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tvpjournal.com | March/April 2015 | TODAy'S VETERINARy PRACTICE FELINE CHRONIC KIDNEy DISEASE Peer Reviewed 41 words, the investigators had no way to retrospectively identify cats with serum creatinine concentrations between 1.6 and 2.3 mg/dL. The remainder of the staging system used in this study correlated with standard IRIS stages. Notice the stepwise decline in survival as CKD stage increases: 1151 days for Stage 2b cats (which would be higher if all stage 2 cats had been included) versus 679 days for Stage 3 cats and 35 days for Stage 4 cats. This trend is not surprising, but the actual numbers facilitate better prognostication and emphasize early diagnosis. CKD = chronic kidney disease; GFR = glomerular fltration rate; IRIS = International Renal Interest Society; SDMA = serum symmetric dimethyl- arginine; USG = urine specifc gravity References 1. Brown SA. Linking treatment to staging in chronic kidney disease. In August JR (ed): Consultations in Feline Internal Medicine. St. Louis: Elsevier Saunders, 2010, pp 475-482. 2. Polzin DJ, Osborne CA, Adams LG, Lulich JP. Medical management of feline chronic renal failure. In Kirk RW, Bonagura JD (eds): Kirk's Current Veterinary Therapy XI. Philadelphia: Saunders, 1992, pp 848-853. 3. Ross SJ, Polzin DJ, Osborne CA. Clinical progression of early chronic renal failure and implications for management. In August JR (ed): Consultations in Feline Internal Medicine. St Louis: Elsevier Saunders, 2005, pp 389- 398. 4. Lulich JP, Osborne CA, O'Brien TD, et al. Feline renal failure: Questions, answers, questions. Compend Cont Educ Pract Vet 1992; 14:127-153. 5. White JD, Norris JM, Baral RM, et al. Naturally-occurring chronic renal disease in Australian cats: A prospective study of 184 cases. Aust Vet J 2006; 84:188-194. 6. DiBartola SP, Rutgers HC, Zack PM, Tarr MJ. Clinicopathologic fndings associated with chronic renal disease in cats: 74 cases (1973-1984). JAVMA 1987; 190:1196-1202. 7. Lees GE, Brown SA, Elliott J, et al. Assessment and management of proteinuria in dogs and cats; 2004 ACVIM forum consensus statement (small animal). J Vet Intern Med 2005; 19:377-385. 8. Hall JE, yerramilli M, Obare E, et al. Comparison of serum concentrations of symmetric dimethylarginine and creatinine as kidney function biomarkers in cats with chronic kidney disease. J Vet Intern Med 2014; 28:1676- 1683. 9. Polzin DJ, Osborne CA, Ross S, et al. Dietary management of feline chronic renal failure. Where are we now? In what direction are we headed? J Feline Med Surg 2000; 2:75-82. 10. Chakrabarti S, Syme HM, Elliott J. Clinicopathological variables predicting progression of azotemia in cats with chronic kidney disease. J Vet Intern Med 2012; 26:275- 281. 11. Jepson R, Brodbelt D, Vallance C, et al. Evaluation of predictors of the development of azotemia in cats. J Vet Intern Med 2009; 23:806- 813. 12. Syme HM, Markwell PJ, Pfeiffer D, et al. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria. J Vet Intern Med 2006; 20:528-535. 13. King JN, Tasker S, Gunn-Moore DA, Strehlau G. Prognostic factors in cats with chronic kidney disease. J Vet Intern Med 2007; 21:906-916. 14. King JN, Gunn-Moore DA, Tasker S, et al. Tolerability and effcacy of benazepril in cats with chronic kidney disease. J Vet Intern Med 2006; 20:1054-1064. 15. Mizutani H, Koyama H, Watanabe T, et al. Evaluation of the clinical effcacy of benazepril in the treatment of chronic renal insuffciency in cats. J Vet Intern Med 2006; 20:1074-1079. 16. Jepson RE, Elliott J, Brodbelt D, Syme HM. Effect of control of systolic blood pressure on survival in cats with systemic hypertension. J Vet Intern Med 2007; 21:402-409. 17. Boyd LM, Langston C, Thompson K, et al. Survival in cats with naturally occurring chronic kidney disease (2000-2002). J Vet Intern Med 2008; 22:1111-1117. G REGORY F. GRAUER Gregory F. Grauer, DVM, MS, Diplomate ACVIM (Small Animal Internal Medicine), is a professor and the Jarvis Chair of Medicine in the Department of Clinical Sciences at Kansas State University College of Veterinary Medicine. Dr. Grauer's clinical and research interests involve the small animal urinary system, and he is on the board of directors of the IRIS and American Society of Veterinary Nephrology and Urology. Dr. Grauer received his postgraduate training in internal medicine at Colorado State University. He has been a faculty member at University of Wisconsin School of Veterinary Medicine and Colorado State University College of Veterinary Medicine. TablE 7. Survival Data From 211 Cats Based on IRIS CKD Stages 17 STAGE AT BASELINE a NUMBER OF PATIENTS MEDIAN SURVIVAL (range of days) b Stage 2b (2.3–2.8 mg/dL) 82 (39.4%) 1151 (1014–1565) Stage 3 (2.9–5 mg/dL) 84 (40.3%) 679 (445–910) Stage 4 (> 5 mg/dL) 42 (20.2%) 35 (21–99) a. Serum creatinine concentration in parentheses b. 95% confdence interval