más selectivo con la comida
• Mal aliento con un olor raro o químico, distinto al aliento normal de un perro
• Vómito, náuseas (se lame los labios, babea, se aparta del plato) o heces blandas que van y vienen
• Poca energía: duerme más, muestra menos interés en el paseo o en jugar, con un cansancio que no es solo la edad
• Encías pálidas y se cansa rápido, porque la enfermedad renal puede causar anemia (pocos glóbulos rojos)
• Pérdida de músculo que puedes sentir con la mano sobre la columna y las patas traseras, así que lo sientes más huesudo aunque la barriga se vea igual
• Debilidad, que se tambalee o que el cuello se le vea caído puede significar que el potasio bajó demasiado, algo que ocurre en algunos perros con enfermedad renal: cuéntalo en la consulta en vez de atribuirlo a la edad

Estándar de atención

1. Stage and substage with IRIS before you treat anything - the treatment plan is a function of the stage

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   Stage 1-4 on fasting blood creatinine assessed on at least two occasions in a stable patient, using SDMA alongside creatinine in dogs, then substage on proteinuria (UPC) and on systemic arterial blood pressure. Every subsequent decision - diet, phosphate control, antiproteinuric therapy, antihypertensive therapy, anaemia management - is keyed to that stage and substage, and re-staging is how you tell progression from a bad day. IRIS publishes a separate Treatment Recommendations document specifically for dogs, and a separate canine proteinuric-kidney-disease consensus.

   Productos nombrados: None - this step is diagnostic and organisational.

   IRIS (International Renal Interest Society) staging system and IRIS Treatment Recommendations for Dogs (2026 revisions), the internationally used framework for canine and feline CKD, alongside the IRIS Consensus Recommendations for Treatment of Canine Proteinuric Kidney Disease published as a J Vet Intern Med supplement. Guidance is consensus-based, not trial-derived: treat it as the accepted organising framework rather than as high-level efficacy evidence.

   International Renal Interest Society. IRIS Staging of CKD (2026); IRIS Treatment Recommendations for Dogs (modified 2026); IRIS CKD Pocket Guide (June 2026). | IRIS Canine GN Study Group Standard Therapy Subgroup: Brown S, Elliott J, Francey T, Polzin D, Vaden S. Consensus recommendations for standard therapy of glomerular disease in dogs. J Vet Intern Med. 2013;27 Suppl 1:S27-43. PMID 24635378. DOI 10.1111/jvim.12230

2. Put the dog on a renal therapeutic diet - the intervention with randomised canine evidence of fewer uraemic crises and lower mortality in mild-to-moderate disease

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   A commercially formulated renal diet (reduced and high-quality protein, restricted phosphorus, added omega-3, alkalinising, potassium-replete) is first-line for dogs with AZOTEMIC CKD. Scope matters in two directions. First, the trial evidence is for mild and moderate renal failure - it does not license the same claim in IRIS stage 4, where the diet is still used but for symptom and phosphate control rather than on this trial's endpoints. Second, protein restriction is NOT indicated in IRIS stage 1, and the non-azotemic proteinuric dog is a different management problem (localise and quantify the protein, consider biopsy) rather than an early candidate for a low-protein food. It is a prescription intervention, not a lifestyle tweak: transition slowly over one to three weeks alongside the food the dog already accepts, because a renal diet the dog refuses is worse than no renal diet at all. Palatability and intake are part of the prescription - weigh the dog and track intake. Two adherence failures undo the whole intervention and must be raised at the visit where the diet is prescribed, not later: (1) treats, dental chews, bones, jerky, cheese, deli meat and table food are usually phosphorus-dense and will defeat a restricted-phosphorus diet even when the bowl is compliant - move the dog's treat allowance to the same therapeutic line or to veterinarian-approved low-phosphorus options; (2) unformulated home-cooked and raw 'kidney' recipes are not equivalent to a formulated renal food and are a common route to both nutrient deficiency and unintended phosphorus loading - refer to a board-certified veterinary nutritionist if a home-prepared diet is genuinely necessary. Water is never restricted to manage the polyuria the diet does not fix.

   Productos nombrados: Veterinary therapeutic renal diets (dry and wet). No specific commercial brand is endorsed here; product choice should follow the dog's intake and the clinic's nutritional assessment.

   Double-masked, randomised, controlled clinical trial in 38 dogs with spontaneous chronic renal failure followed up to 24 months. Compared with adult maintenance food, the renal food had a beneficial effect on uraemic crises AND mortality rate in dogs with MILD AND MODERATE renal failure, and dogs fed the renal food had a slower decline in renal function. This is the strongest single piece of causal evidence in canine CKD management, and it is dietary. State the comparator honestly: the renal food was tested against one adult maintenance food, NOT against benazepril, telmisartan, amlodipine, phosphate binders, capromorelin or any injectable product. No head-to-head trial of a renal diet against any injectable agent exists in dogs, so no superiority claim over any other therapeutic class can be made from this trial.

   Jacob F, Polzin DJ, Osborne CA, Allen TA, Kirk CA, Neaton JD, Lekcharoensuk C, Swanson LL. Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs. J Am Vet Med Assoc. 2002;220(8):1163-70. PMID 11990962. DOI 10.2460/javma.2002.220.1163

3. Control serum phosphorus to the stage-appropriate target

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   Dietary phosphate restriction first (which the renal diet delivers), then an intestinal phosphate binder given WITH food if phosphorus stays above the stage target after four to six weeks on diet alone. Recheck phosphorus after every change. Hyperphosphataemia is not a number to note and move past - it is one of the strongest measured survival signals in canine CKD and it drives renal secondary hyperparathyroidism and FGF-23 elevation. Two binder-specific hazards must be on the record before the first prescription. ALUMINIUM HYDROXIDE: aluminium is cleared renally, so it accumulates in exactly this population, and chronic aluminium toxicity is why aluminium hydroxide was abandoned as a phosphate binder in human dialysis medicine (Bichu 2019, PMID 31309799, states the discontinuation explicitly). A canine or feline incidence study was NOT located in this research pass, so the honest position is that the hazard is extrapolated rather than quantified in dogs - which argues for a defined review date rather than open-ended dosing, and for stopping and reassessing if weakness, ataxia or an unexplained microcytosis appears. CALCIUM CARBONATE AND OTHER CALCIUM-BASED BINDERS: these add a calcium load, and the very variable this step is built on - calcium-phosphorus product - carried the highest hazard ratio for death in Rudinsky 2018 (HR 4.092). Do not start a calcium-based binder in a hypercalcaemic dog, do not combine one with calcitriol without monitoring, and monitor ionised calcium and the calcium-phosphorus product, not phosphorus alone, once one is running.

   Productos nombrados: Phosphate binders used in dogs include aluminium hydroxide, calcium carbonate, lanthanum carbonate and sevelamer, each with the per-agent cautions in the detail field. NO FDA-approved veterinary phosphate binder for dogs was located in this research pass - these are marketed as supplements or used extralabel, so dosing, quality and the monitoring plan are the prescriber's responsibility.

   Prospective cohort of 27 azotemic CKD dogs (IRIS stage 2 n=9, stage 3 n=12, stage 4 n=6) followed until death or study end. Hyperphosphataemia carried a hazard ratio of 3.20 (95% CI 1.357-7.548, P=.005) and increased calcium-phosphorus product 4.092 (1.771-9.454, P=.003) for death; survival differed significantly across IRIS stages (P=.01). Honest caveat: n=27, univariable Cox regression, single centre - this establishes phosphorus as a strong prognostic association, NOT as proof that lowering it extends canine survival. Phosphate targets themselves come from IRIS consensus.

   Rudinsky AJ, Harjes LM, Byron J, Chew DJ, Toribio RE, Langston C, Parker VJ. Factors associated with survival in dogs with chronic kidney disease. J Vet Intern Med. 2018;32(6):1977-1982. PMID 30325060. DOI 10.1111/jvim.15322 | Bichu S, Tilve P, Kakde P, et al. Relationship between the use of aluminium utensils for cooking meals and chronic aluminum toxicity in patients on maintenance hemodialysis. J Assoc Physicians India. 2019;67(4):52-56. PMID 31309799 (human nephrology, cited only for the aluminium-binder discontinuation)

4. Measure, then reduce, persistent renal proteinuria - and in dogs the head-to-head trial favours telmisartan

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   Confirm persistence and renal origin, then start RAAS blockade, working from the canine-specific consensus (IRIS Canine GN Study Group standard-therapy recommendations, Brown 2013) with the ACVIM proteinuria and hypertension statements alongside it. In the only head-to-head randomised canine trial, telmisartan 1.0 mg/kg PO q24h reduced UPC more than enalapril 0.5 mg/kg PO q12h at day 30 (median -65% vs -35%, P=.002) and remained superior at days 60 and 90 among dogs still proteinuric at earlier visits. Recheck creatinine, potassium and UPC 7-14 days after starting or up-titrating. The therapeutic target in the ACVIM hypertension consensus is a UPC reduction of at least 50%, ideally to below 0.5. Three safety rules travel with this step and must be written on the owner's discharge sheet, not just in the record. (1) SICK-DAY RULE: the drug is withheld and the clinic called during vomiting, diarrhoea, anorexia, any dehydrating episode and before general anaesthesia. RAAS blockade removes the angiotensin-II-dependent efferent arteriolar tone that maintains filtration when perfusion falls, so continuing it through a hypovolaemic event is a recognised route into acute-on-chronic kidney injury - and this page's own red flags describe that loop. Nothing is restarted without a call. (2) REPRODUCTIVE CONTRAINDICATION: this whole class is fetotoxic. The FDA-approved veterinary telmisartan label states that pregnant women should avoid contact with the product 'because substances that act on the renin-angiotensin-aldosterone system (RAAS) such as angiotensin receptor blockers (ARBs) can cause fetal and neonatal morbidity and death during pregnancy in humans.' Do not use an ACE inhibitor or an ARB in a pregnant, lactating or breeding bitch, and counsel pregnant members of the household not to handle the medication. (3) HYPOTENSION: these agents lower blood pressure as well as proteinuria - avoid or reduce in a hypotensive, hypovolaemic or septic patient, and recheck pressure, not just creatinine, after every change.

   Productos nombrados: Telmisartan (angiotensin II receptor blocker) 1.0 mg/kg PO q24h and enalapril 0.5 mg/kg PO q12h as studied in Lourenco 2020; benazepril 0.25 to <0.5 mg/kg PO q24h as studied in King 2017. REGULATORY STATUS, STATED BY REGULATOR: no FDA-approved telmisartan, enalapril or benazepril product carrying a CANINE chronic kidney disease indication was located in this research pass. The FDA-approved telmisartan product located is Semintra (telmisartan oral solution, NADA 141-501), and its label reads 'SEMINTRA is indicated for the control of systemic hypertension in cats' - cats, not dogs, and hypertension, not CKD. Benazepril holds veterinary authorisations in some European jurisdictions, but the authorising regulator, species and indication were NOT verified in this research pass and must not be described as an approval for canine CKD. So: use in dogs with CKD rests on these published canine trials and on IRIS and ACVIM consensus, not on a canine CKD label in any jurisdiction we verified - and that should be said to the client. Label cautions that do transfer as class information: the Semintra label contraindicates use with telmisartan hypersensitivity, states that safe use was not evaluated in cats under 9 months of age, in pregnant, lactating or breeding cats, or in cats with hepatic disease, and warns that the drug can cause mild or non-regenerative anaemia.

   Prospective, randomised, double-masked clinical trial, 39 client-owned dogs with CKD and persistent renal proteinuria (UPC >0.5 if azotemic, 1.0 or greater if non-azotemic), block-randomised on azotaemia and hypertension status, followed 120 days. Telmisartan superior to enalapril at day 30, 60 and 90. Critical safety finding from the same trial: when combination therapy was permitted at day 90, clinically relevant azotaemia developed in 4 of 13 dogs (31%). Supporting canine evidence: benazepril significantly reduced UPC versus placebo (P=.0032) in a 49-dog multicentre blinded placebo-controlled trial, but that trial recruited too few dogs to conclude anything about survival (median renal survival 305 vs 287 days, P=.53).

   Lourenco BN, Coleman AE, Brown SA, Schmiedt CW, Parkanzky MC, Creevy KE. Efficacy of telmisartan for the treatment of persistent renal proteinuria in dogs: A double-masked, randomized clinical trial. J Vet Intern Med. 2020;34(6):2478-2496. PMID 33165969. DOI 10.1111/jvim.15958 | King JN, Font A, Rousselot JF, Ash RA, Bonfanti U, Brovida C, Crowe ID, Lanore D, Pechereau D, Seewald W, Strehlau G. Effects of Benazepril on Survival of Dogs with Chronic Kidney Disease: A Multicenter, Randomized, Blinded, Placebo-Controlled Clinical Trial. J Vet Intern Med. 2017;31(4):1113-1122. PMID 28669137. DOI 10.1111/jvim.14726 | IRIS Canine GN Study Group Standard Therapy Subgroup: Brown S, Elliott J, Francey T, Polzin D, Vaden S. Consensus recommendations for standard therapy of glomerular disease in dogs. J Vet Intern Med. 2013;27 Suppl 1:S27-43. PMID 24635378. DOI 10.1111/jvim.12230 | Semintra (telmisartan oral solution) label, NADA 141-501, DailyMed

5. Identify and treat systemic hypertension using the ACVIM categories

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   Measure systolic blood pressure at every CKD visit under standardised conditions, and examine the eyes including the fundus at the same visit. Treat any patient with blood pressure persistently in the hypertensive (160-179 mmHg) or severely hypertensive (180 mmHg or above) category. In dogs, a RAAS inhibitor is generally preferred as initial therapy because of its antiproteinuric effect; amlodipine is the calcium channel blocker option. The consensus states the exception verbatim: 'The exception to the use of a RAAS inhibitor as initial, sole agent, treatment is severely hypertensive dogs (SBP > 200 mm Hg) for which the initial coadministration of a RAAS inhibitor and a CCB... is appropriate.' The secondary goal in a CKD dog is the proteinuria target above. Ocular target-organ damage is the reason this is urgent rather than routine: the consensus records retinal haemorrhage, multifocal retinal oedema, hyphema, secondary glaucoma and retinal degeneration in hypertensive patients, and that 'acute onset of blindness from complete bilateral exudative retinal detachment may be a presenting complaint' - while also stating that effective treatment can reattach the retina but 'restoration of vision generally occurs in only a minority of patients.' Say both halves to owners.

   Productos nombrados: Amlodipine, quoted from the consensus statement as 0.1-0.25 mg/kg q24h in dogs (up to 0.5 mg/kg in cats and dogs); enalapril or benazepril as the RAAS inhibitor, with the sick-day, reproductive and hypotension rules in the proteinuria step applying in full. No product approved by FDA specifically for canine CKD-associated hypertension was located in this research pass.

   ACVIM consensus statement, indexed in PubMed as a Practice Guideline - an update to the 2007 statement presented at the 2017 ACVIM Forum. Provides the four SBP risk-of-target-organ-damage categories verbatim (normotensive, minimal TOD risk, SBP <140 mm Hg; prehypertensive, low TOD risk, 140-159; hypertensive, moderate TOD risk, 160-179; severely hypertensive, high TOD risk, 180 or above) and the treatment-initiation threshold. Consensus guidance, not an RCT. Supporting canine observational evidence for the ocular emphasis: in 65 dogs with concurrent blood-pressure measurement and complete ophthalmic examination, 62% of the 42 hypertensive dogs had at least one hypertension-associated ocular lesion, retinal haemorrhage was commonest (40%), and 60% of dogs referred for blood-pressure measurement after an ophthalmic examination proved hypertensive (LeBlanc 2011).

   Acierno MJ, Brown S, Coleman AE, Jepson RE, Papich M, Stepien RL, Syme HM. ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med. 2018;32(6):1803-1822. PMID 30353952. DOI 10.1111/jvim.15331 | LeBlanc NL, Stepien RL, Bentley E. Ocular lesions associated with systemic hypertension in dogs: 65 cases (2005-2007). J Am Vet Med Assoc. 2011;238(7):915-21. PMID 21453181. DOI 10.2460/javma.238.7.915

6. Rule out and treat the reversible causes sitting on top of the chronic disease

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   CKD is a substrate, not an excuse. Pyelonephritis, ureteral or urethral obstruction, uroliths, hypercalcaemia, dehydration, NSAID exposure and - in endemic regions - leishmaniosis and leptospirosis all cause step-down losses of function that are partly recoverable if found. Urine culture is not optional in a CKD dog with a sudden deterioration. Handle the two urinary syndromes SEPARATELY, because the stewardship logic differs. SPORADIC BACTERIAL CYSTITIS is a lower-tract problem: ISCAID first-line is plain amoxicillin or a trimethoprim-sulfonamide for 3-5 days, and the guidelines decline to prefer amoxicillin-clavulanate over amoxicillin absent evidence the beta-lactamase inhibitor is needed - so naming the broader-spectrum product inverts the guideline. Fluoroquinolones and third-generation cephalosporins are reserved for documented resistance to first-line agents. Subclinical bacteriuria is often best left untreated. PYELONEPHRITIS is an upper-tract infection in a dog with no nephron reserve, and delay costs function permanently: culture first, then start prompt empiric systemic therapy with reliable gram-negative coverage and de-escalate on the result. HONEST LIMIT: the specific empiric agent ISCAID recommends for canine pyelonephritis, and the treatment duration, could NOT be verified against the source text in this research pass (Vet J is paywalled and no open ISCAID PDF was located), so no empiric pyelonephritis agent or duration is asserted here - take both from the current ISCAID document rather than from this page, and do not read the cystitis reservation rule as a prohibition on appropriate empiric coverage for an upper-tract infection.

   Productos nombrados: For sporadic cystitis, ISCAID first-line is plain amoxicillin or a trimethoprim-sulfonamide; culture-directed therapy for pyelonephritis, with the empiric agent and duration taken from the current ISCAID text rather than from this page. TRIMETHOPRIM-SULFAMETHOXAZOLE CARRIES THREE CKD-SPECIFIC CAUTIONS that must accompany it on this page or it should not be used here at all: (1) trimethoprim inhibits the renal tubular transporters that secrete creatinine, so measured creatinine can rise with no fall in GFR (transporter mechanism: Lepist 2014, PMID 24646860, human/in-vitro) - never re-stage a dog, or escalate therapy, on a creatinine drawn during therapy; (2) sulfonamide crystalluria risk rises in dehydrated patients and patients that cannot concentrate urine, which describes every CKD dog - ensure hydration; (3) idiosyncratic sulfonamide reactions (keratoconjunctivitis sicca, hepatopathy, blood dyscrasias) and dose-interval adjustment in renal impairment apply. Domperidone as studied in Cavalera 2022 in leishmaniotic dogs: NO DOSE IS REPRODUCED HERE. The published dose is a volume per bodyweight and the abstract does not state the suspension's strength, so transcribing it without a concentration invites a large overdose from a different-strength product - take the mg/kg dose and the concentration from the trial's full methods and the specific product in hand. Note what the drug is: domperidone is a dopamine D2 antagonist used here as a prolactin-inducing immunostimulant for leishmaniosis, not a renal drug. It is not an FDA-approved canine product in the United States, and domperidone appears on FDA's list of bulk drug substances for use in compounding that may present significant safety risks (503A Category 2, list updated 22 April 2026).

   ISCAID guidelines for diagnosis and management of bacterial urinary tract infections in dogs and cats (Weese 2019) - confirmed in PubMed as a Practice Guideline with the stated journal, volume and pages, and the sporadic-cystitis recommendations above are carried from the project's verified evidence corpus; the pyelonephritis recommendations were not verifiable against the source in this pass and are therefore not quantified here. Guideline-level evidence throughout. For the regional aetiology point: a prospective randomised controlled 11-month field trial in 22 Leishmania-exposed or -infected dogs with early-stage CKD found that domperidone plus a renal diet slowed progression - serum SDMA remained stable in the treated group while rising in controls. Small (n=12 treated, 10 control), single-region (Italy), restricted to EARLY-STAGE CKD in Leishmania-exposed dogs, and not an FDA-approved use. It is a treatment trial and carries no epidemiological weight: do not cite it for how common leishmanial nephropathy is, or for its distribution across ages and breeds.

   Weese JS, Blondeau J, Boothe D, Guardabassi LG, Gumley N, Papich M, Jessen LR, Lappin M, Rankin S, Westropp JL, Sykes J. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Vet J. 2019;247:8-25. PMID 30971357. DOI 10.1016/j.tvjl.2019.02.008 | Cavalera MA, Gernone F, Uva A, Donghia R, Zizzadoro C, Zatelli A. Efficacy of domperidone plus renal diet in slowing the progression of chronic kidney disease in dogs with leishmaniosis. Parasit Vectors. 2022;15(1):397. PMID 36316751. DOI 10.1186/s13071-022-05537-8 | Lepist EI, Zhang X, Hao J, et al. Contribution of the organic anion transporter OAT2 to the renal active tubular secretion of creatinine. Kidney Int. 2014;86(2):350-7. PMID 24646860. DOI 10.1038/ki.2014.66

7. Keep the dog hydrated, eating and free of nausea - this is where quality of life is won or lost

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   Free access to fresh water AT ALL TIMES - water is never restricted in a dog that cannot concentrate urine, and the nocturnal accidents that tempt owners to restrict it are managed with more outings, washable bedding and belly bands instead. Wet food or added water, and a low threshold for subcutaneous or intravenous fluids around any dehydrating event. FLUID SUPPORT IS NOT RISK-FREE AND THIS PAGE'S OWN PREVALENCE DATA SAY SO: cardiac disease was a significant comorbid disorder in CKD dogs in the UK primary-care study (O'Neill 2013), so any dog going home with subcutaneous fluids needs a written volume and frequency ceiling, an instruction not to exceed it, and the signs of volume overload - increased respiratory rate or effort at rest, restlessness, a soft cough, ventral or limb oedema - with an instruction to stop and call. Re-examine the plan in any dog with a murmur, known heart disease or unexplained tachypnoea before sending fluids home at all. Treat nausea and vomiting actively rather than waiting for the owner to raise it; then treat inappetence. Gastroprotection where there is evidence of uraemic gastritis or GI bleeding. An anorexic CKD dog loses muscle, and muscle atrophy is independently associated with shorter survival.

   Productos nombrados: Maropitant: Cerenia Tablets (NADA 141-262, dogs, PREVENTION of acute vomiting and of motion-sickness vomiting) and Cerenia Injectable Solution (NADA 141-263, dogs, prevention AND treatment of acute vomiting; cats, treatment of vomiting) - name the dosage form when you name the indication, observe the label minimum ages (2 months dogs, 4 months for canine motion sickness and for cats) and the puppy bone-marrow caution under 11 weeks. Capromorelin oral solution - Entyce, NADA 141-457, FDA-approved for appetite stimulation in DOGS, effectiveness not evaluated beyond 4 days on the label. DO NOT SUBSTITUTE Elura (capromorelin, NADA 141-536, approved 19 October 2020), which is indicated for management of weight loss in CATS with CKD: it is a feline product, its supporting randomised trial was conducted in cats with CKD, and that feline trial must never be presented as canine CKD evidence. Gastroprotectants (proton pump inhibitors) are used extralabel in dogs.

   Maropitant is FDA-approved in dogs, but the indication depends on the DOSAGE FORM and the two must not be merged. CERENIA Tablets (NADA 141-262): 'indicated for the prevention of acute vomiting and the prevention of vomiting due to motion sickness in dogs' - prevention only. CERENIA Injectable Solution (NADA 141-263): 'indicated for the prevention and treatment of acute vomiting in dogs', and in cats 'for the treatment of vomiting in cats'. Label age limits: tablets are dosed from 2 months of age for acute vomiting and from 4 months for motion sickness; the injectable from 2 months in dogs and 4 months in cats. Both labels carry the same caution that in puppies younger than 11 weeks of age, histological evidence of bone marrow hypocellularity was seen more often and more severely in treated than control puppies. Neither approval is specific to CKD. Capromorelin (Entyce, NADA 141-457, first approved 16 May 2016 per the FDA Freedom of Information Summary) is FDA-approved for appetite stimulation in DOGS; its pivotal canine efficacy data come from a randomised, masked, placebo-controlled study in 12 healthy adult beagles per group over 4 days (food consumption +60.55 plus/minus 39.87% vs -11.15 plus/minus 14.23% placebo, P<0.001), so the honest caveats are that the pivotal population was healthy laboratory beagles rather than inappetent CKD patients, and that the label itself states effectiveness was not evaluated beyond four days of treatment in the clinical field study. Label adverse events for capromorelin in dogs include diarrhoea, vomiting, elevated BUN, polydipsia and hypersalivation - the elevated BUN matters in this population and should not be misread as progression.

   Zollers B, Rhodes L, Heinen E. Capromorelin oral solution (ENTYCE) increases food consumption and body weight when administered for 4 consecutive days to healthy adult Beagle dogs in a randomized, masked, placebo controlled study. BMC Vet Res. 2017;13(1):10. PMID 28056951. DOI 10.1186/s12917-016-0925-z | Rathore M, Das N, Ghosh N, Guha R. Insights on discovery, efficacy, safety and clinical applications of ghrelin receptor agonist capromorelin in veterinary medicine. Vet Res Commun. 2023;48(1):1-10. PMID 37493940. DOI 10.1007/s11259-023-10184-0 | Cerenia Tablets label (NADA 141-262) and Cerenia Injectable Solution label (NADA 141-263), DailyMed

8. Manage the metabolic consequences: acidosis, potassium in both directions, and the anaemia of CKD

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   Check bicarbonate/total CO2 and supplement alkali if metabolic acidosis persists on a renal diet. WATCH POTASSIUM IN BOTH DIRECTIONS AND TREAT BOTH. RAAS inhibitors and advancing azotaemia push potassium up; polyuria, inappetence, vomiting and diarrhoea push it down, and hypokalaemia is easy to miss because it presents as the weakness, poor appetite and exercise intolerance already attributed to the CKD - measure it rather than inferring it, and supplement documented hypokalaemia rather than treating a number you assumed. For ANAEMIA, this is the delivery of what the staging step promises and it has a defined order: confirm it is the anaemia of CKD rather than something else you can fix, by looking for gastrointestinal blood loss (melaena, the uraemic gastritis this page treats elsewhere) and by assessing iron status, before any erythropoiesis-stimulating agent is considered. IRIS treatment recommendations for dogs set the intervention point at haematocrit below 30%, or persistent anaemia in the 30-35% range. Transfusion is for the symptomatic or rapidly falling patient rather than a fixed number, and that threshold is clinical judgement: no canine CKD transfusion-trigger trial was located in this research pass.

   Productos nombrados: Potassium citrate or sodium bicarbonate for acidosis; potassium gluconate for DOCUMENTED hypokalaemia only - potassium supplementation in a dog on a RAAS inhibitor without a measured value risks hyperkalaemia. NO FDA-approved erythropoiesis-stimulating agent for dogs was located in this research pass - darbepoetin alfa and epoetin are human products used extralabel, and anti-erythropoietin antibody formation causing a worsened, transfusion-dependent anaemia is a recognised risk of that class in animals.

   IRIS Treatment Recommendations for Dogs (modified 2026) - consensus guidance, with the anaemia threshold stated explicitly (treat at haematocrit <30%, or persistent anaemia at 30-35%). No randomised canine trial of alkali therapy, potassium supplementation, iron supplementation, ESA therapy or transfusion thresholds in CKD was located in this research pass, so these steps rest on consensus and pathophysiology rather than on canine RCT evidence - say so rather than implying trial support.

   International Renal Interest Society. IRIS Treatment Recommendations for Dogs (modified 2026).

9. Protect the remaining nephrons: audit every drug the dog is on, especially NSAIDs

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   Review the whole medication list at every CKD visit, including anything the owner buys without a prescription. NSAIDs reduce renal prostaglandin-dependent perfusion and are the most common avoidable insult in this population - and because osteoarthritis and CKD are both diseases of old dogs, the collision is routine. Avoid aminoglycosides where alternatives exist, and tell owners that aminoglycoside antibiotics are on the avoid-list so they can raise it at another clinic. Adjust doses of renally cleared drugs. Plan fluid support around any anaesthetic or contrast study, and apply the RAAS sick-day rule before anaesthesia. Keep the owner's household list in view too: grapes and raisins including in baked goods, ethylene glycol antifreeze, cholecalciferol/vitamin D rodenticide, calcipotriene/calcipotriol psoriasis cream, and human ibuprofen, naproxen, aspirin and acetaminophen (paracetamol). And make the cross-species rule explicit in both directions - a dog's NSAID must never be given to a cat (the Galliprant label states plainly 'GALLIPRANT should only be given to dogs. Do not use in cats'), and no dog should ever receive another animal's prescription.

   Productos nombrados: NSAIDs to use with extreme caution or avoid in canine CKD include carprofen, meloxicam, deracoxib, firocoxib and robenacoxib; grapiprant (Galliprant, NADA 141-455) is mechanistically distinct (EP4 prostaglandin receptor antagonist) but its own label names existing renal dysfunction and dehydration as greatest-risk conditions, it is not established as renal-safe in azotemic dogs, and it carries the age and weight limits above. Human analgesics - ibuprofen, naproxen, aspirin, acetaminophen (paracetamol) - are never given to a dog at all. For OA pain in a CKD dog, discuss non-NSAID multimodal options with the attending veterinarian per the 2022 AAHA Pain Management Guidelines - do not simply continue the NSAID.

   Mechanistic and label-based rather than trial-based, and worth stating that way. The named canine NSAID and EP4-antagonist labels supply the concrete limits: Galliprant (grapiprant tablets, NADA 141-455) is indicated for control of pain and inflammation associated with osteoarthritis in dogs, is contraindicated in dogs with grapiprant hypersensitivity, states that dogs under 8 lb (3.6 kg) cannot be accurately dosed and that safe use was not evaluated in dogs younger than 9 months or in breeding, pregnant or lactating dogs - and, decisively for this page, states that 'patients at greatest risk for adverse events are those that are dehydrated, on concomitant diuretic therapy, or those with existing renal, cardiovascular, and/or hepatic dysfunction.' That is the grapiprant label describing the CKD patient, which is why grapiprant cannot be offered as the renal-safe alternative. The concrete trial-derived safety datum in this space is iatrogenic: in the canine telmisartan trial, permitting ACE inhibitor plus ARB combination therapy produced clinically relevant azotaemia in 4 of 13 dogs (31%) - a 31% harm rate from stacking two guideline-supported drugs. Escalate one agent at a time and recheck.

   Lourenco BN et al. J Vet Intern Med. 2020;34(6):2478-2496. PMID 33165969. DOI 10.1111/jvim.15958 (combination-therapy azotaemia rate) | Gruen ME, Lascelles BDX, Colleran E, Gottlieb A, Johnson J, Lotsikas P, Marcellin-Little D, Wright B. 2022 AAHA Pain Management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc. 2022;58(2):55-76. PMID 35195712. DOI 10.5326/JAAHA-MS-7292 | Galliprant (grapiprant tablets) label, NADA 141-455, DailyMed

10. Re-stage on a schedule and treat the trend, not the single number

    Aprobado / respaldado por guías

    A stable-patient recheck in a CKD dog comprises: fasting creatinine and SDMA, phosphorus, calcium (ionised where available), potassium, total CO2 or bicarbonate, albumin, haematocrit, urinalysis with specific gravity, UPC, standardised systolic blood pressure, an eye examination including the fundus, and a calibrated bodyweight with body condition score and muscle condition score - plus a full medication and supplement review. Intervals are set by IRIS stage: more often as stage advances, and always 7-14 days after starting or changing a RAAS inhibitor or antihypertensive, and 4-6 weeks after a diet or binder change. One value is an event; a plotted trend is the disease. Re-staging is also what catches an acute-on-chronic event early enough to reverse the reversible part. Do not re-stage on a creatinine drawn during a dehydrating episode, during trimethoprim-sulfonamide therapy, or in an unstable patient - all three manufacture apparent progression.

    Productos nombrados: None - this step is monitoring.

    IRIS staging and treatment recommendations require serial measurement in the stable patient by design, and stage at diagnosis was significantly associated with hazard of renal death in UK primary-care dogs (O'Neill 2013). Cadence is consensus- and stage-driven; a canine trial comparing monitoring intervals was NOT located, so exact intervals should be presented as clinical judgement rather than as evidence.

    O'Neill DG et al. J Vet Intern Med. 2013;27(4):814-21. PMID 23647231. DOI 10.1111/jvim.12090 | International Renal Interest Society, IRIS Staging of CKD (2026).

11. Have the prognosis conversation early, and honestly

    Aprobado / respaldado por guías

    Median survival from a primary-care CKD diagnosis was 226 days (95% CI 112-326), and it is stage-dependent - which means the conversation about what good days look like, what the family can sustain, and where the line is should happen while the dog is still well, not in an emergency room at 2 a.m. This is not pessimism; it is what lets owners spend the available time well. Early detection through senior wellness screening is the only lever that meaningfully changes the number, and that is a defensible reason to promote screening.

    Productos nombrados: None.

    Population-based survival analysis in 107,214 UK primary-care dogs: median survival 226 days from diagnosis, with IRIS stage and BUN at diagnosis significantly associated with hazard of CKD death. Note this is survival from DIAGNOSIS in primary care, which reflects how late CKD is usually caught - it is not a statement about how long the disease takes to develop. It is also UK data, and no equivalent Colombian or Latin American figure was located.

    O'Neill DG, Elliott J, Church DB, McGreevy PD, Thomson PC, Brodbelt DC. Chronic kidney disease in dogs in UK veterinary practices: prevalence, risk factors, and survival. J Vet Intern Med. 2013;27(4):814-21. PMID 23647231. DOI 10.1111/jvim.12090

Cómo se diagnostica

• Confirm it is chronic and confirm it is renal before staging. Azotaemia plus inadequately concentrated urine (a urine specific gravity measured on the same visit, before fluids) separates renal from pre-renal and post-renal causes. A single abnormal creatinine is not a diagnosis - IRIS staging requires fasting blood creatinine on at least two occasions in a stable patient.
• Run creatinine and SDMA together, and read them honestly. In 97 client-owned dogs with scintigraphic GFR as the reference, creatinine and SDMA had similar overall diagnostic performance for detecting reduced GFR (AUC 0.98 vs 0.96; sensitivity 90% for both at prespecified cutoffs of 1.3 mg/dL and 14 ug/dL; specificity 90% vs 87%), and cystatin C was inferior to both (Pelander 2019, PMID 30791142). SDMA can add information and may rise earlier in some dogs, but it is not a magic early-detection test and should not be sold as one. Beware drug interference in the other direction: trimethoprim inhibits renal tubular transporters that secrete creatinine, so a dog on a potentiated sulfonamide can show a higher measured creatinine with no change in GFR (the transporter mechanism is documented in Lepist 2014, PMID 24646860 - human and in-vitro work, not a canine study). Do not re-stage a dog on a creatinine drawn during trimethoprim-sulfonamide therapy.
• Quantify proteinuria properly. Localise it (rule out lower urinary tract inflammation and haemorrhage with urinalysis and sediment), confirm persistence over at least two to three occasions weeks apart, then quantify with urine protein:creatinine ratio - the escalating, stepwise approach set out in the 2004 ACVIM Forum consensus statement on proteinuria (Lees 2005, PMID 15954557), with the canine-specific diagnostic consensus of the IRIS Canine GN Study Group alongside it (Littman 2013, PMID 24635376). UPC >0.5 was the threshold used to define renal proteinuria in azotemic dogs in the telmisartan RCT.
• Measure systolic arterial blood pressure at every CKD visit, properly - acclimatised patient, correct cuff width, several consistent readings - and classify it against the ACVIM categories, quoted verbatim from the consensus statement: normotensive (minimal target-organ-damage risk) SBP <140 mm Hg; prehypertensive (low risk) 140-159; hypertensive (moderate risk) 160-179; severely hypertensive (high risk) 180 or above. Pair the cuff with an eye examination including fundic examination, because ocular lesions are how hypertension declares itself between visits: in 65 dogs assessed for both, 62% of the hypertensive dogs (26/42) had at least one hypertension-associated ocular lesion and retinal haemorrhage was the commonest at 40% (LeBlanc 2011, PMID 21453181).
• Search actively for a treatable or reversible contributor rather than accepting 'old kidneys'. Urine culture for pyelonephritis (CKD dogs can have occult upper-urinary-tract infection), imaging for uroliths, obstruction, renal dysplasia or asymmetry, ionised calcium for hypercalcaemia, and a drug and toxin history covering NSAIDs, aminoglycosides, grapes/raisins, ethylene glycol, cholecalciferol rodenticide and vitamin D analogue creams. In endemic regions, test for Leishmania infantum and for leptospirosis - both cause canine renal disease and both change management.
• Get the full biochemical and haematological picture that prognosis actually depends on: phosphorus, calcium (ideally ionised), potassium, bicarbonate or total CO2, albumin, and haematocrit. In 27 azotemic CKD dogs followed to death, hyperphosphataemia (HR 3.20, 95% CI 1.357-7.548, P=.005), increased calcium-phosphorus product (HR 4.092, 1.771-9.454, P=.003), increased UPC (HR 3.191, 1.310-7.773, P=.01), muscle atrophy (HR 2.334, 1.352-4.030, P=.01) and BCS <4/9 (HR 1.579, 1.003-2.282, P=.05) were all significantly associated with shorter survival (Rudinsky 2018, PMID 30325060). Note that study is small and the analysis univariable. Read potassium in BOTH directions - RAAS inhibitors and advancing azotaemia push it up, while polyuria, inappetence and GI losses push it down, and hypokalaemia presents as the weakness and poor appetite that get blamed on the disease itself. Record body condition score AND muscle condition score at every visit alongside a calibrated bodyweight - muscle loss in CKD is prognostic in its own right and is invisible if you chart bodyweight only.
• Reserve renal biopsy for the specific question it answers - the dog with significant persistent renal proteinuria, especially if non-azotemic or young, where distinguishing an immune-complex glomerulonephritis from other glomerulopathy changes whether immunosuppression is even considered (IRIS Canine GN Study Group immunosuppression consensus, Segev 2013, PMID 24635379). It is not part of routine staging.