Chronic Kidney Disease in Dogs

Chronic kidney disease (CKD) in dogs is a progressive condition in which the kidneys gradually lose their ability to function properly.

Because early kidney disease often causes few or no obvious symptoms, routine blood work and urinalysis are essential for detecting the disease before significant kidney damage occurs.

Although CKD cannot be cured, early diagnosis and long-term management can help improve your dog’s comfort and quality of life.

What Is Chronic Kidney Disease in Dogs?

Chronic kidney disease (CKD) in dogs is a progressive condition in which the kidneys gradually lose their ability to function properly.

The kidneys perform many essential functions, including:

• Filtering waste products and toxins from the bloodstream
• Maintaining fluid, mineral, and electrolyte balance
• Conserving water and important blood proteins
• Helping regulate blood pressure
• Supporting red blood cell production

Download the medical illustration of chronic kidney disease in dogs. 

As kidney function declines, waste products and toxins accumulate in the bloodstream, leading to nausea, malaise, and a gradual decline in your dog's quality of life if the disease is left untreated or unmanaged.

Unfortunately, the loss of kidney function is irreversible. Once kidney tissue is damaged, it cannot regenerate.

Chronic kidney disease often develops gradually and may be present for months or even years before it is diagnosed. The disease progresses at a different rate in every dog, making it difficult to predict how quickly it will worsen.

Veterinarians typically classify CKD into four IRIS stages (Stages I–IV) based on laboratory test results and a dog's clinical signs. Staging helps guide treatment recommendations and long-term management.

Symptoms of Chronic Kidney Disease in Dogs

Dogs with chronic kidney disease often don't develop noticeable symptoms until approximately 75% of kidney function has been lost.

As CKD progresses, symptoms typically become more frequent and more severe. Dogs in later stages of the disease generally experience a greater number of clinical signs than those in earlier stages.

Symptoms of chronic kidney disease may include:

• Increased thirst
• Increased urine production or other changes in urination
• Decreased appetite
• Weight loss
• Muscle wasting
• Weakness and lethargy
• Dehydration
• Nausea
• Intermittent vomiting
• Oral ulcers (mouth sores) and bad breath
• Pale gums
• Poor coat quality
• Anemia (low red blood cell count)
• Vision loss, often related to secondary hypertension (high blood pressure)

Because many of these symptoms are common to other medical conditions, blood work and urinalysis are needed to confirm a diagnosis of chronic kidney disease.

Causes of Chronic Kidney Disease in Dogs

In many dogs, the exact cause of chronic kidney disease (CKD) is never identified, but several injuries and medical conditions can contribute to permanent kidney damage.

By definition, chronic kidney disease is an ongoing, progressive, and irreversible condition that develops over time.

Some dogs develop CKD after a serious kidney injury, including:

• Severe infections, such as leptospirosis, tick-borne diseases, or pyelonephritis (kidney infection)
• Heatstroke
• Envenomation from venomous bites or stings
• Exposure to toxins, including antifreeze, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or certain antibiotics

Chronic kidney disease has also been associated with some immune-mediated diseases and certain types of cancer.

Some dog breeds appear to have a higher risk of developing chronic kidney disease, including:

• Basenji
• Bernese Mountain Dog
• Boxer
• Bull Terrier
• Cairn Terrier
• Cavalier King Charles Spaniel
• Cocker Spaniel
• English Cocker Spaniel
• Shar-Pei
• West Highland White Terrier

How Veterinarians Diagnose Chronic Kidney Disease in Dogs

Veterinarians diagnose chronic kidney disease using a combination of a physical examination, blood tests, urinalysis, and, when needed, additional diagnostic testing.

Initial testing typically includes blood work and a urinalysis to evaluate kidney function and identify changes commonly associated with CKD.

Depending on the results, your veterinarian may also recommend:

• A urine protein-to-creatinine (UPC) ratio to evaluate protein loss in the urine (proteinuria).
• A urine culture to check for urinary tract infections, which are more common in dogs with CKD.
• Blood pressure measurement because hypertension commonly occurs with chronic kidney disease.
• Abdominal radiographs (X-rays) or ultrasound to evaluate for kidney stones, tumors, or kidney infarcts.
• A kidney biopsy in rare cases when additional information is needed.

Treatment for Chronic Kidney Disease in Dogs

Although chronic kidney disease (CKD) cannot be cured, many dogs can be successfully managed with diet, medications, and supportive care to improve their quality of life.

Treatment recommendations are based on your dog's stage of CKD. Dogs in IRIS Stages III and IV generally require more intensive treatment than those in Stages I and II.

Medications

Medications are commonly prescribed to control symptoms associated with CKD, including nausea, vomiting, and decreased appetite.

Common medications may include:

• Cerenia®
• Ondansetron
• Omeprazole
• Capromorelin (appetite stimulant)
• Mirtazapine (appetite stimulant)

Prescription Kidney Diets

Most dogs with CKD benefit from a prescription kidney-support diet that is lower in protein, phosphorus, and sodium while helping maintain a healthy acid-base balance.

Common veterinary diets include:

• Blue Buffalo Natural Veterinary Diet KS Kidney Support
• Royal Canin Renal Support
• Hill's Prescription Diet k/d
• Purina Pro Plan Veterinary Diets NF Kidney Function

Fluid Therapy

Fluid therapy is an important part of managing chronic kidney disease because it helps improve hydration and flush waste products from the bloodstream.

Depending on your dog's condition, fluids may be administered:

• Intravenously (IV) in the hospital
• Subcutaneously (under the skin) at home

Dogs with CKD should always have access to fresh, clean water. Many veterinarians recommend using a pet water fountain to encourage increased water intake.

Management of Chronic Kidney Disease in Dogs

Managing chronic kidney disease requires lifelong monitoring, ongoing treatment, and regular veterinary care to help maintain your dog's quality of life.

Because CKD is a progressive disease, dogs typically require more frequent veterinary examinations and laboratory testing than healthy dogs. Your veterinarian will also monitor your dog's quality of life as symptoms change over time.

Continue all medications, prescription diets, and follow-up appointments exactly as recommended. Many treatments will be needed for the rest of your dog's life.

Long-term management may include:

• Dietary supplements such as Azodyl®, a prebiotic/probiotic product that may help reduce waste products normally eliminated by the kidneys.
• Phosphorus binders such as aluminum hydroxide or Epakitin® for dogs with elevated phosphorus levels.
• Potassium supplements such as Renal K+® for dogs with low potassium levels.
• Anti-nausea and anti-vomiting medications for dogs that experience intermittent vomiting or decreased appetite.

With consistent monitoring and individualized treatment, many dogs with chronic kidney disease can maintain a good quality of life for months or even years after diagnosis.