Chronic Kidney Disease and IRIS Staging: Ensuring Consistency of Care
Diagnosis and management of chronic kidney disease (CKD) in pets does not need to be difficult. Pet owners look to their trusted veterinarians and the practice's team for guidance about how to manage their companion's condition. IRIS CKD Staging Guidelines can provide support for you and your team as you discuss next steps with pet parents.
But what happens if the team's messaging is inconsistent? For example, you may enter an examination room to discuss follow-up and monitoring options with a client who has a pet with a chronic health condition and the client says, "That's not what the other doctor told me. He said we'd only need to check blood work once a year and that we only have to do the smaller panel." Then, there's a problem.
Most veterinarians have navigated awkward situations like this. With more and more relief veterinarians assisting depleted teams, or private practices being bought by corporate organizations, continuity of message is vitally important.
But, what if there were a system to help align a team as they diagnose, stage, treat, and monitor serious diseases, such as CKD, so veterinarians didn't have to go it alone? The IRIS CKD Staging Guidelines provide that needed consistency.
The Purpose of the IRIS CKD Staging Guidelines
The International Renal Interest Society (IRIS) developed the CKD staging guidelines to facilitate communication within the veterinary community about the diagnosis and management of kidney disease. In addition, IRIS provides useful prognostic information and identifies likely consequences of CKD that may require management at different stages of renal dysfunction.
IRIS makes it easier for veterinarians to communicate with pet owners about what to expect and how to best care for their pet that is diagnosed with this progressive disease. Although staging can't eliminate the initial emotional sting, it can help veterinarians communicate clearly and consistently regarding next steps, monitoring, and prognosis for that patient.
How to Use the IRIS CKD Staging System and Guidelines
Step 1: Diagnose CKD
CKD must be diagnosed prior to designating the patient's IRIS stage. Diagnosis should consider a patient's history, physical exam, laboratory results, imaging, and in some cases histopath results. The patient's level of dysfunction can be further characterized according to renal proteinuria and systemic arterial blood pressure. These tests yield information that may alter treatment recommendations and result in a better long-term outcome for the patient.
Step 2: Stage CKD
IRIS guidelines provide an objective system for staging dogs and cats with CKD based on fasting blood creatinine concentration and blood SDMA concentration. Although staging can be based on one test measured over time, the ideal recommendation is to measure both markers to ensure accuracy. Ideally, your patient's lab results to determine IRIS staging will be consistent. However, there are times when either serum creatinine or SDMA is elevated above the normal range and the other is not. As a veterinarian seeking definitive answers, it can be frustrating when you're faced with ambiguity, especially when trying to develop a logical and consistent treatment plan. When a discrepancy occurs between functional markers like SDMA and creatinine, or when other diagnostic results and/or clinical signs may seem unclear, IRIS may recommend placing the patient in the next highest stage in order to be conservative.
Step 3: Treat CKD
It's best to align the patient's stage with recommendations for continued monitoring and treatment. IRIS provides an action plan for each of the four stages that doctors can share with clients and weave into their pet's ideal treatment plan. Because no two CKD patients are alike, the guidelines provide the flexibility to treat patients based on their individual symptoms and needs, while outlining a core set of principles to follow.
The three IRIS steps provide the protocols and references necessary for teams to determine a plan of action based on data, clearly articulated stages, and actionable recommendations.
Staying on the Same Page
The patient's results, IRIS CKD stage, and plan should be recorded as part of the medical record so that the information is accessed easily and can be evaluated at each visit. As the patient's symptoms or status changes, the stage and treatment recommendations should be updated. If the pet sees a different veterinarian, schedules a consult with a specialist, or has a trip to the emergency room, every professional involved can rely upon the IRIS staging and guidelines to provide consistency of care.
When everyone in the practice follows the same set of clinical guidelines—especially when it comes to a highly nuanced and progressive health condition like CKD—pets can receive the highest quality care, and pet owners can feel confident in your team's recommendations.